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DeCamp LR, Yousuf S, Peters C, Cruze E, Kutchman E. Assessing Strengths, Challenges, and Equity Via Pragmatic Evaluation of a Social Care Program. Acad Pediatr 2024; 24:23-32. [PMID: 37024078 DOI: 10.1016/j.acap.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Models of pragmatic social care program evaluations are needed as many are clinical services programs and are not focused on research, limiting the ability to address key evidence gaps. We describe the use of the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to conduct a pragmatic evaluation of a pediatric ambulatory social care program. METHODS Our evaluation was based on automated electronic health record data on clinics, community partners, social care program processes, and social needs screen data linked to patient sociodemographic characteristics from February 2020 to September 2021. Two Reach outcomes were assessed: 1) the proportion of eligible patients that completed social needs screening and 2) the proportion of positive screens that receive social care program follow-up. The Effectiveness outcome was meeting families' resource need(s). RESULTS Reach among eligible patients who completed screening was 79.2%. Reach for positive screens receiving social care program referrals demonstrated a higher proportion of referrals among patients with a preferred healthcare language (PHL) of Spanish (45.1%) compared to English (31.2%, P < .001). Effectiveness analyses demonstrated that overall, 75.1% of social care program referrals had all social resource needs met, 17.5% had some needs met, and 7.4% had no needs met. The percent of patients with all resource needs met was higher for patients with PHL of Spanish or Non-English, Non-Spanish (79% for each respectively) compared to English (73%, P = .023). CONCLUSIONS Maximizing automated data collection is likely the most feasible way for social care programs to complete evaluation activities outside of the research context.
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Affiliation(s)
- Lisa Ross DeCamp
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora; Department of Pediatrics (LR DeCamp), University of Colorado School of Medicine, Aurora; Adult and Child Center for Outcomes Research and Delivery Science (LR DeCamp), Aurora, Colo.
| | - Sana Yousuf
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Claire Peters
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Ellen Cruze
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
| | - Eve Kutchman
- Children's Hospital Colorado (LR DeCamp, S Yousuf, C Peters, E Cruze, and E Kutchman), Aurora.
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Silva TS, Singh A, Sinjali K, Gochi A, Allison-Aipa T, Luca F, Plasencia A, Lum S, Solomon N, Molina C. Spanish-Speaking Status: A Protective Factor in Colorectal Cancer Presentation at a Safety-Net Hospital. J Surg Res 2022; 280:404-410. [PMID: 36041340 DOI: 10.1016/j.jss.2022.06.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/16/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
INTRODUCTION Lower screening rates and poorer outcomes for colorectal cancer have been associated with Hispanic ethnicity and Spanish-speaking status, respectively. METHODS We reviewed sequential colorectal cancer patients evaluated by the surgical service at a safety-net hospital (SNH) (2016-2019). Insurance type, stage, cancer type, surgery class (elective/urgent), initial surgeon contact setting (outpatient clinic/inpatient consult), operation (resection/diversion), and follow-up were compared by patient-reported primary spoken language. RESULTS Of 157 patients, 85 (54.1%) were men, 91 (58.0%) had colon cancer, 67 (42.7%) primarily spoke Spanish, and late stage (III or IV) presentations occurred in 83 (52.9%) patients. The median age was 58 y, cancer resection was completed in 48 (30.6%) patients, and 51 (32.5%) patients were initially seen as inpatient consults. On univariate analysis, Spanish-speaking status was significantly associated with female sex, Medicaid insurance, being seen as an outpatient consult, and undergoing elective and resection surgery. On multivariable logistic regression, Spanish-speaking patients had higher odds of having Medicaid insurance (AOR 2.28, P = 0.019), receiving a resection (AOR 3.96, P = 0.006), and undergoing an elective surgery (AOR 3.24, P = 0.025). Spanish-speaking patients also had lower odds of undergoing an initial inpatient consult (AOR 0.34, P = 0.046). CONCLUSIONS Spanish-speaking status was associated with a lower likelihood of emergent presentation and need for palliative surgery among SNH colorectal cancer patients. Further research is needed to determine if culturally competent infrastructure in the SNH setting translates into Spanish-speaking status as a potentially protective factor.
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Affiliation(s)
- Trevor S Silva
- Riverside University Health System, Moreno Valley, California
| | - Anika Singh
- Riverside University Health System, Moreno Valley, California
| | - Kiran Sinjali
- University of California Riverside School of Medicine, Riverside, California
| | - Andrea Gochi
- University of California Riverside School of Medicine, Riverside, California
| | - Timothy Allison-Aipa
- Comparative Effectiveness and Clinical Outcomes Research Center (CECORC), Riverside University Health System, Moreno Valley, California
| | - Fabrizio Luca
- Loma Linda University Health, Loma Linda, California
| | - Alexis Plasencia
- Riverside University Health System, Moreno Valley, California; Loma Linda University Health, Loma Linda, California
| | - Sharon Lum
- Riverside University Health System, Moreno Valley, California; University of California Riverside School of Medicine, Riverside, California; Loma Linda University Health, Loma Linda, California
| | | | - Caba Molina
- Riverside University Health System, Moreno Valley, California; University of California Riverside School of Medicine, Riverside, California; Loma Linda University Health, Loma Linda, California.
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Alberto CK, Kemmick Pintor J, Martínez-Donate A, Tabb LP, Langellier B, Stimpson JP. Association of Maternal-Clinician Ethnic Concordance With Latinx Youth Receipt of Family-Centered Care. JAMA Netw Open 2021; 4:e2133857. [PMID: 34757410 PMCID: PMC8581727 DOI: 10.1001/jamanetworkopen.2021.33857] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Disparities in medical home provisions, including receipt of family-centered care (FCC), have persisted for Latinx youths in the US. OBJECTIVE To examine the association between maternal-clinician ethnic concordance and receipt of FCC among US-born Latinx youths. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional secondary analysis of data from the Medical Expenditure Panel Survey from January 1, 2010, to December 31, 2017, was conducted. Data analysis was performed from January 6 to February 3, 2020. Latinx youths (age, ≤17 years) born in the US who had a usual source of care and used care in the past year, their Latina mothers (age, 18-64 years), and youths' health care clinician characteristics (eg, race, ethnicity, and sex) were evaluated using χ2 tests and propensity-score matching methods. MAIN OUTCOMES AND MEASURES Maternal reports on whether their youths' clinician listened carefully to the parent, explained things in a way the parent could understand, showed respect, and spent enough time with the patient. RESULTS There were 2515 US-born Latinx youths with linked maternal characteristics during the study period; 51.67% (95% CI, 48.87%-54.45%) of the youths were male, mean (SD) age was 8.48 (0.17) years (30.86% [95% CI, 28.39%-33.44%] were between ages 5 and 9 years), 61.53% (95% CI, 57.15%-65.74%) had public insurance coverage, and 39.89% (95% CI, 32.33%-47.89%) had mothers who were ethnically concordant with the youths' medical care clinician. We found that for youths with maternal-clinician ethnic concordance, the probabilities of reporting FCC were significantly higher than they would have been in the absence of concordance: that the medical care clinician listened carefully to the parent (average treatment effect on the treated [ATET], 5.44%; 95% CI, 2.14%-8.74%), explained things in a way the parent could understand (ATET, 4.82%; 95% CI, 1.60%-8.03%), showed respect for what the parent had to say (ATET, 5.51%; 95% CI, 2.58%-8.45%), and spent enough time with the patient (ATET, 5.28%; 95% CI, 1.68%-8.88%). CONCLUSIONS AND RELEVANCE Given the increase of Latinx populations and the simultaneous shortage of underrepresented minority health care clinicians, the findings of this study suggest that increasing the number of clinicians from underrepresented minority backgrounds and ethnic-concordant parental-clinician relationships may help reduce disparities in receipt of medical home provision among US-born Latinx youths.
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Affiliation(s)
- Cinthya K. Alberto
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Ana Martínez-Donate
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Loni Philip Tabb
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Brent Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P. Stimpson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Niño MD. Poverty, Material Hardship, and Telomere Length Among Latina/o Children. J Racial Ethn Health Disparities 2021; 9:1315-1324. [PMID: 34047997 PMCID: PMC8162160 DOI: 10.1007/s40615-021-01072-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite increased attention on the links between poverty and the health and wellbeing of youth, few have attempted to understand the physiological consequences associated with different forms of economic disadvantage among Latina/o children. The present study begins to address this gap by (1) examining whether different forms of economic disadvantage were related to telomere length for Latina/o children and (2) determining whether parents' nativity shapes economic disadvantage-telomere length relationships. METHODS Data were drawn from the Fragile Families and Child Wellbeing Study, a longitudinal, stratified multistage probability sample of couples and children in 20 large US cities. The sample consisted of 417 Latina/o children and their parents that were followed from birth to age 9. Ordinary least squares regressions were used to examine relationships between economic disadvantage and telomere length. RESULTS Findings revealed that poverty status was not significantly related to telomere length, whereas some forms of material hardship were shown to play a role in the risk of premature cellular aging. More specifically, medical hardship and difficulty paying bills were associated with shorter telomere length at age 9. Results also provide minimal evidence economic disadvantage-telomere length patterns varied by parents' nativity. Only medical hardship was related to shorter telomere length at age 9 for children with at least one foreign-born parent. CONCLUSION Overall, results indicate that the risk of premature cellular aging depends on the measure of economic disadvantage under investigation. Findings from this study can inform targeted strategies designed to reduce the deleterious consequences associated with economic deprivation.
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Affiliation(s)
- Michael D Niño
- Department of Sociology and Criminology, University of Arkansas, Fayetteville, AR, 72701, USA.
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Alberto CK, Kemmick Pintor J, Young ME, Tabb LP, Martínez-Donate A, Langellier BA, Stimpson JP. Association of Maternal Citizenship and State-Level Immigrant Policies With Health Insurance Coverage Among US-Born Latino Youths. JAMA Netw Open 2020; 3:e2021876. [PMID: 33084899 PMCID: PMC7578764 DOI: 10.1001/jamanetworkopen.2020.21876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The association of state-level immigrant policies with uninsurance among Latino youths remains unknown. OBJECTIVE To assess the association of state-level immigrant integration and criminalization policies with health insurance coverage among US-born Latino youths by maternal citizenship. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study analyzed secondary data from the American Community Survey, January 1, 2016, to December 31, 2018, for US-born Latino youths (age, ≤17 years) and their mothers (age, 18-64 years) as well as state-level indicators of immigrant integration and criminalization policies (in all 50 states and the District of Columbia). EXPOSURES Immigrant integration and criminalization policies. MAIN OUTCOMES AND MEASURES The main outcome was maternal reports of youth uninsurance status at the time of the American Community Survey interview. Variation in youth uninsurance by maternal citizenship, state immigrant integration policy context, and state immigrant criminalization policy context were examined. All analyses were conducted with weighted survey data. RESULTS Of the 226 691 US-born Latino youths (115 431 [50.92%] male; mean [SD] age, 7.66 [4.92] years) included in the study, 36.64% (95% CI, 36.21%-36.92%) had noncitizen mothers. Overall, 7.09% (95% CI, 6.78%-7.41%) of noncitizen mothers reported that their youths were uninsured compared with 4.68% (95% CI, 4.49%-4.88%) of citizen mothers. Of uninsured youths who resided in states with a low level of immigrant integration policies, 9.10% (8.22%-10.06%) had noncitizen mothers and 4.75% (95% CI, 4.19%-5.37%) had citizen mothers; of uninsured youths who resided in states with high criminalization policies, 9.37% (95% CI, 8.90%-9.87%) had noncitizen mothers and 5.91% (95% CI, 5.64%-6.20%) had citizen mothers. In states with few immigrant integration policies, the probability of uninsurance among youths with noncitizen mothers was 3.3% (95% CI, 2.3%-4.4%) higher than that among youths with citizen mothers. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those residing in states with a low level vs a high level of immigrant integration policies was 2.1% (95% CI, 0.6%-3.6%). Among youths residing in states with high levels of immigrant criminalization policies, those with noncitizen mothers had a 2.6% (95% CI, 1.9%-3.0%) higher probability of being uninsured compared with those whose mothers were citizens. Among youths with noncitizen mothers, the difference in the probability of uninsurance between those who resided in a state with a low level vs a state with a high level of immigrant criminalization policies was 1.7% (95% CI, 0.7%-2.7%). CONCLUSIONS AND RELEVANCE The findings of this cross-sectional study suggest that among US-born Latino youths, disparities in uninsurance by maternal citizenship are associated with state-level immigrant integration and criminalization policies and that anti-immigrant policies may be associated with disparities in health care access for US-born Latino youths.
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Affiliation(s)
- Cinthya K. Alberto
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | | | - Maria-Elena Young
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced
| | - Loni Philip Tabb
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Ana Martínez-Donate
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Brent A. Langellier
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Jim P. Stimpson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Alberto CK, Pintor JK, Langellier B, Tabb LP, Martínez-Donate AP, Stimpson JP. Association of maternal characteristics with latino youth health insurance disparities in the United States: a generalized structural equation modeling approach. BMC Public Health 2020; 20:1088. [PMID: 32653037 PMCID: PMC7353771 DOI: 10.1186/s12889-020-09188-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Disparities in access to care persist for Latino youth born in the United States (US). The association of maternal characteristics, such as maternal citizenship status and insurance coverage, on youth health insurance coverage is unclear and is important to examine given the recent sociopolitical shifts occurring in the US. Methods We analyzed pooled cross-sectional data from the 2010–2018 National Health Interview Survey to examine the association of Latina maternal citizenship status on maternal insurance coverage status and youth uninsurance among US-born Latino youth. Our study sample consisted of 15,912 US-born Latino youth (ages < 18) with linked mothers. Our outcome measures were maternal insurance coverage type and youth uninsurance and primary predictor was maternal citizenship status. Generalized structural equation modeling was used to examine the relationships between maternal characteristics (maternal citizenship, maternal insurance coverage status) and youth uninsurance. Results Overall, 7% of US-born Latino youth were uninsured. Just 6% of youth with US-born mothers were uninsured compared to almost 10% of those with noncitizen mothers. Over 18% of youth with uninsured mothers were uninsured compared to 2.2% among youth with mothers who had private insurance coverage. Compared to both US-born and naturalized citizen Latina mothers, noncitizen Latina mothers had 4.75 times the odds of reporting being uninsured. Once adjusted for predisposing, enabling, and need factors, maternal uninsurance was strongly associated with youth uninsurance and maternal citizenship was weakly associated with youth uninsurance among US-born Latino youth. Conclusion Maternal citizenship was associated with both maternal uninsurance and youth uninsurance among US-born Latino youth. Federal- and state-level health policymaking should apply a two-generational approach to ensure that mothers of children are offered affordable health insurance coverage, regardless of their citizenship status, thus reducing uninsurance among US-born Latino youth.
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Affiliation(s)
- Cinthya K Alberto
- Dornsife School of Public Health, Drexel University, 3600 Market St, Philadelphia, PA, 19104, USA.
| | - Jessie Kemmick Pintor
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall, Philadelphia, PA, 19104, USA
| | - Brent Langellier
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall, Philadelphia, PA, 19104, USA
| | - Loni Philip Tabb
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall, Philadelphia, PA, 19104, USA
| | - Ana P Martínez-Donate
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall, Philadelphia, PA, 19104, USA
| | - Jim P Stimpson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, 3215 Market St, Nesbitt Hall, Philadelphia, PA, 19104, USA
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So M, Rojo ALA, Robinson LR, Hartwig SA, Lee ARH, Beasley LO, Silovsky JF, Morris AS, Titchener KS, Roblyer MZ. Parent engagement in an original and culturally adapted evidence-based parenting program, Legacy for Children™. Infant Ment Health J 2020; 41:356-377. [PMID: 32275084 PMCID: PMC7322668 DOI: 10.1002/imhj.21853] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.
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Affiliation(s)
- Marvin So
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Ana L. Almeida Rojo
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Lara R. Robinson
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
| | - Sophie A. Hartwig
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Akilah R. Heggs Lee
- Child Development Studies Team, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830
| | - Lana O. Beasley
- Oklahoma State University, 700 N. Greenwood Ave., Main Hall 1110, Tulsa, OK 74106
- Oklahoma University Health Sciences Center, 1100 NE 13th St., Oklahoma City, OK 73117
| | - Jane F. Silovsky
- Oklahoma University Health Sciences Center, 1100 NE 13th St., Oklahoma City, OK 73117
| | - Amanda S. Morris
- Oklahoma State University, 700 N. Greenwood Ave., Main Hall 1110, Tulsa, OK 74106
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Polk S, Leifheit K, Thornton R, Solomon B, DeCamp LR. Addressing the Social Needs of Spanish- and English-Speaking Families in Pediatric Primary Care. Acad Pediatr 2020; 20:1170-1176. [PMID: 32200111 PMCID: PMC7501201 DOI: 10.1016/j.acap.2020.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the social needs of families working with Health Leads (HL) at 18 pediatric practices in 9 US cities and how reported social needs and success addressing them varied according to parents' preferred health care language. METHODS We evaluated the social needs of English and Spanish speakers who received assistance from HL from September 2013 to August 2015. The study sample included 11,661 households in the 4 regions where HL provided support within pediatric primary care practices. We used multivariable regression stratified by region to assess the association between language and successful resource connections. RESULTS Reported social needs differed by language. Spanish speakers most frequently reported needs related to food (eg, food stamps, Special Supplemental Nutrition Program for Women, Infants, and Children, and food pantries). English speakers most frequently reported child-related needs (eg, childcare vouchers, Head Start, and school enrollment). The association between household language and the odds of a successful resource connection varied by region. CONCLUSIONS Our findings highlight the importance of considering language barriers and community context when addressing unmet social needs as part of primary care.
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Affiliation(s)
- Sarah Polk
- Department of Pediatrics, Johns Hopkins School of Medicine (S Polk, R Thornton, and BS Solomon), Baltimore, Md; Centro SOL, Johns Hopkins School of Medicine (S Polk), Baltimore, Md.
| | - Kathryn Leifheit
- Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USA
| | - Rachel Thornton
- Department of Pediatrics, Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Barry Solomon
- Department of Pediatrics, Johns Hopkins School of
Medicine, Baltimore, MD, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of
Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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Silverman-Lloyd LG, Dominguez Cortez J, Godage SK, Valenzuela Araujo D, Rivera T, Polk S, DeCamp LR. Immigrant Latino parents demonstrated high interactivity with pediatric primary care text messaging intervention. Mhealth 2020; 6:45. [PMID: 33209916 PMCID: PMC7656102 DOI: 10.21037/mhealth.2020.01.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/16/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The majority of Latino immigrants have been shown to have a mobile phone. Cellular phones offer a low-cost method of reaching larger populations and have the potential for increased tailoring and interactivity. This supports the development of mHealth interventions to address healthcare disparities in this population. In this study we sought to evaluate the feasibility and acceptability of interactive Spanish-language text messages sent throughout a child's first year of life in a low-income, limited-English proficient (LEP) Latino population to support families in accessing and using pediatric primary care more effectively. METHODS Participants (n=79) received interactive text messages over a period of 12 months as a part of a multi-modal mHealth intervention conducted at an urban academic pediatric primary care practice. Inclusion criteria were: singleton infant <2 months of age, enrollment in public health insurance, parent age >18, parent preferred healthcare language of Spanish, and at least one household cellular phone. Interactive text messages were designed to promote increased healthcare engagement and prompted participant responses through preprogramed algorithms. Text message sequences included clinic appointment reminders, support for obtaining medicine and completing referral appointments, monitoring of illness care needs and use, and parent support program reminders. Descriptive analyses were used to examine text message volume, usability, and participant response to text sequences. RESULTS Among participants, mean parent age was 30.1 years (SD: 6.1 years); mean years in the US was 7.5 years (SD: 5.1 years). 63.3% of parents had less than a high school education and 84.8% of parents had possible/high likelihood of limited health literacy. Participants completed the majority of sequences with appointment reminder sequences having the quickest response time. The top quartile of responders completed 88.3% of sequences; lower educational attainment was associated with lower text message sequence completion. Participants rated the program positively, especially the appointment reminders. CONCLUSIONS LEP Latino parents successfully engaged with interactive Spanish-language text sequences and parent acceptability was high. This study demonstrates feasibility for interventions employing this technology. Text message interventions may be a feasible approach to reduce healthcare disparities and costs for vulnerable populations.
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Affiliation(s)
- Luke G. Silverman-Lloyd
- University of California, Berkeley-University of California, San Francisco Joint Medical Program, Berkeley, CA, USA
| | - Jose Dominguez Cortez
- Johns Hopkins Center for Health/Salud and Opportunity for Latinos, Baltimore, MD, USA
| | | | | | - Tatiahna Rivera
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Sarah Polk
- Johns Hopkins Center for Health/Salud and Opportunity for Latinos, Baltimore, MD, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA
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10
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DeCamp LR, Godage SK, Valenzuela Araujo D, Dominguez Cortez J, Wu L, Psoter KJ, Quintanilla K, Rivera Rodríguez T, Polk S. A Texting Intervention in Latino Families to Reduce ED Use: A Randomized Trial. Pediatrics 2020; 145:peds.2019-1405. [PMID: 31879276 DOI: 10.1542/peds.2019-1405] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Latino children in immigrant families experience health care disparities. Text messaging interventions for this population may address disparities. The objective of this study was to evaluate the impact of a Spanish-language text messaging intervention on infant emergency department use and well care and vaccine adherence. METHODS The Salud al Día intervention, an educational video and interactive text messages throughout the child's first year of life, was evaluated via randomized controlled trial conducted in an urban, academic pediatric primary care practice from February 2016 to December 2017. Inclusion criteria were publicly insured singleton infant <2 months of age; parent age >18, with Spanish as the preferred health care language; and at least 1 household cellular phone. Primary outcomes were abstracted from the electronic medical record at age 15 months. Intention-to-treat analyses were used. RESULTS A total of 157 parent-child dyads were randomly assigned to Salud al Día (n = 79) or control groups (n = 78). Among all participants, mean parent age was 29.3 years (SD: 6.2 years), mean years in the United States was 7.3 (SD: 5.3 years), and 87% of parents had limited or marginal health literacy. The incidence rate ratio for emergency department use for the control versus intervention group was 1.48 (95% confidence interval: 1.04-2.12). A greater proportion of intervention infants received 2 flu vaccine doses compared with controls (81% vs 67%; P = .04). CONCLUSIONS This Spanish-language text messaging intervention reduced emergency department use and increased flu vaccine receipt among a population at high risk for health care disparities. Tailored text message interventions are a promising method for addressing disparities.
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Affiliation(s)
- Lisa Ross DeCamp
- Center for Salud/Health and Opportunity for Latinos and .,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Sashini K Godage
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - Linxuan Wu
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kevin J Psoter
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | | | - Sarah Polk
- Center for Salud/Health and Opportunity for Latinos and.,Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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11
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Abstract
Nativity is not often considered in the study of health disparities. We conducted a cross-sectional, parent-reported survey of demographics, socioeconomic characteristics, healthcare access, and health conditions in New York City schoolchildren (n = 9029). US-born children with US-born parents (US/US) had higher socioeconomic status, better access to healthcare, and reported higher rates of disease diagnoses compared to US-born children with immigrant parents and to immigrant children. Dental cavities were the only condition in which US/US children reported lower prevalence. US/US children had the best healthcare access, most favorable parent-reported health status and highest rate of satisfaction with healthcare. The magnitude of racial/ethnic disparities varied based on nativity of the children being compared. Factors such as the healthy immigrant effect and differential diagnosis rates may explain the results. In conclusion, nativity influences disease burdens and should be considered in health disparities studies.
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Affiliation(s)
- Sasha A McGee
- District of Columbia Department of Health, Center for Policy, Planning and Evaluation, 899 North Capitol Street NE, Washington, DC, 20002, USA
| | - Luz Claudio
- Department of Preventive Medicine, Division of International Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1057, New York, NY, 10029, USA.
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12
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Experiences in Care According to Parental Citizenship and Language Use Among Latino Children in California. Acad Pediatr 2018; 18:20-25. [PMID: 28065799 DOI: 10.1016/j.acap.2016.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess differences in health care access, utilization, and experiences among Latino children in California according to parental citizenship status and language use. METHODS Data are from the 2011 and 2012 California Health Interview Survey public use child files. A total of 2841 interviews of parents of Latino children younger than the age of 12 years were conducted. Analyses were conducted to determine the associations between access (usual of source of care, delay in receiving needed care, health insurance), utilization (physician visits in past year, emergency department visits), and experiences (doctor listens, doctor explains instructions clearly, communication via telephone or e-mail) according to parental citizenship status and household language use after adjusting for confounders. RESULTS In multivariate analyses, there were no significant differences in access to care according to parental citizenship status. Children with 2 noncitizen parents had fewer doctor visits and were less likely to go to the emergency department in the past year than those with 2 citizen parents. Among children with 1 or 2 noncitizen parents, their parents reported worse experiences in care than those with 2 citizen parents. Similar results were observed for language use. Parents of children in bilingual and Spanish-only households were less likely to report that their children's doctors explained things clearly, and parents in Spanish-only households were less likely to communicate via telephone or e-mail than those in English-only households. CONCLUSIONS Health policy should focus on provider-parent communication to ensure health care equity for Latino children whose parents are not citizens or do not speak English.
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13
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Balcazar AJ, Grineski SE, Collins TW. The Hispanic health paradox across generations: the relationship of child generational status and citizenship with health outcomes. Public Health 2015; 129:691-7. [PMID: 26002345 DOI: 10.1016/j.puhe.2015.04.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/06/2015] [Accepted: 04/10/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES In examining the Hispanic health paradox, researchers rarely determine if the paradox persists across immigrant generations. This study examines immigrant respiratory health disparities among Hispanic children in terms of current asthma, bronchitis, and allergies using an expanded six-group immigrant cohort framework that includes citizenship and the fourth-plus generation. STUDY DESIGN Cross-sectional primary survey data from 1568 caretakers of Hispanic schoolchildren in El Paso, Texas (USA), were utilized. METHODS Data were analyzed using generalized linear models. RESULTS Results indicate that a healthy immigrant advantage lasts until the 2.5 generation for bronchitis and allergies (P < 0.05), and until the third generation for asthma (P < 0.10). Citizenship was not an influence on the likelihood of a child having a respiratory health condition. CONCLUSIONS Findings demonstrate the utility of the expanded six-group cohort framework for examining intergenerational patterns in health conditions among immigrant groups.
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Affiliation(s)
- A J Balcazar
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, TX 79968, United States
| | - S E Grineski
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, TX 79968, United States.
| | - T W Collins
- Department of Sociology and Anthropology, University of Texas at El Paso, El Paso, TX 79968, United States
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14
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Balcazar AJ, Grineski SE, Collins TW. The Durability of Immigration-Related Barriers to Health Care Access for Hispanics Across Generations. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2015. [DOI: 10.1177/0739986314567074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conventional manners of operationalizing generational status in studies of health care access in the United States implicitly assume that individuals assimilate into U.S. culture by the 3rd generation. This limits understandings of immigrant health care access as it remains unknown if disparities persist beyond the 3rd generation. Survey data from caretakers of Hispanic schoolchildren in El Paso (Texas, USA; n = 1,568) were utilized in generalized linear models to analyze relationships between immigrant generational status and access to health care. Results showed that higher immigrant generations had better access to care. The greatest disparities between consecutive generational groups occurred between 1st generation noncitizens/naturalized citizens, the 2.5/3rd generations, and the 3rd/4th generations. Results reveal greater durability of barriers in access to health care than has previously been documented.
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15
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Does health insurance continuity among low-income adults impact their children's insurance coverage? Matern Child Health J 2013; 17:248-55. [PMID: 22359243 DOI: 10.1007/s10995-012-0968-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Parent's insurance coverage is associated with children's insurance status, but little is known about whether a parent's coverage continuity affects a child's coverage. This study assesses the association between an adult's insurance continuity and the coverage status of their children. We used data from a subgroup of participants in the Oregon Health Care Survey, a three-wave, 30-month prospective cohort study (n = 559). We examined the relationship between the length of time an adult had health insurance coverage and whether or not all children in the same household were insured at the end of the study. We used a series of univariate and multivariate logistic regression models to identify significant associations and the rho correlation coefficient to assess collinearity. A dose response relationship was observed between continuity of adult coverage and the odds that all children in the household were insured. Among adults with continuous coverage, 91.4% reported that all children were insured at the end of the study period, compared to 83.7% of adults insured for 19-27 months, 74.3% of adults insured for 10-18 months, and 70.8% of adults insured for fewer than 9 months. This stepwise pattern persisted in logistic regression models: adults with the fewest months of coverage, as compared to those continuously insured, reported the highest odds of having uninsured children (adjusted odds ratio 7.26, 95% confidence interval 2.75, 19.17). Parental health insurance continuity is integral to maintaining children's insurance coverage. Policies to promote continuous coverage for adults will indirectly benefit children.
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DeCamp LR, Kieffer E, Zickafoose JS, DeMonner S, Valbuena F, Davis MM, Heisler M. The voices of limited English proficiency Latina mothers on pediatric primary care: lessons for the medical home. Matern Child Health J 2013; 17:95-109. [PMID: 22350630 DOI: 10.1007/s10995-012-0951-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study is to inform medical home implementation in practices serving limited English proficiency Latino families by exploring limited English proficiency Latina mothers' experiences with, and expectations for, pediatric primary care. In partnership with a federally-qualified community health center in an urban Latino neighborhood, we conducted semi-structured interviews with 38 low-income Latina mothers. Eligible participants identified a pediatric primary care provider for their child and had at least one child 3 years old or younger, to increase the probability of frequent recent interactions with health care providers. Interview transcripts were coded and analyzed through an iterative and collaborative process to identify participants' satisfaction with and expectations for pediatric primary care. About half of the mothers interviewed were satisfied with their primary care experiences. Mothers suggested many ways to improve the quality of pediatric primary care for their children to better meet the needs of their families. These included: encouraging providers to invest more in their relationship with families, providing reliable same-day sick care, expanding hours, improving access to language services, and improving care coordination services. Limited English proficiency Latina mothers expect high-quality pediatric primary care consistent with the medical home model. Current efforts to improve primary care quality through application of the medical home model are thus relevant to this population, but should focus on the parent-provider relationship and timely access to care. Promoting this model among practices that serve limited English proficiency Latino families could improve engagement and satisfaction with primary care.
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Affiliation(s)
- Lisa Ross DeCamp
- Department of Pediatrics, Johns Hopkins University, Center for Child and Community Health Research, 5200 Eastern Ave, Baltimore, MD 21224, USA.
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