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Lin Z, Liu H. Race/Ethnicity, Nativity, and Gender Disparities in Unmet Care Needs Among Older Adults in the United States. THE GERONTOLOGIST 2024; 64:gnad094. [PMID: 37434547 PMCID: PMC10943507 DOI: 10.1093/geront/gnad094] [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: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, although considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs. RESEARCH DESIGN AND METHODS The data for this study came from the National Health and Aging Trends Study (2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs. RESULTS Older adults of color, especially women, experienced higher rates of unmet care needs compared with their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates. DISCUSSION AND IMPLICATIONS These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.
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Affiliation(s)
- Zhiyong Lin
- Department of Sociology, The University of Texas at San Antonio, San Antonio, Texas, USA
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Hui Liu
- Center on Aging and the Life Course and Department of Sociology, Purdue University, West Lafayette, Indiana, USA
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Rosenberg J, McDonough Ryan P, Brown C, Schaffer R, O’Brien C, Ganjavi F, Sharifi M. Exploring the determinants of successful implementation of a preventive mental health and wellness intervention for Afghan refugee families: a qualitative analysis. HEALTH EDUCATION RESEARCH 2024; 39:119-130. [PMID: 37534755 PMCID: PMC10952411 DOI: 10.1093/her/cyad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/04/2023] [Indexed: 08/04/2023]
Abstract
Many refugee children experience trauma in early childhood. Effective, tailored interventions are needed to improve refugee children's access to preventive mental health. We interviewed refugee-serving stakeholders and parents participating in an evidence-based preventive mental health and wellness intervention adapted for Afghan refugee children and families who may have experienced trauma. Interview guide development was informed by two implementation science frameworks: the Consolidated Framework for Implementation Research and the Model for Adaptation Design and Impact. A three-person team coded transcripts via rapid qualitative analysis, and the study team reached consensus on themes. Six refugee-serving facilitators and five refugee parents discussed key determinants of successful implementation. Themes included: (i) modeling cultural humility to promote communication about emotions; (ii) needed linguistic support and referral networks to avoid miscommunications and missed communications; (iii) bridging connections between children, families and schools; (iv) different takeaways, or differing goals and expectations between facilitators and participants; and (v) timely, specific cultural considerations to overcome participation barriers. Overall, we found key determinants of successful implementation of a preventive mental health and wellness intervention for refugee children and families included adaptations to enhance cultural humility and sensitivity to cultural context while strengthening communication among facilitators, children and families.
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Affiliation(s)
- Julia Rosenberg
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Patricia McDonough Ryan
- Department of Psychological Sciences, University of Connecticut, 1 University Pl, Stamford, CT 06901, USA
| | - Camille Brown
- Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Rachel Schaffer
- Health Coordination, Elena’s Light, 58 Foundain St Apt J2, New Haven, CT 06515, USA
| | - Caroline O’Brien
- Department of Neuroscience, Georgetown University Medical Center, Building EP-04 3970 Reservoir Rd, NW Washington, DC 20057, USA
| | - Fereshteh Ganjavi
- Founder and Director, Elena’s Light, 58 Foundain St Apt J2, New Haven, CT 06515, USA
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine, Department of Biostatistics, Yale School of Public Health, 333 Cedar Street, New Haven, CT 06510, USA
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Cheng TC, Lo CC. Testing the Multiple Disadvantage Model of Health with Ethnic Asian Children: A Secondary Data Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:483. [PMID: 36612803 PMCID: PMC9819056 DOI: 10.3390/ijerph20010483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/03/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
This study of ethnic Asian children in the United States asked whether their health exhibited relationship with any of six factors: social disorganization, social structural factors, social relationships, the health of their parents, their access to medical insurance, acculturation. The sample of 1350 ethnic Asian children was extracted from the 2018 National Survey of Children's Health. Logistic regression results showed that these children's excellent/very good/good health was associated positively with safe neighborhoods, family incomes, family cohesiveness, family support, and receipt of Temporary Assistance for Needy Families (TANF). In turn, health was associated negatively with single-mother households. Implications of the present results in terms of interventions promoting family support, TANF participation, safe neighborhoods, and professionals' cultural competency are discussed.
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Affiliation(s)
- Tyrone C. Cheng
- School of Social Work, University of Alabama, Little Hall, Tuscaloosa, AL 35401, USA
| | - Celia C. Lo
- Behavioral Research Manager, Peraton, Defense Personnel and Security Research Center, Seaside, CA 93955, USA
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Chaiyachati BH, Peña MM, Montoya-Williams D. Breaking Down the Boxes-Time to Reshape Demographic Data-Reply. JAMA Pediatr 2022; 176:1047-1048. [PMID: 35939315 DOI: 10.1001/jamapediatrics.2022.2777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Barbara H Chaiyachati
- Department of Pediatrics, Hub for Clinical Collaboration, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Michelle-Marie Peña
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana Montoya-Williams
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania
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Duh-Leong C, Tomopoulos S, Nastro A, Sharif I, Gomez LI, Di Caprio C, Nagpal N, Fierman AH. Duration of US Residence And Resource Needs In Immigrant Families With Young Children. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:211-219. [PMID: 36714395 PMCID: PMC9881011 DOI: 10.1007/s10826-021-02182-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/18/2023]
Abstract
To mitigate the negative impact of resource needs on child health, practices serving low-income immigrant families have implemented screening programs to connect families to community resources. Little is known about how duration of US residence relates to patterns of resource needs and indicators of acculturation such as community resource knowledge/experience or self-efficacy. We conducted a cross-sectional analysis of a convenience sample of immigrant families with young children at an urban primary care clinic. These families were seen 5/2018-1/2020 for well child care, screening positive for ≥1 social need using a tool derived from Health Leads. Analysis of 114 families found that newly arrived families with a shorter duration of US residence (≤5 years) were more likely to report immediate material hardships like food insecurity and need for essential child supplies. Newly arrived families were also less likely to have access to technology resources such as a computer or smartphone. Long-term families with a longer duration of US residence (≥15 years) were more likely to report chronic needs like poor housing conditions, but also reported increased community resource knowledge/experience and increased self-efficacy. Primary care pediatric practices should assess immigration contextual factors to identify subgroups such as newly arrived families with young children to target resources (e.g., increase screening frequency) or enhance services (e.g., patient navigators) to relieve resource needs.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Suzy Tomopoulos
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Andrew Nastro
- Division of Child & Adolescent Health, Columbia University Medical Center, 622 West 168th Street, New York, NY 10032, USA
| | - Iman Sharif
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Laura Ibanez Gomez
- Family Health Centers at NYU Langone, 6025 6th Ave, Brooklyn, NY 11220, USA
| | - Cecilia Di Caprio
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Nikita Nagpal
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
| | - Arthur H. Fierman
- Division of General Pediatrics; Department of Pediatrics, NYU Grossman School of Medicine, 462 First Avenue, New York, NY 10016, USA
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Cherian T, Crookes DM, Suglia SF. Association of Maternal Nativity Status and Race/Ethnicity on Emergency Department Utilization Among Children in Vulnerable Families. Pediatr Emerg Care 2021; 37:e1549-e1554. [PMID: 32398598 PMCID: PMC9020465 DOI: 10.1097/pec.0000000000002113] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to determine the role of mothers' nativity and race/ethnicity on their children's emergency department utilization. METHODS Data from the Fragile Families and Child Wellbeing Study was used for the analyses. Descriptive and regression analyses were conducted to compare use of ED services between children of foreign-born versus US-born mothers within different racial groups. RESULTS The sample in this analysis contained 3426 mother-child pairs, of which 14.2% were foreign-born mothers. Adjusting for mother's race, education, and marital status, child's insurance coverage, and caregiver's perception of child's health, children of foreign-born mothers were less likely to use ED services compared with those born to US-born mothers (risk ratio [RR], 0.71 [0.54-0.94]). Emergency department utilization was lower among children of Hispanic, foreign-born mothers (RR, 0.67 [0.46-0.96]) and among children of non-Hispanic Asian or other race, foreign-born mothers (RR, 0.32 [0.14-0.74]) when compared with children of their US-born counterparts in the respective race. CONCLUSIONS Maternal nativity status and race influence child's use of emergency department services. Future research should explore the intersection of parental nativity, immigrant documentation status, and citizenship status and how that may influence children's health care usage.
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Affiliation(s)
- Teena Cherian
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
| | - Danielle M. Crookes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Shakira F. Suglia
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
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Behavioral Health Services use Among Racial and Ethnic Groups: Results from the California Health Interview Survey (CHIS). J Immigr Minor Health 2021; 24:118-124. [PMID: 34333722 DOI: 10.1007/s10903-021-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 10/20/2022]
Abstract
Access and utilization of behavioral health services is a public health issue, yet disparities among racial/ethnic groups persist, resulting in fewer access points and lower utilization. Using pooled 2015 and 2016 California Health Interview Survey (N = 42,089) data of diverse adults, this study examines provider access points for behavioral health services use. Latinx (OR = 0.55, 95% CI, 0.38-0.80), Asian (OR = 0.32, 95% CI, 0.17-0.59), and first generation (OR = 0.56, 95% CI, .38-.83) individuals, reported lower odds of accessing specialty care behavioral health services, compared to no services. First generation adults reported lower odds accessing a primary care physician (OR = 0.66, 95% CI, 0.44-0.98), compared to none. Results advance knowledge of behavioral health services access points among racial, ethnic and immigrant groups, following passage of the California Mental Health Services Act. Findings suggest primary care may be an important entry point for behavioral health service use engagement among underserved populations.
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Araya F, Stingone JA, Claudio L. Inequalities in Exposure to Ambient Air Neurotoxicants and Disparities in Markers of Neurodevelopment in Children by Maternal Nativity Status. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147512. [PMID: 34299963 PMCID: PMC8304619 DOI: 10.3390/ijerph18147512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
Exposure levels to environmental pollutants vary significantly among different populations. These inequities in exposure to hazardous air pollutants (HAP) among different populations can contribute to disparities in neurodevelopmental outcomes. The aim of this study was to determine if exposure to HAP varies by maternal nativity status, a demographic marker often overlooked in the study of health disparities. We also assessed if those inequalities in exposure levels are associated with neurodevelopmental measures in young children. To do this, we obtained data from the Early Childhood Longitudinal Study-Birth cohort (ECLS-B), a nationally representative sample of children born in the U.S. in the year 2001 (n = 4750). Bayley’s Short Form-Research Edition (BSF-R) was used to measure cognitive development at 2 years of age. Using residential location at nine months of age, participants were assigned exposures to ten HAPs identified as potentially neurotoxic. Linear regression models were used to assess the joint effect of maternal nativity status and HAP exposure on neurodevelopment. Results showed inequities in exposure levels to ten different HAPs among the populations, as approximately 32% of children of foreign-born mothers were exposed to high levels of HAPs, compared to 21% of children born to U.S.-born mothers. Adjusting for socioeconomic factors, both isophorone exposure (a marker of industrial pollution) (−0.04, 95% CI, −0.12, 0.04) and maternal nativity status (−0.17, 95% CI, −0.27, −0.06) were independently associated with lower standardized BSF-R mental scores in children. Interaction between nativity status and isophorone was not statistically significant, but the change in mental scores associated with isophorone exposure was greater in children of foreign-born mothers compared to children of U.S.-born mothers (−0.12, vs. −0.03, p = 0.2). In conclusion, exposure to HAPs within the highest quartile was more commonly found among children of foreign-born mothers as compared to children of US-born mothers, indicating inequities in pollutant exposure by nativity status within urban populations. Exposures associated with nativity status may negatively contribute to children’s neurodevelopment.
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Rosenberg J, Leung JK, Harris K, Abdullah A, Rohbar A, Brown C, Rosenthal MS. Recently-Arrived Afghan Refugee Parents' Perspectives About Parenting, Education and Pediatric Medical and Mental Health Care Services. J Immigr Minor Health 2021; 24:481-488. [PMID: 33934263 DOI: 10.1007/s10903-021-01206-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/24/2022]
Abstract
Refugee children are at risk for mental/behavioral health problems but may not receive timely diagnosis or care. Parental experiences and perspectives about resources in the US may help guide interventions to improve mental/behavioral health care. In a community-academic partnership, we performed a qualitative study of recently-arrived Afghan refugee parents, using in-depth, semi-structured interviews to characterize experiences with parenting, education, and health care services. A four-person coding team identified, described, and refined themes. We interviewed 19 parents from ten families, with a median residence in the US of 24 months. Four themes emerged; parents described: (1) shifting focus as safety needs changed, (2) acculturation stress, (3) adjustment to an emerging US support system, and (4) appreciation of an engaged health care system. Health and educational providers' appreciation for the process of acculturation among newly-arrived refugee Afghan families may facilitate screening, diagnostic, and intervention strategies to improve care.
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Affiliation(s)
- Julia Rosenberg
- Yale National Clinician Scholars Program, PO Box 208088, New Haven, CT, 06510, USA. .,Department of Pediatrics, Yale Medical School, New Haven, CT, USA.
| | | | - Kristin Harris
- Integrated Refugee and Immigrant Services, New Haven, CT, USA
| | | | - Arzoo Rohbar
- Integrated Refugee and Immigrant Services, New Haven, CT, USA
| | - Camille Brown
- Department of Pediatrics, Yale Medical School, New Haven, CT, USA
| | - Marjorie S Rosenthal
- Yale National Clinician Scholars Program, PO Box 208088, New Haven, CT, 06510, USA.,Department of Pediatrics, Yale Medical School, New Haven, CT, USA
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Bruzzese JM, Kingston S, Falletta KA, Bruzelius E, Poghosyan L. Individual and Neighborhood Factors Associated with Undiagnosed Asthma in a Large Cohort of Urban Adolescents. J Urban Health 2019; 96:252-261. [PMID: 30645702 PMCID: PMC6458186 DOI: 10.1007/s11524-018-00340-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Undiagnosed asthma adds to the burden of asthma and is an especially significant public health concern among urban adolescents. While much is known about individual-level demographic and neighborhood-level factors that characterize those with diagnosed asthma, limited data exist regarding these factors and undiagnosed asthma. This observational study evaluated associations between undiagnosed asthma and individual and neighborhood factors among a large cohort of urban adolescents. We analyzed data from 10,295 New York City adolescents who reported on asthma symptoms and diagnosis; a subset (n = 6220) provided addresses that we were able to geocode into US Census tracts. Multivariable regression models estimated associations between undiagnosed asthma status and individual-level variables. Hierarchical linear modeling estimated associations between undiagnosed asthma status and neighborhood-level variables. Undiagnosed asthma prevalence was 20.2%. Females had higher odds of being undiagnosed (adjusted odds ratio (AOR) = 1.25; 95% confidence interval (CI) = 1.13-1.37). Compared to White, non-Hispanic adolescents, Asian-Americans had higher risk of being undiagnosed (AOR = 1.41; 95% CI = 1.01-1.95); Latinos (AOR = 0.67; 95% CI = 0.45-0.83); and African-Americans/Blacks (AOR = 0.66; 95% CI = 0.52-0.87) had lower risk; Latinos and African-Americans/Blacks did not differ significantly. Living in a neighborhood with a lower concentration of Latinos relative to White non-Latinos was associated with lower risk of being undiagnosed (AOR = 0.66; CI = 0.43-0.95). Living in a neighborhood with health care provider shortages was associated with lower risk of being undiagnosed (AOR = 0.80; 95% CI =0.69-0.93). Public health campaigns to educate adolescents and their caregivers about undiagnosed asthma, as well as education for health care providers to screen adolescent patients for asthma, are warranted.
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Affiliation(s)
- Jean-Marie Bruzzese
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA.
| | - Sharon Kingston
- Psychology Department, Dickinson College, P.O. Box 1773, Carlisle, PA, 17013, USA
| | - Katherine A Falletta
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Emilie Bruzelius
- Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Lusine Poghosyan
- Columbia University School of Nursing, 630 West 168th Street, Mail Code 6, New York, NY, 10032, USA
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