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Kim Y, Moonie S, Cochran C. Heterogeneity of Asthma Care Among Hispanic Subgroups: Lower Utilization of Hospital-based Care among Spanish-speaking Hispanics. Med Care 2023; 61:470-476. [PMID: 37191547 DOI: 10.1097/mlr.0000000000001868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 03/27/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Studies found heterogeneity of asthma prevalence among Hispanic subgroups using survey data but addressed under-diagnosis issues due to limited access to health care and diagnosis bias. OBJECTIVES To examine heterogeneity by language in health care utilization for asthma among Hispanic subgroups. RESEARCH DESIGN A retrospective, longitudinal cohort study of Medi-Cal claims data (2018-2019) using logistic regression to estimate the odds ratio of health care utilization for asthma. SUBJECTS In all, 12,056 (ages 5-64) Hispanics living in Los Angeles were identified as having persistent asthma. MEASURES Primary language is the predictor variable and outcome measures include ED visits, hospitalizations, and outpatient visits. RESULTS The odds of ED visits among Spanish-speaking Hispanics were lower than English-speaking Hispanics in the subsequent 6 (95% CI=0.65-0.93) and 12 (95% CI=0.66-0.87) months. Spanish-speaking Hispanics were less likely than their English-speaking counterparts to utilize hospitalization in the 6 months (95% CI=0.48-0.98), while they were more likely to utilize outpatient care (95% CI=1.04-1.24). For Hispanics of Mexican origin, the odds of ED visits among Spanish-speaking Hispanics were also lower in the 6 and 12 months (95% CI=0.63-0.93, 95% CI=0.62-0.83), but their odds of outpatient visits were higher for outpatient visits in the 6 months (95% CI=1.04-1.26). CONCLUSIONS Spanish-speaking Hispanics with persistent asthma were less likely than English-speaking Hispanics to utilize ED visits and hospitalizations but were more likely to utilize outpatient visits. The findings suggest the reduced burden of asthma among the Spanish-speaking Hispanic subgroup and contribute to explaining the protection effect, specifically among Spanish-speaking Hispanics living in highly segregated communities.
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Affiliation(s)
- Yonsu Kim
- Department of Healthcare Administration and Policy
| | - Sheniz Moonie
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, United States
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Liguori CA, Sharma NP, Documét PI, Gibbs BB, Taverno Ross SE. Prevalence of healthy diet and activity behaviours among U.S. Latino preschool children living in an emerging Latino community. J Nutr Sci 2023; 12:e67. [PMID: 37396455 PMCID: PMC10311221 DOI: 10.1017/jns.2023.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
This pilot study provides preliminary insights into whether Latino preschool children living in an emerging Latino community (ELC) are meeting recommendations for healthy diet and activity behaviours and whether those behaviours are associated with sociodemographic or home environment variables. Secondary data analysis was conducted utilising cross-sectional baseline survey data from ANDALE Pittsburgh, a home-based intervention study. Measures included parent-reported information on child dietary intake, screen time and the home environment, and objectively measured physical activity and anthropometry. χ2 and Fischer's exact tests were used to determine associations. The study was conducted in an ELC in western Pennsylvania in the US. Fifty-one Latina mothers (age: 33⋅5 ± 6⋅1 years; 63 % Mexican origin; 86 % low acculturation) and their children (age: 3⋅9 ± 1⋅3 years; 55 % male) 2-5 years of age. On average, children consumed 2⋅25 ± 1⋅44 cups of fruits/vegetables, viewed 98⋅7 ± 74⋅2 min of screen time, accumulated 12⋅9 ± 2⋅9 min/h of total physical activity and consumed 15⋅5 ± 26⋅0 kcals of sugar-sweetened beverages per day. Forty-one percent met the fruit/vegetable recommendation, 54 % met the screen time recommendation, 27 % met the physical activity recommendation and 58 % met the sugary drink recommendation. Country of origin (P = 0⋅032) and acculturation (P = 0⋅048) were significantly associated with children meeting sugary drink recommendations. No other relationships were significant. The proportion of children in this sample meeting diet and activity recommendations was mixed. More research with larger sample sizes is needed in ELCs to identify effective intervention strategies for improving health behaviours.
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Affiliation(s)
- Carli A. Liguori
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA 15261, USA
| | - Neil P. Sharma
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA 15261, USA
| | - Patricia I. Documét
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bethany B. Gibbs
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV 26506, USA
| | - Sharon E. Taverno Ross
- Department of Health and Human Development, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA 15261, USA
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Simon MA, Tom LS, Taylor S, Leung I, Vicencio D. 'There's nothing you can do … it's like that in Chinatown': Chinese immigrant women's perceptions of experiences in Chicago Chinatown healthcare settings. ETHNICITY & HEALTH 2021; 26:893-910. [PMID: 30691290 PMCID: PMC6933085 DOI: 10.1080/13557858.2019.1573973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
Objectives: Chinese American women living in linguistically isolated communities are among the least likely to utilize healthcare services. Qualitative research methods can help identify health system vulnerability points to improve local healthcare delivery for this population.Design: We conducted 6 focus groups among 56 Chinese-speaking adult women in Chicago's Chinatown between July and August 2014 to explore their perceptions of experiences receiving medical care and interacting with healthcare providers in Chinatown healthcare settings.Results: Health system/clinic infrastructure and patient-provider communications were perceived barriers to care at Chinatown healthcare settings. Chinese participants reported long wait times, difficulty scheduling appointments, and poor front desk customer service. Communication difficulties at Chinatown healthcare settings involved language barriers with non-Chinese-speaking providers, but consideration for healthcare providers, provider demeanor, and reliance on provider recommendation also hindered patient-provider communications.Conclusions: Findings improve understanding of barriers to care experienced by Chinese immigrant women in one urban Chinatown community.
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Affiliation(s)
- Melissa A. Simon
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center, Chicago, USA
| | - Laura S. Tom
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Shaneah Taylor
- Departments of Obstetrics & Gynecology and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ivy Leung
- Chinese American Service League, Chicago, USA
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Ross SET, Tapia IS, Saunders RP, Documet PI, Pate RR. Implementation Monitoring of a Promotora-Led, Home-Based Obesity Prevention Pilot Study With Latino Preschool Children and Their Mothers. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 41:411-418. [PMID: 33143559 PMCID: PMC11117107 DOI: 10.1177/0272684x20970375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Latino preschool children have higher rates of obesity than children from other racial/ethnic backgrounds. Few effective, culturally-tailored obesity prevention interventions exist that have focused on Latino preschool children, and even fewer have published results of the process evaluation. The purpose of this paper was to monitor reach, fidelity, and completeness of implementation to determine whether ANDALE, a promising promotora-led, home-based pilot study to prevent obesity in Latino preschool children, was implemented as planned. METHODS Guided by a logic model, we assessed reach, implementation fidelity and completeness through descriptive analyses of multiple data sources. Reach was assessed through attendance records. Fidelity was assessed via observation checklist and completeness was assessed via survey with both parents and promotoras in a subsample of 12 families. RESULTS Promotoras recruited participants primarily through their own social networks and delivered the intervention to 50 families (mother-child dyads); the majority were of Mexican-origin, low-acculturation, dual-parent households. Nearly all (98%) families completed the whole 10-week intervention. Results demonstrated completeness and fidelity of implementation were acceptable in a subsample of 12 families. In sum, 75% of families in the subsample met the criteria (≥75%) for overall implementation of essential program elements (i.e., reach, completeness, and fidelity). CONCLUSION Evidence suggests that ANDALE was delivered with high levels of completeness and fidelity in this sample of Latino families with preschool-aged children. These results support implementation of ANDALE in a large, randomized trial.
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Affiliation(s)
- Sharon E. Taverno Ross
- Department of Health and Human Developmen, Health and Human Development, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | | | - Ruth P. Saunders
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, United States
| | - Patricia I. Documet
- Department of Behavioral and Community Health Sciences, Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Russell R. Pate
- Department of Exercise Science, Physical Activity Research Group, University of South Carolina, Columbia, South Carolina, United States
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Hamad R, Öztürk B, Foverskov E, Pedersen L, Sørensen HT, Bøtker HE, White JS. Association of Neighborhood Disadvantage With Cardiovascular Risk Factors and Events Among Refugees in Denmark. JAMA Netw Open 2020; 3:e2014196. [PMID: 32821923 PMCID: PMC7442927 DOI: 10.1001/jamanetworkopen.2020.14196] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
IMPORTANCE Refugees are among the most disadvantaged individuals in society, and they often have elevated risks of cardiovascular risk factors and events. Evidence is limited regarding factors that may worsen cardiovascular health among this vulnerable group. OBJECTIVE To test the hypothesis that refugee placement in socioeconomically disadvantaged neighborhoods is associated with increased cardiovascular risk. DESIGN, SETTING, AND PARTICIPANTS The study population of this quasi-experimental, registry-based cohort study included 49 305 adults 18 years and older who came to Denmark as refugees from other countries during the years of Denmark's refugee dispersal policy from 1986 to 1998. Refugees were dispersed to neighborhoods with varying degrees of socioeconomic disadvantage in an arbitrary manner conditional on observed characteristics. The association of neighborhood disadvantage on arrival with several cardiovascular outcomes in subsequent decades was evaluated using regression models that adjusted for individual, family, and municipal characteristics. Health outcomes were abstracted from the inpatient register, outpatient specialty clinic register, and prescription drug register through 2016. Data analysis was conducted from May 2018 to July 2019. EXPOSURES A composite index of neighborhood disadvantage was constructed using 8 neighborhood-level socioeconomic characteristics derived from Danish population register data. MAIN OUTCOMES AND MEASURES Primary study outcomes included hypertension, hyperlipidemia, type 2 diabetes, myocardial infarction, and stroke. Before data analysis commenced, it was hypothesized that higher levels of neighborhood disadvantage were associated with an increased risk of cardiovascular risk factors and events. RESULTS A total of 49 305 participants were included (median [interquartile range] age, 30.5 [24.9-39.8] years; 43.3% women). Participant region of origin included 6318 from Africa (12.8%), 7253 from Asia (14.7%), 3446 from Eastern Europe (7.0%), 5416 from Iraq (11.0%), 6206 from Iran (12.6%), 5558 from Palestine (via Lebanon, Israel, Occupied Palestinian Territories; 11.3%), and 15 108 from Yugoslavia (30.6%). Adjusted models revealed an association between placement in disadvantaged neighborhoods and increased risk of hypertension (0.71 [95% CI, 0.30-1.13] percentage points per unit of disadvantage index; P < .01), hyperlipidemia (0.44 [95% CI, 0.06-0.83] percentage points; P = .01), diabetes (0.45 [95% CI, 0.09-0.81] percentage points; P = .01), and myocardial infarction (0.14 [95% CI, 0.03-0.25] percentage points; P = .01). No association was found for stroke. Individuals who arrived in Denmark before age 35 years had an increased risk of hyperlipidemia (1.16 [95% CI, 0.41-1.92] percentage points; P < .01), and there were no differences by sex. CONCLUSIONS AND RELEVANCE In this quasi-experimental cohort study, neighborhood disadvantage was associated with increased cardiovascular risk in a relatively young population of refugees. Neighborhood characteristics may be an important consideration when refugees are placed by resettlement agencies and host countries. Future work should examine additional health outcomes as well as potential mediating pathways to target future interventions (eg, neighborhood ease of walking, employment opportunities).
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Affiliation(s)
- Rita Hamad
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Family & Community Medicine, University of California School of Medicine, San Francisco
| | - Buket Öztürk
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Else Foverskov
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University, Denmark
| | - Henrik T. Sørensen
- Department of Clinical Epidemiology, Aarhus University, Denmark
- Center for Population Health Science, Stanford University, Stanford, California
| | - Hans E. Bøtker
- Department of Cardiology, Aarhus University Hospital, Denmark
| | - Justin S. White
- Philip R. Lee Institute for Health Policy Studies, University of California School of Medicine, San Francisco
- Department of Epidemiology & Biostatistics, University of California School of Medicine, San Francisco
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Rodriguez-Alcalá ME, Qin H, Jeanetta S. The Role of Acculturation and Social Capital in Access to Health Care: A Meta-study on Hispanics in the US. J Community Health 2020; 44:1224-1252. [PMID: 31273620 DOI: 10.1007/s10900-019-00692-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A meta-study of 83 articles published from 1981 to 2016 was conducted on Hispanics access to health care in the US. Few of these studies have included acculturation and even fewer the role of social capital as important factors that impact healthcare access for this population. Among those that do include these two factors, there is confusion as to how they are defined and operationalized. Acculturation and social capital could serve to overcome some of the structural barriers in place that manifest stronger among Hispanics who are relatively newcomers to a healthcare system that is highly complex to navigate. The majority of studies included in this systematic review of the literature are in public health journals, which do not focus on sociological aspects as much. This study exposes the need to expand the worldviews used in the literature in order to enrich our understanding of access to health care for Hispanics.
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Affiliation(s)
- Maria E Rodriguez-Alcalá
- Extension Professional in Community Development, University of Missouri, 302 S. Main, Courthouse Basement, Carthage, MO, 64836, USA.
| | - Hua Qin
- Division of Applied Social Sciences, University of Missouri, 228 Gentry Hall, Columbia, MO, 65211, USA
| | - Stephen Jeanetta
- Division of Applied Social Sciences, Extension Community Development Director, Cambio Center Director, University of Missouri, 229 Gentry Hall, Columbia, MO, 65211, USA
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Armenta A, Sarabia H. Receptionists, doctors, and social workers: Examining undocumented immigrant women's perceptions of health services. Soc Sci Med 2020; 246:112788. [PMID: 31958616 DOI: 10.1016/j.socscimed.2020.112788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/18/2019] [Accepted: 01/03/2020] [Indexed: 12/21/2022]
Abstract
In this paper, we examine the attitudes, experiences, and perceptions of health care among unauthorized immigrant women in Philadelphia, Pennsylvania. Research on health care utilization among undocumented immigrants usually focuses on barriers to securing health care access, but little attention has been paid to how these barriers shape patients' experiences. Patients' experiences are important because they affect persistence in care seeking, adherence to treatment regimens, and self-reported health. Drawing from interviews with undocumented Mexican women, we find that receptionists, staff, and social workers play an important role in shaping women's perceptions of health care. In contrast to previous research which finds that negative experiences with providers lead undocumented immigrants to withdraw from seeking medical services, without fail, our respondents persisted and sought care elsewhere. This strategy ensured that all women eventually found care with which they were satisfied, but sometimes after significant delays.
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Hamad R, Niedzwiecki MJ. The short-term effects of the earned income tax credit on health care expenditures among US adults. Health Serv Res 2019; 54:1295-1304. [PMID: 31566732 DOI: 10.1111/1475-6773.13204] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To test the hypothesis that the earned income tax credit (EITC)-the largest US poverty alleviation program-affects short-term health care expenditures among US adults. DATA SOURCES Adult participants in the 1997-2012 waves of the US Medical Expenditure Panel Survey (MEPS) (N = 1 282 080). STUDY DESIGN We conducted difference-in-differences analyses, comparing health care expenditures among EITC-eligible adults in February (immediately following EITC refund receipt) with expenditures during other months, using non-EITC-eligible individuals to difference out seasonal variation in health care expenditures. Outcomes included total out-of-pocket expenditures as well as spending on specific categories such as outpatient visits and inpatient hospitalizations. We conducted subgroup analyses to examine heterogeneity by insurance status. PRINCIPAL FINDINGS EITC refund receipt was not associated with short-term changes in total expenditures, nor any expenditure subcategories. Results were similar by insurance status and robust to numerous alternative specifications. CONCLUSIONS EITC refunds are not associated with short-term changes in health care expenditures among US adults. This may be because the refund is spent on other expenses, because of income smoothing, or because of similar refund-related variation in health care expenditures among noneligible adults. Future studies should examine whether other types of income supplementation affect health care expenditures, particularly among individuals in poverty.
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Affiliation(s)
- Rita Hamad
- Department of Family & Community Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Pullen E, Perry BL, Maupome G. "Does this Look Infected to You?" Social Network Predictors of Dental Help-Seeking Among Mexican Immigrants. J Immigr Minor Health 2019; 20:399-409. [PMID: 28361383 DOI: 10.1007/s10903-017-0572-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Compared to U.S. born Latinos, Mexican immigrants (MAs) have diminished health care access and face substantial barriers to accessing needed dental health services. However, little research has examined how MAs social networks shape their use of dental health services. Using data from 332 Mexican immigrants to the Midwest, this research examines the significance of individual and egocentric network characteristics on two measures of dental health service utilization. Findings reveal that network size, network dental service utilization, and the frequency with which MAs discuss acute problems with network ties, positively correspond to use of oral health services. Conversely, embeddedness in networks where ties hassle egos about dental issues and have low levels of dental health knowledge correspond to lower odds of using these services. This research is among the first to use ego network data and methods to examine the ways network characteristics shape oral health behaviors among this underserved population.
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Affiliation(s)
- Erin Pullen
- Indiana University Network Science Institute, Indiana University, Bloomington, 1001 E State 45/46 Bypass, Bloomington, IN, 47,408, USA.
| | - Brea L Perry
- Department of Sociology/Indiana University Network Science Institute, Indiana University, Bloomington, 1020 E Kirkwood Avenue, Balantine Hall 767, Bloomington, IN, 47,408, USA
| | - Gerardo Maupome
- School of Dentistry / Indiana University Network Science Institute, Indiana University / Purdue University at Indianapolis, 415 Lansing St., Indianapolis, IN, 46,077, USA
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Taverno Ross SE, Macia L, Documét PI, Escribano C, Kazemi Naderi T, Smith-Tapia I. Latino Parents' Perceptions of Physical Activity and Healthy Eating: At the Intersection of Culture, Family, and Health. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2018; 50:968-976. [PMID: 29954715 PMCID: PMC6230483 DOI: 10.1016/j.jneb.2017.12.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 12/12/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore Latino parents' perspectives on healthy living and identify strategies to incorporate in a future child obesity intervention. DESIGN Descriptive, qualitative study. SETTING Participants were recruited from an emerging Latino community (area with low [ < 5%] yet growing concentrations of Latinos) in Allegheny County, PA. PARTICIPANTS Thirty-two parents of preschool children participated in 5 Spanish-language focus groups. PHENOMENON OF INTEREST Parents' perceptions of a healthy lifestyle (ie, physical activity and nutrition). ANALYSIS Data were analyzed using the constant comparison method to identify salient categories, themes, and patterns. RESULTS Three overarching themes were identified: (1) Healthy Living: Beyond One's Control; (2) Estamos Acostumbrados [We Are Used to a Certain Lifestyle]; and (3) Latin American and US Culture Conflict. In general, parents perceived maintaining a healthy lifestyle to require enormous effort and that change was difficult given a lack of knowledge and control. CONCLUSIONS AND IMPLICATIONS Key intervention approaches with this population may include a focus on the family environment. Increasing knowledge, building self-efficacy, and modeling behavior through family recipe preparation and physical activity breaks may be necessary, as well as an emphasis on and orientation to community resources to support behavior change and physical activity and healthy eating habits.
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Affiliation(s)
- Sharon E Taverno Ross
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA.
| | - Laura Macia
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Patricia I Documét
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
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Pinedo M, Zemore S, Rogers S. Understanding barriers to specialty substance abuse treatment among Latinos. J Subst Abuse Treat 2018; 94:1-8. [PMID: 30243409 DOI: 10.1016/j.jsat.2018.08.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/29/2018] [Accepted: 08/07/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND National studies have documented that Latinos are less likely to use specialty substance abuse treatment (e.g., rehabilitation programs, in/out-patient services) than other racial/ethnic groups. Disparities in treatment utilization are particularly pronounced between Latinos and Whites. Few national studies have explicitly examined barriers to treatment by race/ethnicity, and current results are inconclusive. The purpose of this study was to gain a better understanding of barriers to specialty substance abuse treatment among Latinos. METHODS In 2017-2018, in-depth qualitative interviews were conducted with 54 White, Black, and Latino participants who met eligibility criteria for a recent substance use disorder. Participants were recruited via online ads and screened for eligibility through an online survey. Interview questions were grounded in the Theory of Planned Behavior (TBP): Participants were asked about treatment-related barriers in the domains of attitudes, subjective norms, and perceived control. Interviews were transcribed verbatim and coded by two independent coders. Barriers were compared across all interviews and by race/ethnicity. RESULTS Latinos were significantly more likely to report attitudinal and subjective norm barriers than their White and Black counterparts. Within the attitudes domain, results suggested that Latinos largely avoided specialty treatment due to barriers stemming from cultural factors, perceived treatment efficacy, recovery goals, and perceived treatment need. In the area of subjective norms, stigma and perceived lack of social support from family were more pervasive among Latinos' narratives. Lastly, in terms of perceived control, a minority of Latinos reported logistical barriers to treatment. CONCLUSION Specialty substance abuse treatment services have been found to be effective regardless of race/ethnicity. Understanding why Latinos use specialty treatment at low rates is key to reducing existing racial/ethnic disparities related to substance abuse. This study identified several malleable barriers that interventions can target to increase Latinos' utilization of treatment. These barriers may also be key to explaining Latino-White disparities in treatment utilization.
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Affiliation(s)
- Miguel Pinedo
- The University of Texas at Austin, Department of Kinesiology and Health Education, United States of America; Alcohol Research Group, United States of America.
| | - Sarah Zemore
- The University of Texas at Austin, Department of Kinesiology and Health Education, United States of America; Alcohol Research Group, United States of America.
| | - Shannon Rogers
- The University of Texas at Austin, School of Public Health, United States of America.
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12
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Nathan CL, Gutierrez C. FACETS of health disparities in epilepsy surgery and gaps that need to be addressed. Neurol Clin Pract 2018; 8:340-345. [PMID: 30140586 DOI: 10.1212/cpj.0000000000000490] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
Purpose of review Disparities in treatment and outcomes of patients with epilepsy have been identified in several distinct patient populations. The purpose of this review is to organize the literature and establish clear pathways as to why certain patient populations are not receiving epilepsy surgery. By establishing the acronym FACETS (fear of treatment, access to care, communication barriers, education, trust between patient and physician, and social support), we set up a pathway to further study this area in an organized fashion, hopefully leading to objective solutions. Recent findings Studies revealed that African American, Hispanic, and non-English-speaking patients underwent surgical treatment for epilepsy at rates significantly lower compared to white patients. Summary This article explains possible reasons outlined by FACETS for the health disparities in epilepsy surgery that exist in patients of a certain race, socioeconomic status, and language proficiency.
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Affiliation(s)
- Cody L Nathan
- Hospital of the University of Pennsylvania (CLN), Philadelphia; and Department of Neurology (CG), University of Maryland Medical Center, Baltimore
| | - Camilo Gutierrez
- Hospital of the University of Pennsylvania (CLN), Philadelphia; and Department of Neurology (CG), University of Maryland Medical Center, Baltimore
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Taverno Ross SE, Barone Gibbs B, Documet PI, Pate RR. ANDALE Pittsburgh: results of a promotora-led, home-based intervention to promote a healthy weight in Latino preschool children. BMC Public Health 2018; 18:360. [PMID: 29548321 PMCID: PMC5857096 DOI: 10.1186/s12889-018-5266-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/07/2018] [Indexed: 11/11/2022] Open
Abstract
Background Latino preschool children have higher rates of obesity than preschool children from other racial/ethnic groups; however, few effective, culturally appropriate interventions exist targeting this group. The purpose of this study was to test the feasibility of a 10-week, promotora-mediated, home-based intervention to promote a healthy weight in Latino preschool children. Methods Trained promotoras (community health workers) delivered 10, 90-min weekly interactive and tailored sessions to Latino families living in Allegheny County. Participants were recruited through promotoras’ own social networks and community gatherings, flyers, and word of mouth. Primary outcome measures included child body mass index (BMI) z-score and percentile. Secondary outcome measures included child objectively measured physical activity and dietary intake, and the home social and physical environment (e.g., parent health behaviors, parent self-efficacy, parental support, physical activity equipment in the home). The final analysis sample included 49 of 51 participants who completed both baseline and follow-up assessments. Results Participants included mothers (33.5 ± 6.1 years old) and their preschool-aged children who were primarily 1st generation immigrants from Mexico (65%). The primary analyses of BMI percentile and z-score showed no change post-intervention. However, there was a significant decrease in child BMI percentile for overweight and obese children from baseline to follow-up (p < .05). We also saw significant pre/post increases in child daily fruit and vegetable intake, and parent moderate-to-vigorous physical activity, fruit and vegetable servings per day, and self-efficacy; and significant decreases in child saturated fat and added-sugar intake, and child and parent screen time (p’s < .05). Conclusions Despite the short duration of the intervention and follow-up, this pilot study showed promising effects of a promotora-mediated intervention to promote a healthy weight in Latino preschool children. Electronic supplementary material The online version of this article (10.1186/s12889-018-5266-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sharon E Taverno Ross
- Department of Health and Physical Activity, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, 15261, USA.
| | - Bethany Barone Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, 32 Oak Hill Court, Pittsburgh, PA, 15261, USA
| | - Patricia I Documet
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina, 921 Assembly Street, Columbia, SC, 29208, USA
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Dillon FR, Ertl MM, Corp DA, Babino R, De La Rosa M. Latina young adults' use of health care during initial months in the United States. Health Care Women Int 2018; 39:343-359. [PMID: 29043912 PMCID: PMC6089526 DOI: 10.1080/07399332.2017.1388382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined social ecological predictors of health care utilization among Latina young adults during their initial year after immigration to the United States. Participants were 530 Latinas (ages 18-23) who immigrated to Miami-Dade County, Florida, 11.5 months before assessment. We used multiple logistic regression to test predictors of health care usage. Approximately 36% utilized care. Dimensions of marianismo differentially associated with usage. Usage also was more likely for participants who reported more social network attachment, better health, greater neighborhood cohesion, and possessed a job and health insurance. Findings inform interventions to increase health care usage globally among women after immigration.
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Affiliation(s)
- Frank R Dillon
- a Department of Counseling & Counseling Psychology , Arizona State University , Tempe , Arizona , USA
| | - Melissa M Ertl
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Dylan A Corp
- b Department of Educational & Counseling Psychology , University at Albany, State University of New York , Albany , New York , USA
| | - Rosa Babino
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
| | - Mario De La Rosa
- c Center for Research on U.S. Latino HIV/AIDS and Drug Abuse, Florida International University , Miami , Florida , USA
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Ludden TM, Taylor YJ, Simmons LK, Smith HA, de Hernandez BU, Tapp H, Furuseth OJ, Dulin MF. Using Community-Based Participatory Research to Develop Geospatial Models Toward Improving Community Health for Disadvantaged Hispanic Populations in Charlotte, NC. J Prim Prev 2018; 39:171-190. [PMID: 29484532 DOI: 10.1007/s10935-018-0505-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Hispanic immigrant communities across the U.S. experience persistent health disparities and barriers to primary care. We examined whether community-based participatory research (CBPR) and geospatial modeling could systematically and reproducibly pinpoint neighborhoods in Charlotte, North Carolina with large proportions of Hispanic immigrants who were at-risk for poor health outcomes and health disparities. Using a CBPR framework, we identified 21 social determinants of health measures and developed a geospatial model from a subset of those measures to identify neighborhoods with large proportions of Hispanic immigrant populations at risk for poor health outcomes. The geospatial model included four measures-poverty, English ability, acculturation and violent crime-which comprised our Hispanic Health Risk Index (HHRI). We developed a Primary Care Barrier Index (PCBI) to determine (1) how well the HHRI correlated with a statistically derived composite measure incorporating all 21 measures identified through the CBPR process as being associated with access to primary care; (2) whether the HHRI predicted primary care access as well as the statistically-derived composite measure in a statistical model; and (3) whether the HHRI identified similar neighborhoods as the statistically derived composite measure. We collapsed 17 of the 21 social determinants using principal components analysis to develop the PCBI. We determined the correlation of each index with inappropriate emergency department (ED) visits, a proxy for primary care access, using logistic generalized estimating equations. Results from logistic regression models showed positive associations of both the HHRI and the PCBI with the use of the ED for primary care treatable conditions. Enhanced by the knowledge of the local community, the CBPR process with geospatial modeling can guide the multi-tiered validation of social determinants of health and identify neighborhoods that are at-risk for poor health outcomes and health disparities.
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Affiliation(s)
- Thomas M Ludden
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA.
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, Charlotte, NC, 28203, USA
| | - Laura K Simmons
- Urban Institute, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | - Heather A Smith
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | | | - Hazel Tapp
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA
| | - Owen J Furuseth
- Department of Geography and Earth Sciences, University of North Carolina at Charlotte, Charlotte, NC, 28213, USA
| | - Michael F Dulin
- Department of Family Medicine, Atrium Health, Charlotte, NC, 28207, USA
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Pesantes MA, Documet PI. Helping undocumented children in an emerging Latino community. INTERNATIONAL JOURNAL OF MIGRATION, HEALTH AND SOCIAL CARE 2017. [DOI: 10.1108/ijmhsc-11-2015-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to describe and discuss the limitations of strategies that mothers of undocumented Latino children use in an emerging community to address the health needs of their children.
Design/methodology/approach
In-depth interviews with low-income immigrant mothers of undocumented Latino children (n=10) and social service providers (n=6). Interviews were transcribed, coded using Atlas-ti and analyzed to identify common perspectives on the strategies used to secure healthcare for uninsured undocumented children.
Findings
Mothers of undocumented Latino children struggle to secure healthcare for their children. Based on the principles of familismo and personalismo, they rely on social support networks such as friends, relatives and fellow churchgoers to secure information about available healthcare options. Despite the willingness of social and health service providers to help them access healthcare, options are limited and depend on the actions of individuals rather than organized solutions. Securing care for undocumented children using families, friends and sympathetic individual providers as the source of information and advice leads to fragile unsustainable solutions.
Research limitations/implications
This paper adds to the small yet growing literature of Latinos in emerging communities.
Practical implications
Emerging Latino communities are usually unprepared to welcome Latinos and address its various needs. Undocumented children are a particularly vulnerable group and any sustainable strategy to address their needs would require structural changes in existing health services to ensure that undocumented children’s lives are not affected by poor health.
Originality/value
Healthcare access problems for immigrant children are presented from the perspective of parents and offers a nuanced description of health systems unpreparedness to provide care for vulnerable groups whose immigrant status is poorly understood.
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Taverno Ross SE, Documet PI, Pate RR, Smith-Tapia I, Wisniewski LM, Gibbs BB. Study Protocol for a Home-based Obesity Prevention Program in Latino Preschool Children. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2017; 2:85-91. [PMID: 29082322 DOI: 10.1249/tjx.0000000000000038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This paper describes the study design for ANDALE Pittsburgh, a culturally-appropriate, family-based intervention to promote a healthy weight in Latino preschool children. METHODS/DESIGN The study was organized into two major phases: Phase I: Conduct focus groups with 30 Latino parents of preschool children to inform the development of a culturally-appropriate intervention; Phase II: Test the feasibility and effectiveness of the intervention with 50 families. Participants were recruited from an emerging Latino community through community gatherings, flyers, and word of mouth. Six promotoras (females >18 years, active in community) received 25 hours of training using the intervention curriculum finalized after Phase I. Promotoras delivered the home-based intervention to families over 10, 90-minute weekly sessions that included education, practice, and action (i.e., goal setting). Behavior modification constructs and strategies (e.g., goal setting, problem solving, social support), and building of self-efficacy through healthy recipe preparation and physical activity breaks, were also included. Outcomes (e.g., child BMI) were assessed pre- and post-intervention. Process evaluation assessed fidelity, dose, reach, recruitment, and contextual factors using multiple data sources and mixed methods. DISCUSSION The ANDALE Pittsburgh study will expand the body of knowledge on interventions to promote a healthy weight in Latino preschool children living in an emerging Latino community. If successful, this approach will be evaluated in a future, larger-scale intervention and provide a potential model to help to address and prevent obesity in this population.
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Affiliation(s)
- Sharon E Taverno Ross
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | - Patricia I Documet
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, PA
| | - Russell R Pate
- Department of Exercise Science, University of Pittsburgh, Pittsburgh, PA
| | - Ivonne Smith-Tapia
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
| | | | - Bethany B Gibbs
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, PA
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Larimer KA, Gulanick M, Penckofer S. Understanding Determinants of Cardiovascular Health in a Mexican American Community. Health Promot Pract 2017. [PMID: 28629279 DOI: 10.1177/1524839917698095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in Hispanic Americans. Social and physical determinants of health unique to this community must be understood before interventions can be designed and implemented. This article describes a CVD risk assessment conducted in a primarily Mexican American community, using Healthy People 2020 as a model. Social (language, culture, awareness of CVD, and socio-economic status) and physical (presence and use of recreation areas, presence of grocery stores, public transportation, and environmental pollution) determinants of health as well as access to health services were assessed. Fifteen community leaders were interviewed using guided interviews. Database searches and direct observations were conducted. Using these methods provided comprehensive assessment of social and physical determinants of health, and access issues that were unique to the community studied. Findings demonstrated greater awareness of diabetes than CVD as a health problem, with little knowledge of CVD risk factors. Lack of access to health services (lack of insurance, lack of a medical home) and presence of cultural and socioeconomic barriers such as language, unemployment, low income, and lack of insurance were identified. The physical determinants such as environment presented fewer barriers, with adequate access to fruits and vegetables, transportation, and parks. Results revealed target areas for intervention.
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Health of International Marriage Immigrant Women in South Korea: A Systematic Review. J Immigr Minor Health 2017; 20:717-728. [DOI: 10.1007/s10903-017-0604-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Documėt PI, Kamouyerou A, Pesantes A, Macia L, Maldonado H, Fox A, Bachurski L, Morgenstern D, Gonzalez M, Boyzo R, Guadamuz T. Participatory assessment of the health of Latino immigrant men in a community with a growing Latino population. J Immigr Minor Health 2016; 17:239-47. [PMID: 25759869 DOI: 10.1007/s10903-013-9897-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Latino immigrant men are an understudied population in the US, especially in areas with small yet growing Latino populations. For this community-based participatory health assessment we conducted four focus groups and 66 structured surveys with Latino immigrant men, and 10 openended interviews with service providers. We analyzed transcripts using content analysis and survey data using Pearson Chi-square tests. Overall, 53% of participating men had not completed high school. Our findings suggest that their social circumstances precluded men from behaving in a way they believe would protect their health. Loneliness, fear and lack of connections prompted stress among men, who had difficulty locating healthcare services. Newly immigrated men were significantly more likely to experience depression symptoms. Latino immigrant men face social isolation resulting in negative health consequences, which are amplified by the new growth community context. Men can benefit from interventions aimed at building their social connections.
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Mudge S, Rosie J, Stott S, Taylor D, Signal N, McPherson K. Ageing with cerebral palsy; what are the health experiences of adults with cerebral palsy? A qualitative study. BMJ Open 2016; 6:e012551. [PMID: 27737885 PMCID: PMC5073482 DOI: 10.1136/bmjopen-2016-012551] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To enhance understanding of the experiences of ageing with cerebral palsy (CP) in adulthood with a particular focus on experiences with health services. DESIGN A qualitative descriptive methodology was applied to capture adults' views of ageing with CP and related interactions with health services. Semistructured interviews were undertaken with data systematically coded and interpreted by grouping information into categories. Themes that encompassed the categories were identified through thematic analysis. SETTING All healthcare settings. PARTICIPANTS 28 adults (14 women) with CP, aged 37-70 years. RESULTS 5 themes covered the breadth of participants' experiences: (1) acceptance of change; (2) exploring identity: cerebral palsy as only one part of self; (3) taking charge of help; (4) rethinking the future and (5) interacting with health professionals. Being seen and being heard were the features described in positive healthcare interactions. Participants also valued health professionals who reflected on who holds the knowledge?; demonstrated a willingness to learn and respected participants' knowledge and experience. CONCLUSIONS Our findings could, and arguably should, inform more responsive strategies for disabled people in health services and, indeed, all health consumers. Our study supports other findings that impairments related to CP change and, for many, severity of disabling impact increases with age. Increased interactions with health and rehabilitation professionals, as a consequence of these changes, have the potential to impact the person's healthcare experience either positively or negatively. A 'listening health professional' may bridge their knowledge gap and, in recognising the person's own expertise, may achieve three things: a more contextualised healthcare intervention; a better healthcare experience for the person with CP and positive impact on the person's sense of autonomy and identity by recognising their expertise. Future research should identify whether this approach improves the healthcare experience for adults living with CP.
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Affiliation(s)
- Suzie Mudge
- Centre for Person Centred Research, AUT University, Auckland, New Zealand
| | - Juliet Rosie
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Susan Stott
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Nada Signal
- Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand
| | - Kathryn McPherson
- Centre for Person Centred Research, AUT University, Auckland, New Zealand
- Health Research Council of New Zealand, Auckland, New Zealand
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Birth Experiences of Immigrant Latina Women in a New Growth Community. J Racial Ethn Health Disparities 2016; 3:466-72. [PMID: 27294734 DOI: 10.1007/s40615-015-0159-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
Abstract
A woman's birth experience can impact the physical and mental well-being of mothers long after the birth of their child. Little is known about the experiences of Latina women in areas with small, yet growing Latino populations. To understand Latina's perceptions of their childbirth experience and to see how insurance status impacts that experience, we conducted in-depth, semi-structured interviews with a non-proportional quota sampling of ten Latina women, five with and five without health insurance. Most women reported a positive global experience; the birth of a healthy child was the most important factor influencing birth experiences for all of them. Locus of control and support from medical providers and loved ones also shaped experiences. Uninsured women reported lower levels of perceived control and support, which did impact their birthing experience. These differences could be influenced by social status and position. Medical provider, hospital, and policy recommendations are made which could lead to improvements in uninsured Latinas' childbirth experiences.
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Macia L. Experiences of Discrimination in an Emerging Latina/o Community. POLAR-POLITICAL AND LEGAL ANTHROPOLOGY REVIEW 2016. [DOI: 10.1111/plar.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Braschi CD, Sly JR, Singh S, Villagra C, Jandorf L. Increasing colonoscopy screening for Latino Americans through a patient navigation model: a randomized clinical trial. J Immigr Minor Health 2015; 16:934-40. [PMID: 23736964 DOI: 10.1007/s10903-013-9848-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Latinos have a higher rate of mortality and lower rate of colorectal cancer (CRC) screening than most racial groups in the United States. This study examines the predictors of screening colonoscopy (SC) for CRC among Latinos in a patient navigation (PN) intervention. Participants were randomized to either a culturally-targeted PN group (n = 225) or a standard PN group (n = 167). Each completed an interview assessing sociodemographic and intrapersonal information. There was no difference in SC completion between PN groups (80.9 and 79.0 %). Logistic regression revealed that low language acculturation (OR = 2.22) and annual income above $10,000 (OR = 1.97) were independent predictors of completion. Both standard and culturally-targeted PN successfully increased SC completion by nearly 30 % above the recent estimation for physician-referred patients. Our findings suggest a need to further reduce barriers to SC in low income and highly acculturated Latino groups.
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Affiliation(s)
- Caitlyn D Braschi
- Department of Oncological Sciences, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1130, New York, NY, 10029, USA
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Azerkan F, Widmark C, Sparén P, Weiderpass E, Tillgren P, Faxelid E. When Life Got in the Way: How Danish and Norwegian Immigrant Women in Sweden Reason about Cervical Screening and Why They Postpone Attendance. PLoS One 2015; 10:e0107624. [PMID: 26158449 PMCID: PMC4497727 DOI: 10.1371/journal.pone.0107624] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 08/20/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction Danish and Norwegian immigrant women in Sweden have an increased risk of cervical cancer compared to Swedish-born women. In addition, Danish and Norwegian immigrant women follow the national recommendations for attendance at cervical screening to much lesser extent than Swedish-born women. The aim of this study was to explore how Danish and Norwegian immigrant women in Sweden reason about attending cervical screening, focusing on women’s perceptions as to why they and their compatriots do not attend. Methods Eight focus group discussions (FGDs) were conducted with Danish and Norwegian immigrant women living in Stockholm. The women were between 26 and 66 years of age at the time of the FGDs, and were aged between <1 and 48 years old when they immigrated to Sweden. A FGD guide was used, which included questions related to cervical screening, and obstacles and motivators to attend cervical screening. The FGDs were tape recorded and transcribed, and the results analysed according to the principles of qualitative content analysis. Results The main theme was “Women have a comprehensive rationale for postponing cervical screening, yet do not view themselves as non-attenders”. Investigation of women’s rationale for non-attendance after being invited to cervical screening revealed some complex reasons related to immigration itself, including competing needs, organisational and structural factors and differences in mentality, but also reasons stemming from other factors. Postponing attendance at cervical screening was the category that linked all these factors as the reasons to why women did not attend to cervical screening according to the recommendations of the authorities. Conclusions The rationale used to postpone cervical screening, in combination with the fact that women do not consider themselves to be non-attenders, indicates that they have not actively taken a stance against cervical screening, and reveals an opportunity to motivate these women to attend.
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Affiliation(s)
- Fatima Azerkan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Catarina Widmark
- Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Medical Management Center, Karolinska Institutet, Stockholm, Sweden
| | - Pär Sparén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Weiderpass
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromso, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Oslo, Norway
- Samfundet Folkhälsan, Helsinki, Finland
| | - Per Tillgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Faxelid
- Department of Public
Health Sciences, Global Health (IHCAR) Karolinska Institutet, Stockholm, Sweden
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Socio-ecological influences on health-care access and navigation among persons of Mexican descent living on the U.S./Mexico border. J Immigr Minor Health 2015; 16:218-28. [PMID: 23011576 DOI: 10.1007/s10903-012-9714-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The study reported here examines factors influencing decision-making concerning health care access and navigation among persons of Mexican origin living along the U.S./Mexico border. Specifically, the study examined how persons with limited financial resources accessed these two systems. Seven focus groups were held with 52 low income Mexican American people aged 18-65 years. Transcripts were analyzed to identify themes in Atlasti 5.0 software and the theory used included a socio-ecological framework and complemented by constructed from the Social Cognitive Theory. We found that in addition to a lack of insurance and financial resources to pay for health care; fear, embarrassment and denial associated with a diagnosis of illness; poor medical personnel interactions, and desire for quality but streamlined health care also influenced decision making. This theory-based study raises important issues if health care is to improve the health and welfare of disadvantaged populations and points to the need for greater focus on medical homes and prevention and early intervention approaches.
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Rosas LG, Trujillo C, Camacho J, Madrigal D, Bradman A, Eskenazi B. Acceptability of health information technology aimed at environmental health education in a prenatal clinic. PATIENT EDUCATION AND COUNSELING 2014; 97:244-247. [PMID: 25085548 PMCID: PMC4520806 DOI: 10.1016/j.pec.2014.07.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 06/17/2014] [Accepted: 07/13/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients. METHODS A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game. RESULTS The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: (1) benefit of exposure to computer use; (2) reinforcing strategy of health education; and (3) popularity of the interactive game. CONCLUSION The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic. PRACTICE IMPLICATIONS This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures.
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Affiliation(s)
- Lisa G Rosas
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA.
| | - Celina Trujillo
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA
| | - Jose Camacho
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA
| | - Daniel Madrigal
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA
| | - Asa Bradman
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA
| | - Brenda Eskenazi
- Center for Environmental Research and Children's Health (CERCH), University of California Berkeley, School of Public Health, 1995 University Ave. Suite 265, Berkeley 94704 7392, USA
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Chen R, Cheadle A, Johnson D, Duran B. US trends in receipt of appropriate diabetes clinical and self-care from 2001 to 2010 and racial/ethnic disparities in care. DIABETES EDUCATOR 2014; 40:756-66. [PMID: 25142006 DOI: 10.1177/0145721714546721] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to examine trends in the receipt of 8 recommended diabetes clinical and self-care indicators from 2001 to 2010 and assess racial/ethnic disparities in care. METHODS This observational study examined receipt of A1C tests, annual eye and foot exams, flu vaccination, diabetes self-management education (DSME), exercise, self-monitoring of blood glucose (SMBG), and self feet examinations among US adults with diabetes using national survey data from 2001 to 2010. Analyses included estimating proportions for each indicator by year, testing differences in magnitude of change from 2001 to 2010 by race/ethnicity, and regression models to assess changes in care over time and factors associated with care. RESULTS There were significant increases from 2001 to 2010 in A1C tests, annual foot exams, flu shots, DSME, and SMBG but declines in eye and self feet exams. DSME was positively associated with receipt of several care indicators. However, only half of respondents received DSME. White and black non-Hispanics, respectively, experienced improvements in at least 3 indicators. Hispanics experienced a significant increase in exercise but were consistently less likely than whites to receive or engage in most care. CONCLUSIONS While improvements in several indicators were observed, patterns varied by race/ethnicity, with Hispanics falling short on most measures. DSME was strongly associated with most care and demonstrates the potential to improve receipt of recommended care by increasing DSME participation. With the Affordable Care Act (ACA), health professionals have a prime opportunity to leverage ACA provisions to increase access to recommended services, including DSME.
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Affiliation(s)
- Roxana Chen
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
| | - Allen Cheadle
- Group Health Research Institute-Center for Community Health and Evaluation, Seattle, Washington (Dr Cheadle)
| | - Donna Johnson
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
| | - Bonnie Duran
- Department of Health Services, University of Washington, Seattle, Washingon (Drs Chen, Johnson, and Duran)
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Zerr AA, Pina AA. Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services. CHILD & YOUTH CARE FORUM 2014; 43:151-164. [PMID: 24683301 PMCID: PMC3964616 DOI: 10.1007/s10566-013-9230-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral (MEB) disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety. OBJECTIVE Informed by the Behavioral Model of Health Services Use (BMHS), the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity). METHOD Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families. RESULTS Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment. CONCLUSION Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.
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Hansen MC, Cabassa LJ. Pathways to depression care: help-seeking experiences of low-income Latinos with diabetes and depression. J Immigr Minor Health 2013; 14:1097-106. [PMID: 22367667 DOI: 10.1007/s10903-012-9590-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This qualitative study examines help-seeking pathways to depression care of low-income Latinos with diabetes and major depression. A purposive sample (N = 19) of Spanish-speaking, immigrant, low-income Latinos was selected from a randomized clinical trial targeting Latinos with diabetes and major depression. Four focus groups followed by 10 in-depth qualitative interviews were conducted. Narratives were analyzed using the constant comparative method informed by grounded theory. Need for formal care was described in relation to acute somatic symptoms, functional impairment, and mood changes. Treatment initiation occurred through family members and primary care physicians who encouraged or inhibited help-seeking. Adherence to depression care focused on interpersonal aspects of care, evaluated symptom relief, and improved functioning. Help-seeking barriers included self-reliance, language barriers, stigma, competing health demands, and structural barriers. Findings from this study highlight potential points of intervention for developing culturally-appropriate collaborative care approaches for low-income Latinos with diabetes and major depression.
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Affiliation(s)
- Marissa C Hansen
- School of Social Work, University of Southern California, Los Angeles, CA, USA.
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Preventive and curative care utilization among Mexican immigrant women in Birmingham, AL. J Immigr Minor Health 2013; 14:983-9. [PMID: 22370729 DOI: 10.1007/s10903-012-9594-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study aims to describe the utilization of curative and preventive care among Mexican immigrant women in the country of origin versus the US, and to identify factors associated with preventive and curative care utilization. A cross-sectional sample of 185 Mexican immigrant women living in Birmingham, AL between 2004 and 2005 were included in this study. Fisher's Exact tests showed that there was a statistically significant difference between seeking curative care (p < 0.0001) and preventive care (p < 0.0001) in country of origin versus the US. Differences in the reasons for lack of utilization of both curative and preventive care were also observed in the US and the country of origin. These findings suggest that difference in healthcare-seeking behaviors and utilization among Mexican immigrant women between the US and their country of origin may be useful in the development of interventions aimed at increasing the use of preventive and curative care services to this immigrant population in the US.
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Silvestre A, Beatty RL, Friedman MR. Substance use disorder in the context of LGBT health: a social work perspective. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:366-376. [PMID: 23731425 DOI: 10.1080/19371918.2013.774667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The impacts of public and private funding of lesbian, gay, bisexual, and transgender (LGBT) health research, the state of integration of LGBT health issues into the academic and professional training programs of health care practitioners, and the larger social reality experienced by LGBT people profoundly affect substance use and substance use disorders in those populations. This analysis uses a social work perspective and considers the current state of research, professional training, and social oppression as they affect the health of LGBT people. Suggestions for action are offered that may improve the health of LGBT peoples and the practice of social work.
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Affiliation(s)
- Anthony Silvestre
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Kim-Godwin Y, McMurry MJ. Perspectives of nurse practitioners on health care needs among Latino children and families in the rural Southeastern United States: a pilot study. J Pediatr Health Care 2012; 26:409-17. [PMID: 23099307 DOI: 10.1016/j.pedhc.2011.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 02/16/2011] [Accepted: 02/24/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The purpose of this study was to explore perspectives of nurse practitioners on health care needs among Latino children and families in the rural Southeastern United States. METHOD This qualitative research used semi-structured interviews with seven nurse practitioners (NPs) practicing in the rural southeastern part of North Carolina. Flanagan's critical incident technique was used to describe the experiences of NPs providing health care for Latino children and parents. RESULTS Data analysis indicates that the most commonly reported illnesses by Latino children are upper respiratory infections and asthma, followed by otitis media, obesity, anemia, pneumonia, leukemia, and tumors. Barriers to health care for children included language and cultural differences, lack of access to care (e.g., lack of insurance, cost, and transportation), and health illiteracy/low education level of parents. The findings also suggest that Latinos are preserving their traditional health practices when treating their children's illnesses, such as through use of foods, hot/cold items, herbs, coin on "belly button," traditional juices, healing bracelets, and evil eye. DISCUSSION The findings of the study imply the need to incorporate culturally sensitive care when providing care for Latino children and parents.
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Dulin MF, Tapp H, Smith HA, de Hernandez BU, Coffman MJ, Ludden T, Sorensen J, Furuseth OJ. A trans-disciplinary approach to the evaluation of social determinants of health in a Hispanic population. BMC Public Health 2012; 12:769. [PMID: 22966865 PMCID: PMC3490764 DOI: 10.1186/1471-2458-12-769] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/30/2012] [Indexed: 12/29/2022] Open
Abstract
Background Individual and community health are adversely impacted by disparities in health outcomes among disadvantaged and vulnerable populations. Understanding the underlying causes for variations in health outcomes is an essential step towards developing effective interventions to ameliorate inequalities and subsequently improve overall community health. Working at the neighborhood scale, this study examines multiple social determinates that can cause health disparities including low neighborhood wealth, weak social networks, inadequate public infrastructure, the presence of hazardous materials in or near a neighborhood, and the lack of access to primary care services. The goal of this research is to develop innovative and replicable strategies to improve community health in disadvantaged communities such as newly arrived Hispanic immigrants. Methods/design This project is taking place within a primary care practice-based research network (PBRN) using key principles of community-based participatory research (CBPR). Associations between social determinants and rates of hospitalizations, emergency department (ED) use, and ED use for primary care treatable or preventable conditions are being examined. Geospatial models are in development using both hospital and community level data to identify local areas where interventions to improve disparities would have the greatest impact. The developed associations between social determinants and health outcomes as well as the geospatial models will be validated using community surveys and qualitative methods. A rapidly growing and underserved Hispanic immigrant population will be the target of an intervention informed by the research process to impact utilization of primary care services and designed, deployed, and evaluated using the geospatial tools and qualitative research findings. The purpose of this intervention will be to reduce health disparities by improving access to, and utilization of, primary care and preventative services. Discussion The results of this study will demonstrate the importance of several novel approaches to ameliorating health disparities, including the use of CBPR, the effectiveness of community-based interventions to influence health outcomes by leveraging social networks, and the importance of primary care access in ameliorating health disparities.
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Affiliation(s)
- Michael F Dulin
- Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Charlotte, NC 28207, USA
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Hansen MC, Aranda MP. Sociocultural influences on mental health service use by Latino older adults for emotional distress: exploring the mediating and moderating role of informal social support. Soc Sci Med 2012; 75:2134-42. [PMID: 23021849 DOI: 10.1016/j.socscimed.2012.06.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 05/28/2012] [Accepted: 06/27/2012] [Indexed: 10/28/2022]
Abstract
This study investigated the determinants of mental health services for emotional distress by low-income older Latinos living in Los Angeles County (United States). The functional effects of informal support on service use were tested while accounting for dimensions of support and sociocultural factors. Using data from a cross-sectional survey of older Latinos (n = 235), we preformed a secondary data analysis using path analysis with Poisson regression to assess mediation and moderation models by type of perceived support, emotional and instrumental. Data was originally collected between 1998 and 2005. Results indicated that no mediation effects were present however significant moderation effects emerged. Respondents with low levels of linguistic acculturation and informal support used fewer services. Variations by type of informal support emerged, with emotional support presenting the best model fit compared to instrumental support in the moderation model analysis. The direct effects of linguistic acculturation and age remained significant after controlling for need. Findings reveal limited informal support is a risk factor for the underutilization of mental health services by older Latinos with low levels of linguistic acculturation as they age. Integrating support resources that assist in navigating service systems and address language barriers can enhance service use by older Latino adults. Implications for service delivery and program development are discussed.
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Affiliation(s)
- Marissa C Hansen
- University of Houston, Graduate College of Social Work, 110HA Social Work Building, Houston, TX 77204-4013, United States.
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Katz VS, Ang A, Suro R. An Ecological Perspective on U.S. Latinos’ Health Communication Behaviors, Access, and Outcomes. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2012. [DOI: 10.1177/0739986312445566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
U.S. Latinos experience constrained access to formal health care resources, contributing to higher incidence of preventable diseases and chronic health conditions than the general population. The authors explore whether a rich set of informal health communication connections—to friends, family, radio, television, Internet, newspapers, magazines, churches, and community organizations—can compensate, even partially, for not having access to doctors. The authors find no evidence of any such compensatory mechanism among respondents to the Pew Hispanic Center/Robert Wood Johnson Latino Health Survey ( N = 3,899). Analyses revealed that the informal health communication ecologies of respondents with favorable immigration/nativity status and greater income, education, and language proficiencies were more diversified than those of respondents reporting less favorable social status. Further analyses revealed that diversified informal health communication ecologies related to health care access (regular doctor visits, uninterrupted health insurance, and regular health care location) and favorable health outcomes (self-ratings of general health, health-related efficacy, and knowledge of diabetes symptoms).
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Affiliation(s)
- Vikki S. Katz
- Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| | - Alfonso Ang
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Roberto Suro
- University of Southern California, Los Angeles, CA, USA
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Dastjerdi M. The case of Iranian immigrants in the greater Toronto area: a qualitative study. Int J Equity Health 2012; 11:9. [PMID: 22369146 PMCID: PMC3305531 DOI: 10.1186/1475-9276-11-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 02/27/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Iranians comprise an immigrant group that has a very different cultural background from that of the mainstream Canadian population and speaks a language other than English or French; in this case mainly Farsi (Persian). Although Iranian immigrants in Toronto receive a high proportion of care from Farsi-speaking family physicians and health care providers than physicians who cannot speak Farsi, they are still not satisfied with the provided services. The purpose of this study was to identify the obstacles and issues Iranian immigrants faced in accessing health care services as seen through the eyes of Iranian health care professionals/providers and social workers working in Greater Toronto Area, Canada. METHODS Narrative inquiry was used to capture and understand the obstacles this immigrant population faces when accessing health care services, through the lens of fifty Iranian health care professionals/providers and social workers. Thirty three health care professionals and five social workers were interviewed. To capture the essence of issues, individual interviews were followed by three focus groups consisting of three health care professionals and one social worker in each group. RESULTS Three major themes emerged from the study: language barrier and the lack of knowledge of Canadian health care services/systems; lack of trust in Canadian health care services due to financial limitations and fear of disclosure; and somatization and needs for psychological supports. CONCLUSION Iranians may not be satisfied with the Canadian health care services due to a lack of knowledge of the system, as well as cultural differences when seeking care, such as fear of disclosure, discrimination, and mistrust of primary care. To attain equitable, adequate, and effective access to health care services, immigrants need to be educated and informed about the Canadian health care system and services it provides. It would be of great benefit to this population to hold workshops on health topics, and mental health issues, build strong ties with the community by increasing their involvement, use plain language, design informative and health related websites in both Farsi and English, and provide a Farsi speaking telephone help line to answer their health related issues.
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Affiliation(s)
- Mahdieh Dastjerdi
- Faculty of Health, School of Nursing, York University, Toronto, Toronto, ON, Canada.
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Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program's lifestyle intervention in an underserved Latino population. DIABETES EDUCATOR 2011; 37:564-72. [PMID: 21690435 DOI: 10.1177/0145721711411107] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective was to take prevention from the clinic to the community by including a high-risk group and working with the community to tailor, enhance, deliver, and evaluate a community-based version of the Diabetes Prevention Program's (DPP) clinic-based lifestyle intervention. METHODS This was a nonrandomized prospective study using a single-group design. Study eligibility included a screening glucose value in the normal to prediabetes range with no current diagnosis of diabetes, overweight, not pregnant nor planning to become pregnant during study period, aged 18 to 65, Latino, living in the study target communities, and no reported medical restrictions related to the program goals. A total of 69 individuals participated. The Healthy Living Program (HLP) was based on the DPP's 1-year intensive lifestyle program, was tailored and enhanced for a Latino community, and was delivered by community health workers. Anthropometric and paper and pencil measures were administered to examine program outcome at 6 months and 12 months. RESULTS In general, results indicate statistically significant improvements in anthropometrics and many behavioral outcomes, particularly at 6 months. Participants demonstrated forward movement through the stages of change during the program. CONCLUSIONS Results support the effectiveness of the intervention and show that delivery of the translated version of the DPP's lifestyle intervention in the community by community residents holds promise as one strategy to reach people at increased risk of developing diabetes. Use of this translation model, including collaboration with community health workers, offers diabetes educators an opportunity to extend their reach into underserved communities.
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Affiliation(s)
| | - Susan Oros
- The University of Illinois at Chicago, Chicago, Illinois
| | - Young Ku Choi
- The University of Illinois at Chicago, Chicago, Illinois
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Daher AM, Ibrahim HS, Daher TM, Anbori AK. Health related quality of life among Iraqi immigrants settled in Malaysia. BMC Public Health 2011; 11:407. [PMID: 21624118 PMCID: PMC3128021 DOI: 10.1186/1471-2458-11-407] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 05/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants everywhere face several demands for health and maintaining good health and quality of life could be challenging. Iraqis are the second largest refugee group that has sought refuge in the recent years, yet little is known about their health related quality of life (HRQOL). The study aims at assessing the HRQOL among Iraqis living in Malaysia. METHODS A self-administered Arabic version of Sf-36 questionnaire was distributed among 300 Iraqi migrants in Malaysia. The questionnaire taps eight concepts of physical and mental health to assess the HRQOL. Univariate analysis was performed for group analysis (t test, ANOVA) and Multiple Linear Regression was used to control for confounding effects. RESULTS Two hundred and fifty three participants ranging in age from 18 to 67 years (Mean = 33.6) returned the completed questionnaire. The majority was males (60.1%) and more than half of the respondents (59.5%) were married. Less than half (45.4%) and about a quarter (25.9%) reported bachelor degree and secondary school education respectively and the remaining 28.7% had either a master or a PhD degree.Univariate analysis showed that the HRQOL scores among male immigrants were found to be higher than those of females in physical function (80.0 vs. 73.5), general health (72.5 vs. 60.7) and bodily pain (87.9 vs. 72.5) subscales. The youngest age group had significantly higher physical function (79.32) and lower mental health scores (57.62).The mean score of physical component summary was higher than the mental component summary mean score (70.22 vs. 63.34).Stepwise multiple linear regression, revealed that gender was significantly associated with physical component summary (β = - 6.06, p = 0.007) and marital status was associated with mental component summary (β = 7.08, p = 0.003). CONCLUSIONS From the data it appears that Iraqi immigrants living in Malaysia have HRQOL scores that might be considered to indicate a relatively moderate HRQOL. The HRQOL is significantly affected by gender and marital status. Further studies are needed to explore determinants of HRQOL consequent to immigration. The findings could be worthy of further exploration.
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Affiliation(s)
- Aqil M Daher
- Department of Population Health and Preventive Medicine, Faculty of Medicine, Universiti Teknology MARA, Shah Alam, Selangor, Malaysia.
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Dulin MF, Tapp H, Smith HA, Urquieta de Hernandez B, Furuseth OJ. A community based participatory approach to improving health in a Hispanic population. Implement Sci 2011; 6:38. [PMID: 21481262 PMCID: PMC3094257 DOI: 10.1186/1748-5908-6-38] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 04/11/2011] [Indexed: 11/24/2022] Open
Abstract
Background The Charlotte-Mecklenburg region has one of the fastest growing Hispanic communities in the country. This population has experienced disparities in health outcomes and diminished ability to access healthcare services. This city is home to an established practice-based research network (PBRN) that includes community representatives, health services researchers, and primary care providers. The aims of this project are: to use key principles of community-based participatory research (CBPR) within a practice-based research network (PBRN) to identify a single disease or condition that negatively affects the Charlotte Hispanic community; to develop a community-based intervention that positively impacts the chosen condition and improves overall community health; and to disseminate findings to all stakeholders. Methods/design This project is designed as CBPR. The CBPR process creates new social networks and connections between participants that can potentially alter patterns of healthcare utilization and other health-related behaviors. The first step is the development of equitable partnerships between community representatives, providers, and researchers. This process is central to the CBPR process and will occur at three levels -- community members trained as researchers and outreach workers, a community advisory board (CAB), and a community forum. Qualitative data on health issues facing the community -- and possible solutions -- will be collected at all three levels through focus groups, key informant interviews and surveys. The CAB will meet monthly to guide the project and oversee data collection, data analysis, participant recruitment, implementation of the community forum, and intervention deployment. The selection of the health condition and framework for the intervention will occur at the level of a community-wide forum. Outcomes of the study will be measured using indicators developed by the participants as well as geospatial modeling. On completion, this study will: determine the feasibility of the CBPR process to design interventions; demonstrate the feasibility of geographic models to monitor CBPR-derived interventions; and further establish mechanisms for implementation of the CBPR framework within a PBRN.
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Affiliation(s)
- Michael F Dulin
- Department of Family Medicine, Carolinas HealthCare System, 2001 Vail Avenue, Charlotte, NC 28207 USA
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Delorme DE, Huh J, Reid LN. Evaluation, use, and usefulness of prescription drug information sources among Anglo and Hispanic Americans. JOURNAL OF HEALTH COMMUNICATION 2010; 15:18-38. [PMID: 20390975 DOI: 10.1080/10810730903460526] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This survey was conducted to determine and compare how Anglo and Hispanic Americans evaluate and use interpersonal, advertising, and mediated sources of prescription drug information. Findings suggest the following: (1) Hispanics rely on doctors, Internet advertising sources, and direct-to-consumer advertising (DTCA), while Anglos frequently use health-related websites and health care professionals; (2) Anglos are more likely to use health-related websites such as WebMD, although Anglos and Hispanics do not appear significantly different in Internet source usefulness evaluation; (3) Hispanics rely on television (TV) and DTC TV advertising more than Anglos, and this tendency is stronger for strong than weak Hispanic identifiers; (4) Hispanics evaluate TV news stories and TV advertising as more useful than Anglos; (5) Hispanics evaluate DTCA more positively and with less skepticism than Anglos; and (6) Hispanic ethnic identification level is positively related to preferences for Spanish-language media and health care professionals.
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Affiliation(s)
- Denise E Delorme
- Nicholson School of Communication, University of Central Florida, Orlando, Florida, USA
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Bass E. The enigma of higher income immigrants with lower rates of health insurance coverage in the United States. J Immigr Minor Health 2009; 8:1-9. [PMID: 19834995 DOI: 10.1007/s10903-006-6337-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This research compares rates of health insurance coverage among middle-class non-elderly immigrants to native-born American adults using data from the March 1996-2000 Supplements to the Current Population Survey. Probit regressions reveal that immigrants were three times as likely to be uninsured at income levels exceeding $50,000, controlling for economic, demographic and immigrant-related characteristics. Work-related characteristics, income, martial status and nativity considerably influenced health insurance status for all adults, but work-related factors had the strongest effect on immigrants' rates of coverage. Why, ceteris paribus, immigrants have lower coverage rates is unclear. Many low-income and recent immigrants face barriers to access due to legal status or job sector. But lower rates of health insurance coverage which persist among long-time residents at higher income levels cannot be explained by such barriers, a finding highly relevant for policy makers. Encouraging uninsured immigrants to opt into health plans voluntarily will remain a challenge.
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Affiliation(s)
- Elizabeth Bass
- James A. Haley VAMC, VISN 8 Patient Safety Center of Inquiry, 11605 North Nebraska Avenue, Tampa, Florida 33612, USA.
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Claudio L, Stingone JA. Primary household language and asthma care among Latino children. J Health Care Poor Underserved 2009; 20:766-79. [PMID: 19648704 DOI: 10.1353/hpu.0.0164] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
To determine if language barriers affect the level of asthma management and quality of health care in Latino children, a cross-sectional, parent-report survey was conducted in 26 randomly selected public elementary schools in New York City. The overall response rate was 76.9%, yielding a sample of 1,847 Latino children. The prevalence of asthma among Latinos from Spanish-speaking households was 20.8%, compared with 25.8% among Latino children from English-speaking households. Although asthmatics from Spanish-speaking families were less likely to have symptoms than children from English-speaking families, they were twice as likely to be hospitalized for asthma (9.4% vs. 4.4%, p<.02). Asthmatics from Spanish-speaking households were more likely to have public health insurance and to use a community/hospital clinic for care. Spanish-speaking parents were less likely to report having access to care on weekends or to have communicated with their child's physician about recommended components of an asthma management plan.
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Affiliation(s)
- Luz Claudio
- Department of Community Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Wells JN, Cagle CS, Marshall D, Hollen ML. Perceived Mood, Health, and Burden in Female Mexican American Family Cancer Caregivers. Health Care Women Int 2009; 30:629-54. [DOI: 10.1080/07399330902928857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation with a primary care provider in New Zealand: who is, who isn't. Health Policy 2009; 91:286-96. [PMID: 19201046 DOI: 10.1016/j.healthpol.2008.12.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 12/23/2008] [Accepted: 12/26/2008] [Indexed: 11/23/2022]
Abstract
AIMS New Zealand has a mixed public-private funded primary care system. In the last decade, considerable effort has gone into reducing the financial barriers to primary care, with some targeting of greater public funding of practices in more deprived areas. In this paper we explore the association of socio-demographic factors with affiliation with a primary care provider (PCP), and specifically examine the association with deprivation. Affiliation refers to having a doctor, nurse or medical centre one could go to if need arises. METHODS We used data from the third wave (2004-2005) of an ongoing 8-year panel study of 22,000 adults that includes a health add-on. This paper utilises demographic, socio-economic and health behaviour characteristics of those who reported affiliation with a PCP at wave 3. Affiliation itself was measured with the question: "do you have a doctor, nurse or medical centre you usually go to, if you need to see a doctor?" Logistic regression is used to determine the independent association of a range of socio-demographic factors with affiliation with a PCP. RESULTS Of the total of 18,320 respondents, 1530 (8.3%) reported no affiliation with a PCP. The odds of affiliation was significantly lower for males compared to females (OR 0.45, 95% CI: 0.39-0.50), never married compared to currently married (OR 0.48, 95% CI: 0.41-0.57), Asians compared to New Zealand Europeans (OR 0.47, 95% CI: 0.38-0.57), current smokers compared to never smokers (OR 0.79, 95% CI: 0.68-0.91) and those with post-school education compared to no education (OR 0.65, 95% CI: 0.55-0.76) and higher for older adults aged 65 years and over compared to young adults aged 15-24 years old (OR 5.14, 95% CI: 3.59-7.36), those reporting poor self-assessed health compared to those reporting good health (OR 1.45, 95% CI: 1.06-1.98), and those reporting one or more co-morbid conditions compared to no co-morbid conditions (OR 2.02, 95% CI: 1.78-2.29). However, there was no significant difference in affiliation with a PCP between those living in the most deprived areas and the least deprived areas. CONCLUSIONS Affiliation to a PCP is a measure of potential access to primary care. Overall, our data provide some support for the hypothesis that people with high health needs have high rates of affiliation with a PCP (e.g., elderly, women, Māori and those in poor health). The results also suggest that current health policies in New Zealand, with their emphasis on a strong primary health care system, are ensuring that people with greater health care needs are affiliated with a PCP.
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Shobe MA, Coffman MJ, Dmochowski J. Achieving the American dream: facilitators and barriers to health and mental health for Latino immigrants. JOURNAL OF EVIDENCE-BASED SOCIAL WORK 2009; 6:92-110. [PMID: 19199139 DOI: 10.1080/15433710802633601] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed.
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Affiliation(s)
- Marcia A Shobe
- University of Arkansas, School of Social Work,1 University of Arkansas, ASUP 106, Fayetteville, AR 72701, USA.
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Stevens GD, West-Wright CN, Tsai KY. Health insurance and access to care for families with young children in California, 2001-2005: differences by immigration status. J Immigr Minor Health 2008; 12:273-81. [PMID: 18780183 DOI: 10.1007/s10903-008-9185-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 08/26/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine differences and trends in health insurance coverage and access to care for California families by immigration status. METHODS Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented. RESULTS Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16-0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52-0.91), dental visits (OR = 0.47, CI: 0.35-0.63), and a regular source of care (OR = 0.51, CI: 0.37-0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62-4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67-0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.
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Affiliation(s)
- Gregory D Stevens
- Department of Family Medicine, Center for Community Health Studies, University of Southern California Keck School of Medicine, 1000 South Fremont Avenue, Alhambra, CA 91803, USA.
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Stewart M, Anderson J, Beiser M, Mwakarimba E, Neufeld A, Simich L, Spitzer D. Multicultural Meanings of Social Support among Immigrants and Refugees. INTERNATIONAL MIGRATION 2008. [DOI: 10.1111/j.1468-2435.2008.00464.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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