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Chang E, Davis TL, Berkman ND. Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic. Med Care 2024; 62:367-375. [PMID: 38054852 PMCID: PMC11081476 DOI: 10.1097/mlr.0000000000001963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. OBJECTIVE To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. RESEARCH DESIGN Multivariate logistic regression analysis of National Health Interview Survey data (July-December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. RESULTS A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. CONCLUSIONS Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.
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Affiliation(s)
- Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, WI
| | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
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2
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Argibay S, Auchincloss AH, Chaparro MP, Kravitz C, Eastus A, Langellier BA. Impact of county and state immigration policies on immigrant household enrollment in the supplemental nutrition assistance program. J Migr Health 2024; 9:100224. [PMID: 38596617 PMCID: PMC11002295 DOI: 10.1016/j.jmh.2024.100224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/18/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Low-income immigrants who are eligible to participate in the Supplemental Nutrition Assistance Program (SNAP) participate at lower rates compared to non-immigrants. Immigrant households may be more likely to participate in SNAP if they live in areas with policies that integrate them into society and protect them from deportation. Methods Data on low-income immigrant households came from the 2019 American Community Survey (N = 87,678). The outcome was whether any household member received SNAP in the previous 12 months. Immigrant policy exposures came from two sources: the State Immigration Policy Resource, which includes 18 immigrant criminalizing and integrating policies, and a database that identified 'sanctuary policies' (SP), which we summarized at the county level. Multivariable logistic regression adjusted for person/household-level and area-level confounders. Results Living in a jurisdiction with a SP was associated with 21% higher odds of enrolling in SNAP compared to living in a jurisdiction without a SP (adjusted odds ratio [aOR] 1.21, 95% CI=1.11,1.31). Relative to the least immigrant friendly states, living in the most immigrant-friendly states was associated with 16% higher odds of SNAP enrollment (aOR=1.16, 95%CI=1.06-1.28). When SP and state-level immigrant friendly policy environment were cross-classified, SNAP participation was 23% and 26% higher for those living in jurisdictions with one- and both- exposures, respectively, relative to those with neither (aOR 1.23; CI 1.12,1.36; aOR 1.26; CI 1.15,1.37). Conclusions Many at high risk of food insecurity - including immigrants and citizens in households with immigrants - are eligible for SNAP but under-enroll. Policies that welcome and safeguard immigrants could reduce under enrollment.
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Affiliation(s)
- Sofia Argibay
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel, University. Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
| | - Amy H. Auchincloss
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel, University. Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
| | - M. Pia Chaparro
- Department of Health Systems and Population Health, School of, Public Health, University of Washington, 305 J Raitt Hall, Box 353410, Seattle, WA 98195, United States
| | - Caroline Kravitz
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel, University. Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
| | - Alexandra Eastus
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel, University. Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
| | - Brent A. Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel, University. Nesbitt Hall, 3215 Market St., Philadelphia, PA 19104, United States
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3
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Ling IC, Choi HY, Sudhinaraset M. Navigating a climate of administrative burden: the perspectives of young adult undocumented immigrants in applying for COVID-19 disaster relief assistance for immigrants in California. Front Public Health 2024; 12:1304704. [PMID: 38425463 PMCID: PMC10902714 DOI: 10.3389/fpubh.2024.1304704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/19/2024] [Indexed: 03/02/2024] Open
Abstract
Undocumented immigrants experienced high levels of economic insecurity during the COVID-19 pandemic while being excluded from government-based relief and unemployment benefits. In April 2020, California became the first state to offer financial aid to undocumented immigrants through the innovative Disaster Relief Assistance for Immigrants (DRAI) program in collaboration with several community-based organizations (CBOs). However, the process of applying for aid was marked by many implementation challenges, such as intake and language access; however, little data exists on the direct experiences of the undocumented community. This qualitative study examines the experiences of undocumented Asian and Latinx young adults living in California in applying for DRAI through framework of administrative burden. Themes distilled from participant experiences highlight how administrative burden via learning, psychological, and compliance costs shape the ways in which undocumented immigrants navigate policies and programs, such as DRAI. These experiences highlight the need for policymakers to address structural and programmatic administrative burdens in policy development; failure to do so result in detrimental impacts that outweigh financial benefits or cause communities to forgo needed resources.
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Affiliation(s)
- Irving C. Ling
- Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Hye Young Choi
- School of Medicine, Yale University, New Haven, CT, United States
| | - May Sudhinaraset
- Fielding School of Public Health, University of California, Los Angeles, CA, United States
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Thoumi A, Plasencia G, Madanay F, Ho ESA, Palmer C, Kaalund K, Chaudhry N, Labrador A, Rigsby K, Onunkwo A, Almonte I, Gonzalez-Guarda R, Martinez-Bianchi V, Cholera R. Promoting Latinx health equity through community-engaged policy and practice reforms in North Carolina. Front Public Health 2023; 11:1227853. [PMID: 38074704 PMCID: PMC10701733 DOI: 10.3389/fpubh.2023.1227853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Introduction The Latinx Advocacy Team & Interdisciplinary Network for COVID-19 (LATIN-19) is a unique multi-sector coalition formed early in the COVID-19 pandemic to address the multi-level health inequities faced by Latinx communities in North Carolina. Methods We utilized the National Institute on Minority Health and Health Disparities (NIMHD) Research Framework to conduct a directed content analysis of 58 LATIN-19 meeting minutes from April 2020 through October 2021. Application of the NIMHD Research Framework facilitated a comprehensive assessment of complex and multidimensional barriers and interventions contributing to Latinx health while centering on community voices and perspectives. Results Community interventions focused on reducing language barriers and increasing community-level access to social supports while policy interventions focused on increasing services to slow the spread of COVID-19. Discussion Our study adds to the literature by identifying community-based strategies to ensure the power of communities is accounted for in policy reforms that affect Latinx health outcomes across the U.S. Multisector coalitions, such as LATIN-19, can enable the improved understanding of underlying barriers and embed community priorities into policy solutions to address health inequities.
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Affiliation(s)
- Andrea Thoumi
- Margolis Center for Health Policy, Duke University, Washington, NC, United States
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
| | - Gabriela Plasencia
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Farrah Madanay
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Ethan Shih-An Ho
- Pratt School of Engineering, Duke University, Durham, NC, United States
| | - Caroline Palmer
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Kamaria Kaalund
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
| | - Nikhil Chaudhry
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Amy Labrador
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Kristen Rigsby
- Trinity College of Arts & Sciences, Duke University, Durham, NC, United States
| | - Adaobi Onunkwo
- Fuqua School of Business, Duke University, Durham, NC, United States
| | | | - Rosa Gonzalez-Guarda
- LATIN-19, Durham, NC, United States
- School of Nursing, Duke University, Durham, NC, United States
| | - Viviana Martinez-Bianchi
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, United States
- LATIN-19, Durham, NC, United States
| | - Rushina Cholera
- Margolis Center for Health Policy, Duke University, Durham, NC, United States
- Department of Pediatrics, School of Medicine, Duke University, Durham, NC, United States
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5
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Chen L, Young MEDT, Rodriguez MA, Kietzman K. Immigrants' Enforcement Experiences and Concern about Accessing Public Benefits or Services. J Immigr Minor Health 2023; 25:1077-1084. [PMID: 36859637 PMCID: PMC10509127 DOI: 10.1007/s10903-023-01460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/03/2023]
Abstract
Although exclusionary immigration policies are associated with fear of deportation and avoidance of public benefits, relationships between immigration enforcement policy and public charge policies are largely unknown. Using a California population-based survey of 1103 Asian and Latinx immigrants in 2018, we tested the relationship between immigrants' experiences with law enforcement and their concern about public charge. Direct encounters with various forms of law enforcement, including being asked to show proof of citizenship by law enforcement, staying inside to avoid police or immigration officials, and having known someone who had been deported, were associated with immigrants' avoidance of public benefits due to public charge concerns. Latinx immigrants were more likely to be concerns about public charge than Asians. Intersections among immigration policies deserve further consideration. There is a need to provide accurate and reliable information to immigrant communities about public benefits and advocate for inclusive immigration policies.
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Affiliation(s)
- Lei Chen
- Department of Social Welfare, Luskin School of Public Affairs and Center for Health Policy Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California Merced, 5200 Lake Road, Merced, CA, 95343, USA.
| | - Michael A Rodriguez
- Department of Family Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Kathryn Kietzman
- Center for Health Policy Research, University of California Los Angeles, Los Angeles, CA, USA
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6
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Vu M, Trinh D, Kandula NR, Pham NHT, Makelarski J, Seligman HK. Low-Income Asian Americans: High Levels Of Food Insecurity And Low Participation In The CalFresh Nutrition Program. Health Aff (Millwood) 2023; 42:1420-1430. [PMID: 37729587 DOI: 10.1377/hlthaff.2023.00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Little is known about food insecurity and the extent of Supplemental Nutrition Assistance Program (SNAP) participation in the heterogeneous Asian American population. Using California Health Interview Survey data from the period 2011-20, we examined both issues among low-income Asian American adults from six origin groups: Chinese, Filipino, Japanese, Korean, South Asian, and Vietnamese. We found high and varied levels of overall food insecurity, with the highest burden among Filipino adults (40 percent). Food insecurity by severity was also heterogenous; very low food security affected 2 percent of Chinese adults but 9 percent and 10 percent of Filipino and Japanese adults, respectively. Participation in CalFresh (California-implemented SNAP) ranged from 11 percent and 12 percent among Korean and Chinese adults, respectively, to 20 percent among Vietnamese adults. Compared with English-proficient low-income Asian American adults, those with limited English proficiency were no less likely to participate in CalFresh, possibly reflecting language assistance required by California law and provided by community-based organizations. These results underscore the importance of collecting and reporting disaggregated data by Asian origin group that could inform targeted outreach and interventions.
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Affiliation(s)
- Milkie Vu
- Milkie Vu , Northwestern University, Chicago, Illinois
| | - Duy Trinh
- Duy Trinh, Princeton University, Princeton, New Jersey
| | | | - Nhat-Ha Tran Pham
- Nhat-Ha Tran Pham, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hilary K Seligman
- Hilary K. Seligman, University of California San Francisco, San Francisco, California
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7
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Newton EH, Valenzuela RG, Cruz-Menoyo PM, Feliberti K, Shub TD, Trapini CZM, Espinosa de Los Reyes S, Melian CM, Peralta LD, Alcalá HE. Racial/Ethnic Differences in Non-Discretionary Risk Factors for COVID-19 Among Patients in an Early COVID-19 Hotspot. J Racial Ethn Health Disparities 2023; 10:2363-2373. [PMID: 36178630 PMCID: PMC9524304 DOI: 10.1007/s40615-022-01416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/06/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Baseline disparities in non-discretionary risk factors, i.e., those not readily altered, like family size and work environment, appear to underlie the disproportionate COVID-19 infection rates seen among Hispanic persons and, at surge onsets, Black persons. No study has systematically compared such risk factors by race/ethnicity among infected individuals. METHODS Using a cross-sectional survey, we compared household, job, and socioeconomic characteristics among 260 Hispanic, non-Hispanic Black, and non-Hispanic White adults with confirmed or probable COVID-19 in New York from March to May 2020. We used logistic regression to identify independent relationships. RESULTS In bivariate analysis, we found significant differences by race/ethnicity in the following: (1) rates of household crowding (p < 0.001), which were highest for Hispanic patients (45.1%) and lowest for White patients (0.9%); (2) rates of non-healthcare frontline work (p < 0.001), which were highest for Hispanic patients (71.0% of those employed) and lowest for White patients (31.4%); (3) rates of working close to people (p < 0.001), which were highest for Black patients (69.4%) and lowest for Hispanic patients (32.3%); and (4) rates of frontline healthcare work (p = 0.004), which were higher for Black (44.9%) and White (44.3%) patients than Hispanic patients (19.4%). Adjusting for covariates eliminated most differences but not that for household crowding. CONCLUSIONS Non-discretionary COVID-19 risk factors among patients in the initial surge differed substantially by race/ethnicity. Socioeconomic factors explained most differences, but household crowding was independently associated with Hispanic ethnicity. Our findings highlight the ongoing need for universal safeguards for US frontline workers, including mandated paid sick leave and expanded affordable housing options.
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Affiliation(s)
- Erika H Newton
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, HSC L4-050, New York, NY, 11794-8350, USA.
| | - Rolando G Valenzuela
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, HSC L4-050, New York, NY, 11794-8350, USA
| | - Priscilla M Cruz-Menoyo
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, HSC L4-050, New York, NY, 11794-8350, USA
| | - Kimberly Feliberti
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, HSC L4-050, New York, NY, 11794-8350, USA
- AdventHealth Celebration, Celebration, Orlando, FL, USA
| | - Timothy D Shub
- Department of Emergency Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, HSC L4-050, New York, NY, 11794-8350, USA
| | - Cadence Z M Trapini
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, New York, NY, USA
- Department of Psychiatry, Rush University Medical Center, Chicago, IL, USA
| | | | - Christina M Melian
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, New York, NY, USA
| | - Leslie D Peralta
- Renaissance School of Medicine at Stony, Brook University, Stony Brook, New York, NY, USA
| | - Héctor E Alcalá
- Department of Family, Population and Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook, New York, NY, USA
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA
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8
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Torres CIH, Gold R, Kaufmann J, Marino M, Hoopes MJ, Totman MS, Aceves B, Gottlieb LM. Social Risk Screening and Response Equity: Assessment by Race, Ethnicity, and Language in Community Health Centers. Am J Prev Med 2023; 65:286-295. [PMID: 36990938 PMCID: PMC10652909 DOI: 10.1016/j.amepre.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. METHODS Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. RESULTS Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. CONCLUSIONS Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
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Affiliation(s)
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente and OCHIN, Inc., Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, OHSU, Portland, Oregon
| | | | - Molly S Totman
- Quality, Community Care Cooperative, Boston, Massachusetts
| | - Benjamín Aceves
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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Hassani A, Omaleki V, Erikat J, Frost E, Streuli S, Sahid R, Yusufi H, Fielding-Miller R. Overcrowded housing reduces COVID-19 mitigation measures and lowers emotional health among San Diego refugees from September to November of 2020. PLoS One 2023; 18:e0286993. [PMID: 37339139 DOI: 10.1371/journal.pone.0286993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/29/2023] [Indexed: 06/22/2023] Open
Abstract
Refugee communities are vulnerable to housing insecurity, which drives numerous health disparity outcomes in a historically marginalized population. The COVID-19 pandemic has only worsened the ongoing affordable housing crisis in the United States while continuing to highlight disparities in health outcomes across populations. We conducted interviewer-administered surveys with refugee and asylum seekers in San Diego County at the height of the COVID-19 pandemic to understand the social effects and drivers of COVID-19 in one of the largest refugee communities in the United States. Staff from a community-based refugee advocacy and research organization administered the surveys from September-November 2020. 544 respondents participated in the survey, which captured the diversity of the San Diego refugee community including East African (38%), Middle Eastern (35%), Afghan (17%), and Southeast Asian (11%) participants. Nearly two-thirds of respondents (65%) reported living in overcrowded conditions (> 1 individual per room) and 30% in severely crowded conditions (> 1.5 individuals per room). For each additional person per room, self-reported poor emotional health increased. Conversely, family size was associated with a lower likelihood of reporting poor emotional health. Crowded housing was significantly associated with a lower probability of accessing a COVID-19 diagnostic test, with every additional reported person per room there was approximately an 11% increase in the probability of having never accessed a COVID-19 testing. Access to affordable housing had the largest effect size and was associated with fewer people per room. Overcrowding housing is a structural burden that reduces COVID-19 risk mitigation behaviors. Improved access to affordable housing units or receiving vouchers could reduce overcrowded housing in vulnerable refugee communities.
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Affiliation(s)
- Ashkan Hassani
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Vinton Omaleki
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Jeanine Erikat
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Elizabeth Frost
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
- Joint Doctoral Program in Public Health (Global Health), San Diego State University, San Diego, California, United States of America
| | - Samantha Streuli
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
| | - Ramla Sahid
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Homayra Yusufi
- Partnership for the Advancement of New Americans, San Diego, California, United States of America
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Center on Gender Equity and Health, University of California, San Diego, La Jolla, California, United States of America
- School of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California, United States of America
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Saadi A, Morales B, Chen L, Sudhinaraset M. Understanding the function of social capital among Mexican and Chinese immigrants in Southern California: A qualitative study. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100247. [PMID: 38469391 PMCID: PMC10927253 DOI: 10.1016/j.ssmqr.2023.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Altaf Saadi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brenda Morales
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
| | - Lei Chen
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA, USA
| | - May Sudhinaraset
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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PONCE NINEZA, SHIMKHADA RITI, ADKINS‐JACKSON PARISB. Making Communities More Visible: Equity-Centered Data to Achieve Health Equity. Milbank Q 2023; 101:302-332. [PMID: 37096622 PMCID: PMC10126976 DOI: 10.1111/1468-0009.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/18/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Despite decades of research exposing health disparities between populations and communities in the US, health equity goals remain largely unfulfilled. We argue these failures call for applying an equity lens in the way we approach data systems, from collection and analysis to interpretation and distribution. Hence, health equity requires data equity. There is notable federal interest in policy changes and federal investments to improve health equity. With this, we outline the opportunities to align these health equity goals with data equity by improving the way communities are engaged and how population data are collected, analyzed, interpreted, made accessible, and distributed. Policy priority areas for data equity include increasing the use of disaggregated data, increasing the use of currently underused federal data, building capacity for equity assessments, developing partnerships between government and community, and increasing data accountability to the public.
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Affiliation(s)
- NINEZ A. PONCE
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
- Los Angeles Fielding School of Public HealthUniversity of California
| | - RITI SHIMKHADA
- Center for Health Policy ResearchUniversity of CaliforniaLos Angeles
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12
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Abudiab S, de Acosta D, Shafaq S, Yun K, Thomas C, Fredkove W, Garcia Y, Hoffman SJ, Karim S, Mann E, Yu K, Smith MK, Coker T, Dawson-Hahn E. "Beyond just the four walls of the clinic": The roles of health systems caring for refugee, immigrant and migrant communities in the United States. Front Public Health 2023; 11:1078980. [PMID: 37064664 PMCID: PMC10097984 DOI: 10.3389/fpubh.2023.1078980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/06/2023] [Indexed: 04/18/2023] Open
Abstract
This article is part of the Research Topic 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict'. Introduction Refugee, immigrant and migrant (hereafter referred to as "immigrant") communities have been inequitably affected by the COVID-19 pandemic. There is little data to help us understand the perspectives of health systems on their role, in collaboration with public health and community-based organizations, in addressing inequities for immigrant populations. This study will address that knowledge gap. Methods This qualitative study used semi-structured video interviews of 20 leaders and providers from health systems who cared for immigrant communities during the pandemic. Interviewees were from across the US with interviews conducted between November 2020-March 2021. Data was analyzed using thematic analysis methods. Results Twenty individuals representing health systems participated with 14 (70%) community health centers, three (15%) county hospitals and three (15%) academic systems represented. The majority [16 health systems (80%)] cared specifically for immigrant communities while 14 (70%) partnered with refugee communities, and two (10%) partnered with migrant farm workers. We identified six themes (with subthemes) that represent roles health systems performed with clinical and public health implications. Two foundational themes were the roles health systems had building and maintaining trust and establishing intentionality in working with communities. On the patient-facing side, health systems played a role in developing communication strategies and reducing barriers to care and support. On the organizational side, health systems collaborated with public health and community-based organizations, in optimizing pre-existing systems and adapting roles to evolving needs throughout the pandemic. Conclusion Health systems should focus on building trusting relationships, acting intentionally, and partnering with community-based organizations and public health to handle COVID-19 and future pandemics in effective and impactful ways that center disparately affected communities. These findings have implications to mitigate disparities in current and future infectious disease outbreaks for immigrant communities who remain an essential and growing population in the US.
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Affiliation(s)
- Seja Abudiab
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Sheeba Shafaq
- Community Leadership Board, National Resource Center for Refugees, Immigrants and Migrants, San Francisco, CA, United States
| | - Katherine Yun
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Christine Thomas
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Windy Fredkove
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Yesenia Garcia
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Sarah J. Hoffman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | - Sayyeda Karim
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Erin Mann
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis, MN, United States
| | - Kimberly Yu
- Independent Consultant, Seattle, WA, United States
| | - M. Kumi Smith
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, United States
| | - Tumaini Coker
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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Abstract
Early in the pandemic, New York City's public hospital system partnered with multiple philanthropic foundations to offer an unconditional cash transfer program for low-income New Yorkers affected by COVID-19. The $1000 cash transfers were designed to help people meet their most immediate health and social needs and were incorporated into healthcare delivery and contact tracing workflows as a response to the public health emergency. To better understand program recipients' experiences, researchers conducted 150 telephone surveys with randomly sampled cash transfer recipients and 20 in-depth qualitative interviews with purposefully sampled survey participants. Survey participants were predominantly Latinx (87%) and women (65%). The most common reported uses of the $1000 were food and rent. Most participants (79%) reported that without the $1000 cash transfer they would have had difficulty paying for basic expenses or making ends meet, with specific positive effects reported related to food, housing, and ability to work. The majority of survey participants reported that receiving the cash assistance somewhat or greatly improved their physical health (83%) and mental health (89%). Qualitative interview results generally supported the survey findings.
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14
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Ormiston CK, Chiangong J, Williams F. The COVID-19 Pandemic and Hispanic/Latina/o Immigrant Mental Health: Why More Needs to Be Done. Health Equity 2023; 7:3-8. [PMID: 36744233 PMCID: PMC9892920 DOI: 10.1089/heq.2022.0041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Cameron K. Ormiston
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA.,Address correspondence to: Cameron K. Ormiston, BS, Division of Intramural Research, National Institute on Minority Health and Health Disparities, Two White Flint North, 11545 Rockville Pike, Rockville, MD 20852, USA.
| | - Jolyna Chiangong
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Faustine Williams
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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15
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Iraheta S, Morey BN. Mixed-Immigration Status Families During the COVID-19 Pandemic. Health Equity 2023; 7:243-250. [PMID: 37096057 PMCID: PMC10122215 DOI: 10.1089/heq.2022.0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Introduction To understand how mixed-immigration status families-families with a mixture of people with and without documentation-in the United States (U.S.) fared during the COVID-19 pandemic. Specifically, this study highlights how health inequities were exacerbated during the height of the pandemic due to the implementation of anti-immigration policies such as Public Charge Rule, which stipulates that receiving public benefits is grounds for inadmissibility for immigrants seeking naturalization. Methods In-depth semistructured interviews were conducted over Zoom with 14 members of mixed-status families between February and April 2021. The interviews were audio recorded, transcribed, and analyzed using Atlas.ti. Using grounded theory, we assessed the level of awareness about Public Charge Rule and the health challenges these families faced during the COVID-19 pandemic. Results Themes that emerged included financial problems, job insecurity, housing insecurity, food insecurity, mental health problems, distrust of government and health officials, and a fear of Public Charge Rule. We present a framework for understanding health inequities for mixed-status families during the COVID-19 pandemic. Discussion Public Charge Rule caused fear and confusion for mixed-status families during the COVID-19 pandemic, resulting in individuals not receiving public benefits they urgently needed. This created heightened mental health problems due to job, housing, and food insecurity. Health Equity Implications We discuss how trust between mixed-status families and the government needs foundational rebuilding. In addition to streamlining the process for these families to apply for legal status, it is important to protect and support mixed-status families through programs and policies during public health emergencies.
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Affiliation(s)
- Stephanie Iraheta
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
- Address correspondence to: Stephanie Iraheta, BA, Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Drive, Irvine, CA 92697-3957, USA.
| | - Brittany N. Morey
- Department of Health, Society, and Behavior, Program in Public Health, University of California, Irvine, Irvine, California, USA
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16
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Wang SS, Glied S, Babcock C, Chaudry A. Changes in the Public Charge Rule and Health of Mothers and Infants Enrolled in New York State’s Medicaid Program, 2014‒2019. Am J Public Health 2022; 112:1747-1756. [DOI: 10.2105/ajph.2022.307066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives. To examine the effect of the January 2017 leak of the federal government’s intent to broaden the public charge rule (making participation in some public programs a barrier to citizenship) on immigrant mothers and newborns in New York State. Methods. We used New York State Medicaid data (2014–2019) to measure the effects of the rule leak (January 2017) on Medicaid enrollment, health care utilization, and severe maternal morbidity among women who joined Medicaid during their pregnancies and on the birth weight of their newborns. We repeated our analyses using simulated measures of citizenship status. Results. We observed an immediate statewide delay in prenatal Medicaid enrollment by immigrant mothers (odds ratio = 1.49). Using predicted citizenship, we observed significantly larger declines in birth weight (−56 grams) among infants of immigrant mothers. Conclusions. Leak of the public charge rule was associated with a significant delay in prenatal Medicaid enrollment among immigrant women and a significant decrease in birth weight among their newborns. Local public health officials should consider expanding health access and outreach programs to immigrant communities during times of pervasive antiimmigrant sentiment. (Am J Public Health. 2022; 112(12):1747–1756. https://doi.org/10.2105/AJPH.2022.307066 )
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Affiliation(s)
- Scarlett Sijia Wang
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Sherry Glied
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Claudia Babcock
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
| | - Ajay Chaudry
- The authors were affiliated with the Wagner School of Public Service at New York University, New York, NY, at the completion of the article
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17
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Himmelstein J, Cai C, Himmelstein DU, Woolhandler S, Bor DH, Dickman SL, McCormick D. Specialty Care Utilization Among Adults with Limited English Proficiency. J Gen Intern Med 2022; 37:4130-4136. [PMID: 35349026 PMCID: PMC9708984 DOI: 10.1007/s11606-022-07477-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 03/03/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND People with limited English proficiency (LEP) face greater barriers to accessing medical care than those who are English proficient (EP). Language-related differences in the use of outpatient care across the full spectrum of physician specialties have not been studied. OBJECTIVE To compare outpatient visit rates to physicians in 28 specialties by people with LEP vs EP. DESIGN Multivariable negative binomial regression analysis of nationally representative data from the Medical Expenditure Panel Survey (pooled 2013-2018) with adjustment for age, sex, and self-reported health status. PARTICIPANTS 149,611 survey respondents aged 18 and older. EXPOSURE LEP, defined as taking the survey in a language other than English. MAIN MEASURES Annual per capita adjusted visit rate ratios (ARRs) comparing visit rates by LEP and EP persons to individual specialties, and to three categories of specialties: (1) primary care (internal or family medicine, geriatrics, general practice, or obstetrics/gynecology), (2) medical-subspecialties, or (3) surgical specialties. KEY RESULTS Patients with LEP were underrepresented in 26 of 28 specialties. Disparities were particularly large for the following: pulmonology (ARR, 0.26; 95% CI, 0.20-0.35), orthopedics (ARR, 0.35; 95% CI, 0.30-0.40), otolaryngology (ARR, 0.40; 95% CI, 0.27-0.59), and psychiatry (ARR, 0.43; 95% CI, 0.32-0.58). Among individuals with several specific common chronic conditions, LEP-EP disparities in visits to specialties in those conditions generally persisted. Disparities were larger for medical subspecialties (ARR, 0.41; 95% CI, 0.36-0.46) and surgical specialties (ARR, 0.46; 95% CI, 0.42-0.50) than for primary care (ARR, 0.76; 95% CI, 0.72 to 0.79). CONCLUSIONS Patients with LEP are underrepresented in most outpatient specialty practices, particularly medical subspecialties and surgical specialties. Our findings highlight the need to remove language barriers to physician services in order to ensure access to the full spectrum of outpatient specialty care for people with LEP.
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Affiliation(s)
- Jessica Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Christopher Cai
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - David U Himmelstein
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - Steffie Woolhandler
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- City University of New York at Hunter College, New York, NY, USA
| | - David H Bor
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel L Dickman
- Planned Parenthood South Texas, San Antonio, TX, USA
- The University of Texas at Austin, Austin, TX, USA
| | - Danny McCormick
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
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18
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Darney BG, Boniface E, Jacobson LE, Fuentes-Rivera E, Saavedra-Avendaño B, Coleman-Minahan K, Riosmena F. Adolescent Reproductive Health Outcomes Among Mexican-Origin Women on Both Sides of the U.S.-Mexico Border. J Adolesc Health 2022; 71:679-687. [PMID: 35985916 DOI: 10.1016/j.jadohealth.2022.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Much reproductive health research on the Latina population overlooks heterogeneity by national origin, nativity, and age and also ignores how U.S.-based populations differ from those in "sending" nations. The purpose of this study is to describe a history of adolescent birth, age at first sex, and contraceptive use at first sex in the Mexican-origin population in both the United States and Mexico. METHODS We developed a binational dataset merging two comparable nationally representative cross-sectional surveys in the United States and Mexico and used covariate balancing propensity scores to balance the age structure of our four samples: U.S.-born Latinas of Mexican origin, foreign-born Latinas of Mexican origin, U.S.-born non-Latina Whites, and Mexican women residing in Mexico. We used a negative binomial regression and calculated the predicted probability of experiencing at least one adolescent birth for each ethnicity/nativity group, stratified by 5-year age group. We also described age and contraceptive use at first sex. RESULTS Foreign-born Latinas of Mexican origin and Mexicans in Mexico had similar adjusted probabilities of reporting an adolescent birth (30.1% and 29.9%, respectively), which were higher than those of Mexican-Americans (26.2%) and U.S.-born non-Latina Whites (11.6%). History of an adolescent birth is declining across all four groups among younger ages. Differences do not appear to be driven by the timing of first sex but by contraceptive use, which is increasing among younger age groups. DISCUSSION Access to and use of effective contraception rather than timing of initiation of sexual activity is a key determinant of U.S. Latina and Mexican adolescent births.
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Affiliation(s)
- Blair G Darney
- Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon; Instituto Nacional de Salud Publica (INSP), Center for Population Health Research (CISP), Cuernavaca, Mexico; Health Research Consortium (CISIDAT), Cuernavaca, Mexico.
| | - Emily Boniface
- Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, Oregon
| | - Laura E Jacobson
- Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, Oregon; OHSU-PSU School of Public Health, Portland, Oregon
| | | | | | - Kate Coleman-Minahan
- College of Nursing, University of Colorado Anschutz Medical Campus, Denver, Colorado; CU Population Center, University of Colorado Boulder, Boulder, Colorado
| | - Fernando Riosmena
- CU Population Center, University of Colorado Boulder, Boulder, Colorado; Population Program and Geography Department, University of Colorado Boulder, Boulder, Colorado
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19
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Bustamante AV, Félix‐Beltrán L, Nwadiuko J, Ortega AN. Avoiding Medicaid enrollment after the reversal of the changes in the public charge rule among Latino and Asian immigrants. Health Serv Res 2022; 57 Suppl 2:195-203. [PMID: 35775930 PMCID: PMC9660423 DOI: 10.1111/1475-6773.14020] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To estimate the avoidance of Medicaid enrollment among Latino and Asian immigrants due to fears about immigration status. In 2019, changes to the "public charge" rule made it difficult for immigrants to receive a green card or permanent residence visa, particularly for those who used health and nutrition benefits. Despite the Biden administration's reversal of these changes, fear and misinformation persist among immigrants. DATA SOURCES Pooled data from the 2017 to 2020 California Health Interview Survey. STUDY DESIGN We used adjusted predicted probability models to estimate differences in access to and use of health care and health insurance coverage among Latino and Asian immigrant adults with and without green cards, using US citizens as the reference. We estimated the avoidance of Medicaid enrollment among immigrants without a green card, the immigrant population subject to the public charge rule. DATA COLLECTION/EXTRACTION METHODS Population stratified by race/ethnicity and green card status. PRINCIPAL FINDINGS Latino immigrants without a green card were -23.1% (CI: -27.8, -18.4) less likely to be insured, -9.2% (CI: -12.8, -5.5) less likely to have Medicaid coverage, -9.3% (CI: -14.5, -4.1) less likely to have a usual source of care, and -8.4% (CI: -13.2, -0.3) less likely to have a physician visit relative to citizens. Asian immigrants without a green card were -11.7% (CI: -19.7, -3.72) less likely to be insured, -8.8% (CI: -11.6, -6.1) less likely to have Medicaid coverage, -11.6% (CI: -19.3, -3.9) less likely to have a usual source of care, and -11.0% (CI: -19.2, -2.3) less likely to have a physician visit. Between 107,956 and 192,905 Latino immigrants and 1294 and 4702 Asian immigrants in California likely avoided Medicaid enrollment due to fears about their immigration status. CONCLUSION While our estimates are lower than those of previous studies, our findings highlight barriers to health care for immigrants despite the reversal of the changes in the public charge rule. Since the public charge rule was not abolished, immigrants with low incomes might choose not to seek health care, despite recent efforts in California to expand Medicaid coverage to all eligible immigrants regardless of documentation statuses.
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Affiliation(s)
- Arturo Vargas Bustamante
- Department of Health Policy and ManagementUCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | | | - Joseph Nwadiuko
- UCLA Fielding School of Public HealthLos AngelesCaliforniaUSA
| | - Alexander N. Ortega
- Department of Health Management and PolicyDornsife School of Public Health, Drexel UniversityPhiladelphiaPennsylvaniaUSA
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20
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Damle M, Wurtz H, Samari G. Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100094. [PMID: 35578651 PMCID: PMC9095080 DOI: 10.1016/j.ssmqr.2022.100094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic has disproportionately affected minoritized racial groups, especially Latinx immigrants, evidenced by the high rates of COVID-19 infections, hospitalizations, and deaths among this population. With increasing xenophobia and anti-immigrant sentiment in parallel to the pandemic, it is critical to understand the perspectives of Latinx populations. This study explores Latinx immigrant women's perceptions of racism and xenophobia in their health care experiences in New York City (NYC) during the COVID-19 pandemic and, further, seeks to understand the role of perceived discrimination in health care settings and on health care access. Data were analyzed using a constant comparative method of analysis from twenty-one in-depth interviews conducted with foreign-born women in the five boroughs of New York City from diverse countries across Latin America. Four central themes emerged including: structural inequalities, discriminatory health care experiences, victimization in public institutions, and overcoming discrimination in health care settings. Latinx immigrant women described the ways in which perceptions and experiences of discrimination shaped their capacity to address health-related needs during the COVID-19 pandemic. This study provides evidence to a growing body of literature suggesting that structural racism and xenophobia and perceptions of anti-immigrant discrimination, including resulting structural inequalities, may have a negative effect on individuals' ability to access and engage the health care system, resulting in avoidance of health care services - a critical need during a global pandemic. Scholars, policymakers, and practitioners alike should be mindful of how racism and xenophobia shape Latinx immigrant communities' engagement with the health care system.
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Affiliation(s)
- Monika Damle
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Heather Wurtz
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Goleen Samari
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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21
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Miller DP, John RS, Yao M, Morris M. The 2016 Presidential Election, the Public Charge Rule, and Food and Nutrition Assistance Among Immigrant Households. Am J Public Health 2022; 112:1738-1746. [DOI: 10.2105/ajph.2022.307011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. To investigate whether the 2016 US presidential election and the subsequent leak of a proposed change to the public charge rule reduced immigrant families’ participation in food and nutrition assistance programs. Methods. We used nationally representative data on n = 57 808 households in the United States from the 2015–2018 Current Population Survey–Food Security Supplement. We implemented difference-in-difference-in-difference analyses to investigate whether the election and proposed rule change produced decreases in immigrant families’ participation in food and nutrition assistance programs and whether such decreases varied according to state policy generosity toward immigrants. Results. Findings indicate significant and large decreases in Supplemental Nutrition Assistance Program, School Breakfast Program, and National School Lunch Program participation among immigrants in moderately generous states but no changes to receipt of food assistance from nongovernmental sources or to household food insecurity. Conclusions. Both anti-immigrant rhetoric and the perceived threat of policy enactment can be enough to produce chilling effects that have potentially serious implications for the health of immigrant households and thus the health of the nation. (Am J Public Health. 2022;112(12):1738–1746. https://doi.org/10.2105/AJPH.2022.307011 )
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Affiliation(s)
- Daniel P. Miller
- All authors are with the School of Social Work, Boston University, Boston, MA
| | - Rachel S. John
- All authors are with the School of Social Work, Boston University, Boston, MA
| | - Mengni Yao
- All authors are with the School of Social Work, Boston University, Boston, MA
| | - Melanie Morris
- All authors are with the School of Social Work, Boston University, Boston, MA
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22
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Wolstein J, Babey SH, Tan S, Shimkhada R, Ponce NA. Association of California Immigrants' Avoidance of Public Programs Due to Immigration Concerns With Delayed Access to Health Care. JAMA Netw Open 2022; 5:e2246525. [PMID: 36512360 PMCID: PMC9856315 DOI: 10.1001/jamanetworkopen.2022.46525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022] Open
Abstract
This cross-sectional study examines the association of avoidance of public programs among California immigrants with delayed access to health care services and prescriptions owing to concerns about how their interaction with these services may affect their immigration status.
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Affiliation(s)
- Joelle Wolstein
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California
| | - Susan H. Babey
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
| | - Sean Tan
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California
| | - Riti Shimkhada
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California
| | - Ninez A. Ponce
- UCLA Center for Health Policy Research, UCLA Fielding School of Public Health, Los Angeles, California
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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23
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Young MEDT, Perez-Lua F, Sarnoff H, Plancarte V, Goldman-Mellor S, Payán DD. Working around safety net exclusions during the COVID-19 pandemic: A qualitative study of rural Latinx immigrants. Soc Sci Med 2022; 311:115352. [PMID: 36126474 PMCID: PMC9444313 DOI: 10.1016/j.socscimed.2022.115352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 06/07/2022] [Accepted: 09/01/2022] [Indexed: 11/16/2022]
Abstract
Rural Latinx immigrants experienced disproportionately negative health and economic impacts during the COVID-19 pandemic. They contended with the pandemic at the intersection of legal status exclusions from the safety net and long-standing barriers to health care in rural regions. Yet, little is known about how rural Latinx immigrants navigated such exclusions. In this qualitative study, we examined how legal status stratification in rural contexts influenced Latinx immigrant families' access to the safety net. We conducted interviews with first- and second-generation Latinx immigrants (n = 39) and service providers (n = 20) in four rural California communities between July 2020 and April 2021. We examined personal and organizational strategies used to obtain economic, health, and other forms of support. We found that Latinx families navigated a limited safety net with significant exclusions. In response, they enacted short-term strategies and practices - workarounds - that met immediate, short-term needs. Workarounds, however, were enacted through individual efforts, allowing little recourse beyond immediate personal agency. Some took the form of strategic practices within the safety net, such as leveraging resources that did not require legal status verification; in other cases, they took the form of families opting to avoid the safety net altogether.
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Affiliation(s)
- Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA.
| | - Fabiola Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Hannah Sarnoff
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | | | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA, 5200 N Lake Road, Merced, CA, 95343, USA
| | - Denise Diaz Payán
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, CA, 92697, USA
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Payán DD, Perez-Lua F, Goldman-Mellor S, Young MEDT. Rural Household Food Insecurity among Latino Immigrants during the COVID-19 Pandemic. Nutrients 2022; 14:2772. [PMID: 35807952 PMCID: PMC9268956 DOI: 10.3390/nu14132772] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/01/2022] [Accepted: 07/01/2022] [Indexed: 01/27/2023] Open
Abstract
U.S. food insecurity rates rapidly increased during the COVID-19 pandemic, with disproportionate impacts on Latino immigrant households. We conducted a qualitative study to investigate how household food environments of rural Latino immigrants were affected during the COVID-19 pandemic. Thirty-one respondents (42% from low food security households) completed interviews (July 2020-April 2021) across four rural counties in California. A rural household food security conceptual framework was used to analyze the data. Early in the pandemic, food availability was impacted by school closures and the increased consumption of meals/snacks at home; food access was impacted by reduced incomes. Barriers to access included limited transportation, excess distance, and lack of convenience. Key resources for mitigating food insecurity were the Supplemental Nutrition Assistance Program (SNAP), the Pandemic Electronic Benefits Transfer (P-EBT), school meals, charitable food programs, and social capital, although the adequacy and acceptability of charitable food distributions were noted issues. Respondents expressed concern about legal status, stigma, and the public charge rule when discussing barriers to government nutrition assistance programs. They reported that food pantries and P-EBT had fewer access barriers. Positive coping strategies included health-promoting food substitutions and the reduced consumption of meals outside the home. Results can inform the development of policy and systems interventions to decrease food insecurity and nutrition-related health disparities among rural Latino immigrants.
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Affiliation(s)
- Denise Diaz Payán
- Department of Health, Society and Behavior, Program in Public Health, University of California, Irvine, CA 92697, USA
| | - Fabiola Perez-Lua
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
| | - Maria-Elena De Trinidad Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, CA 95343, USA; (F.P.-L.); (S.G.-M.); (M.-E.D.T.Y.)
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Mann‐Jackson L, Ravindran S, Perez A, Linton JM. Navigating immigration policy and promoting health equity: Practical strategies for clinicians. J Hosp Med 2022; 17:220-224. [PMID: 35504526 PMCID: PMC9305560 DOI: 10.1002/jhm.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Lilli Mann‐Jackson
- Department of Social Sciences and Health Policy, CTSI Program in Community-Engaged ResearchWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Senthuran Ravindran
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Alexander Perez
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Julie M. Linton
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
- Office of Student Affairs and AdmissionsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
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Morey BN, Valencia C, Lee S. Correlates of Undiagnosed Hypertension Among Chinese and Korean American Immigrants. J Community Health 2022; 47:425-436. [PMID: 35103847 PMCID: PMC8805138 DOI: 10.1007/s10900-022-01069-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/24/2022]
Abstract
Asian Americans are more likely to be unaware that they have hypertension compared to non-Hispanic white Americans, despite having higher risk of hypertension at lower body-mass indices. Furthermore, immigrants are more likely than their United States (U.S.)-born counterparts to have undiagnosed hypertension, placing them at greater risk of subsequent morbidity and mortality. This study examines the social determinants of undiagnosed hypertension among Asian American immigrants. Using a study of foreign-born Chinese and Korean Americans between the ages of 50-75 years-old recruited from physicians' clinics in the Baltimore-Washington DC Metropolitan Area (n = 355), we used blood pressure readings measured by trained staff members, self-reported diagnosis by a medical professional, and self-reported hypertension medication use to determine hypertension status-whether patients were non-hypertensive, had diagnosed hypertension, or had undiagnosed hypertension. Using multinomial logistic regression, we examined how demographic, socioeconomic, and immigration-related factors were associated with hypertension status. Results indicated that older age, male gender, Korean subgroup, and marital status were associated with having diagnosed hypertension compared to being non-hypertensive. Lack of health insurance was the strongest predictor of having undiagnosed hypertension compared to being non-hypertensive. Acculturation variables had no strong associations with hypertension status. We then explored correlates of health insurance status for Chinese and Korean American immigrants. Those without health insurance were more likely to have lower income and to be not currently employed. Our findings point to the importance of increasing health insurance access for Asian American immigrant groups to ensure that hypertension is not left undiagnosed and untreated.
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Affiliation(s)
- Brittany N Morey
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA.
| | - Connie Valencia
- Department of Health, Society, & Behavior, Program in Public Health, University of California, Irvine, 653 E. Peltason Dr., Anteater Instruction and Research Building (AIRB) 2022, Irvine, CA, 92697-3957, USA
| | - Sunmin Lee
- Department of Medicine, School of Medicine, University of California, Irvine, Irvine, CA, USA
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Mann-Jackson L, Simán FM, Hall MA, Alonzo J, Linton JM, Rhodes SD. State Preemption of Municipal Laws and Policies that Protect Immigrant Communities: Impact on Latine Health and Well-Being in North Carolina. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221087884. [PMID: 35343266 PMCID: PMC8961392 DOI: 10.1177/00469580221087884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some U.S. municipalities have proclaimed themselves "sanctuary cities" and/or adopted laws and policies limiting local involvement in enforcement of federal immigration policies. Several states, however, have adopted laws that preempt municipal laws and policies designed to protect immigrants. We explored the consequences of House Bill (H.B.) 318, one such preemption law in North Carolina (NC), on the health and well-being of Latine immigrants. METHODS We conducted focus groups with Latine immigrants (n=49) and in-depth interviews with representatives from health, social service, and immigrant-serving organizations and local government (including law enforcement) (n=21) in NC municipalities that, before HB 318, adopted laws and policies supporting immigrants. Data were analyzed using constant comparison. RESULTS Twelve themes emerged, including the positive impacts of municipal sanctuary laws and policies are limited by preemption and other state and federal actions; laws and policies like HB 318 are confusing, have a chilling effect on health services use, and make life harder overall for Latine communities; intensified federal immigration enforcement has increased fear among Latine communities; Trump administration policies worsened anti-immigrant climates; and use of community identification cards and greater information dissemination and inter-organization coordination can lessen the consequences of preemption and other restrictive laws and policies. CONCLUSION State preemption of protective municipal laws and policies negatively and profoundly affects immigrant health and well-being. However, creative strategies have been implemented to respond to preemption. These findings provide critical data for decision-makers and community leaders regarding the detrimental impacts of preemption laws and mitigation of these impacts.
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Affiliation(s)
- Lilli Mann-Jackson
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | | | - Mark A. Hall
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- Wake Forest University School of
Law, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | - Julie M. Linton
- University of South Carolina (UofSC)
School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
| | - Scott D. Rhodes
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
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Miller R, Arita K, Igarashi NH, Fujii D, Yumino A, Jimba M. Social support as a bridge: A rapid realist review of migrant inclusion in the Japanese response to the COVID-19 pandemic. J Migr Health 2022; 6:100135. [PMID: 36117644 PMCID: PMC9472581 DOI: 10.1016/j.jmh.2022.100135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 06/24/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Inclusion of migrants in public health policy in Japan is rare. We synthesized the evidence on migrant inclusion during COVID-19. Vulnerability derived from movement restrictions and socioeconomic background. Access to support programs was conceptually equal, yet structurally inequitable. Structural gaps were bridged with social support from host society.
Government policy to address the COVID-19 pandemic has been complex with profound impacts on vulnerable minorities like international migrants. In Japan migrants are an important and growing community but their consideration in health policy is rare. We conducted a rapid realist review about ‘what works’ for the equitable inclusion of migrants during the pandemic as a case study for other public health emergencies. Due to the time-sensitive needs of policy-makers in the ongoing COVID-19 emergency, our evidence search was purposive, yet exploratory and iterative in nature. We assessed academic and gray literature sources, published in either English or Japanese, that examined the policy response to COVID-19 in Japan and its impact on migrants. A panel of external stakeholders was also consulted during the review process. This evidence synthesis suggests that, rather than illness alone, restrictions on movement and socioeconomic background lead to the considerable impact of policy on the well-being of migrants. Many policy responses, while conceptually inclusive and flexible, were often structurally inequitable for migrants. Poor outcomes included confusion about changing virus-related regulations and need for technical assistance to access support. Social support from volunteers and non-profit organizations were consistently left to connect migrants with unmet needs to available services. Using the diverse international community of Japan as an example, we show that, during public health emergencies, social support from civil society remains crucial for bridging structural inequities. For equitable inclusion of migrants, evidence-informed policy will be key for governments to better protect migrants’ right to health and well-being in future emergencies.
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Affiliation(s)
- Russell Miller
- Department of Community and Global Health, The University of Tokyo, Tokyo
- Corresponding author.
| | - Kuniko Arita
- Department of Community and Global Health, The University of Tokyo, Tokyo
| | | | - Daiki Fujii
- Department of Community and Global Health, The University of Tokyo, Tokyo
| | - Aya Yumino
- Department of Community and Global Health, The University of Tokyo, Tokyo
- Kawasaki Medical Cooperative Association, Asao Clinic, Kawasaki, Japan
| | - Masamine Jimba
- Department of Community and Global Health, The University of Tokyo, Tokyo
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Jewers M, Ku L. Noncitizen Children Face Higher Health Harms Compared With Their Siblings Who Have US Citizen Status. Health Aff (Millwood) 2021; 40:1084-1089. [PMID: 34228524 DOI: 10.1377/hlthaff.2021.00065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Immigrant children in the US have very limited health insurance coverage and health care access. Immigration status is not static: Census data show that the majority of census respondents who enter as noncitizen children eventually become citizens. Eligibility restrictions that prevent noncitizen children from being publicly insured can contribute to their experiencing poorer health and higher medical costs in their adult lives. We isolate the impact of lack of citizenship from socioeconomic factors by comparing citizen and noncitizen siblings living in mixed-status families, using fixed-effects models to net out socioeconomic factors shared within families. Lacking citizenship increased a child's risk of being uninsured and lowered by 26 percentage points the chances that they would have Medicaid or Children's Health Insurance Program coverage. Noncitizen children had significantly more delays in needed medical care because of cost, primarily mediated by the lack of insurance coverage. The US should reexamine policies that exclude noncitizen children from public health insurance programs.
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Affiliation(s)
- Mariellen Jewers
- Mariellen Jewers is an adjunct professor at Rollins College, in Winter Park, Florida. Much of this work was completed while she was a doctoral candidate at the Trachtenberg School of Public Policy and Public Administration at George Washington University, in Washington, D.C
| | - Leighton Ku
- Leighton Ku is a professor in the Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University
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