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Suleman S, Chamberlain LJ. Impact of COVID-19 on the Health of Migrant Children in the United States: From Policy to Practice. Pediatr Clin North Am 2024; 71:551-565. [PMID: 38754941 DOI: 10.1016/j.pcl.2024.01.019] [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] [Indexed: 05/18/2024]
Abstract
In this article, the authors provide an overview how the COVID-19 pandemic impacted the health and wellbeing of migrant children in conflict zones, in transit and post-settlement in the United States. In particular, the authors explore how policies implemented during the pandemic directly and indirectly affected migrant children and led to widening disparities in the aftermath of the pandemic. Given these circumstances, the authors provide recommendations for child health care providers caring for migrant children to mitigate and bolster resilience and health.
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Affiliation(s)
- Shazeen Suleman
- Department of Pediatrics, Stanford University School of Medicine, Center for Academic Medicine, 453 Quarry Road, MC 5459, Palo Alto, CA 94304-1419, USA.
| | - Lisa J Chamberlain
- Department of Pediatrics, Stanford University School of Medicine, Center for Academic Medicine, 453 Quarry Road, MC 5459, Palo Alto, CA 94304-1419, USA
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Marshall D, Perez M, Wang X, Matone M, Montoya-Williams D. Exploring Prenatal Care Quality and Access During the COVID-19 Pandemic Among Pregnant Immigrants in Philadelphia Through the Lens of Community-Based Organizations. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:241-250. [PMID: 37284484 PMCID: PMC10240328 DOI: 10.1089/whr.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/08/2023]
Abstract
Background The peak of the COVID-19 pandemic led to decreased maternal and child health care engagement, especially among marginalized populations. Existing disparities in prenatal care access and quality faced by pregnant immigrant people are likely to be amplified by the pandemic. Materials and Methods We conducted a study with direct service providers (DSPs) at community-based organizations (CBOs) serving pregnant immigrant families in the Philadelphia region. Semistructured interviews addressed barriers and facilitators to prenatal health care access and engagement among immigrant families both before and then after the onset of the pandemic in March 2020. Additional questions elicited context about the demographics of service populations, organizational connectedness to health care providers, and pandemic-related operational changes. Results Between June and November 2021, 10 interviews were conducted in English and Spanish with DSPs at 5 CBOs. Primary themes included diminished access and quality of care received due to decreased language accessibility, increased restrictions around support persons, shifts to telemedicine, and changes to appointment scheduling. Additional themes included heightened hesitancy engaging with services due to documentation status, confusion around legal rights, financial strain, and health insurance status. Interviewees provided suggestions for improving service access during and postpandemic for immigrant pregnant people, including implementation of culturally responsive group prenatal care, institutional policies to improve understanding of legal rights, and increased financial supports. Conclusions Understanding emergent and exacerbated barriers to prenatal care access and quality during the COVID-19 pandemic provides context for how to improve health equity for immigrant pregnant people through public health and health care policies as the pandemic continues, and once it has subsided.
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Affiliation(s)
- Deanna Marshall
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mikaela Perez
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Epidemiology & Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diana Montoya-Williams
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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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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Rosenberg J, Rosenthal A, Castillo S, Edwards E, Erickson C, Nogelo P, Fenick AM. Medical Certification for Utility Shut-Off Protection and Health-Related Social Needs. Pediatrics 2022; 150:e2022057571. [PMID: 36226533 PMCID: PMC9647589 DOI: 10.1542/peds.2022-057571] [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] [Accepted: 08/23/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition. METHODS After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021). RESULTS Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively. CONCLUSIONS Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.
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Affiliation(s)
| | - Alice Rosenthal
- Yale School of Medicine, New Haven, Connecticut
- Yale New Haven Hospital, New Haven, Connecticut
- Center for Children’s Advocacy, Hartford, Connecticut
| | | | - Emily Edwards
- Frank H. Netter School of Medicine, Quinnipiac University, Hamden, Connecticut
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Rosenberg J, Shabanova V, McCollum S, Sharifi M. Insurance and Health Care Outcomes in Regions Where Undocumented Children Are Medicaid-Eligible. Pediatrics 2022; 150:e2022057034. [PMID: 36004541 PMCID: PMC10171371 DOI: 10.1542/peds.2022-057034] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Expansion of insurance eligibility is associated with positive health outcomes. We compared uninsurance and health care utilization for (1) all children, and (2) children in immigrant families (CIF) and non-CIF who resided inside and outside of the seven US states/territories offering public health insurance to children regardless of documentation status ("extended-eligibility states/territories"). METHODS Using the cross-sectional, nationally representative National Survey of Children's Health-2019, we used survey-weighted, multivariable Poisson regression to assess the association of residence in nonextended- versus extended-eligibility states/territories with uninsurance and with health care utilization measures for (1) all children, and (2) CIF versus non-CIF, adjusting for demographic covariates. RESULTS Of the 29 433 respondents, the 4035 (weighted 27.2%) children in extended- versus nonextended-eligibility states/territories were more likely to be CIF (27.4% vs 20.5%, P < .001), 12 to 17 years old (37.2% vs 33.2%, P = .048), non-White (60.1% vs 45.9%, P < .001), and have a non-English primary language (20.6% vs 11.1%, P < .001).The relative risk of uninsurance for children in nonextended- versus extended-eligibility states/territories was 2.0 (95% confidence interval 1.4-3.0), after adjusting for covariates. Fewer children in extended- versus nonextended-eligibility states/territories were uninsured (adjusted prevalence 3.7% vs 7.5%, P < .001), had forgone medical (2.2% vs 3.1%, P = .07) or dental care (17.1% vs 20.5%, P = .02), and had no preventive visit (14.3% vs 17.0%, P = .04). More CIF than non-CIF were uninsured, regardless of residence in nonextended- versus extended-eligibility states/territories: CIF 11.2% vs 5.7%, P < .001; non-CIF 6.1% vs 3.1% P < .001. CONCLUSIONS Residence in nonextended-eligibility states/territories, compared with in extended-eligibility states/territories, was associated with higher uninsurance and less preventive health care utilization.
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Montez K, Brown CL, Garg A, Rhodes SD, Song EY, Taxter AJ, Skelton JA, Albertini LW, Palakshappa D. Trends in food insecurity rates at an academic primary care clinic: a retrospective cohort study. BMC Pediatr 2021; 21:364. [PMID: 34452604 PMCID: PMC8390339 DOI: 10.1186/s12887-021-02829-3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Healthcare organizations are increasingly screening and addressing food insecurity (FI); yet, limited data exists from clinic-based settings on how FI rates change over time. The objective of this study was to evaluate household FI trends over a two-year period at a clinic that implemented a FI screening and referral program. METHODS In this retrospective cohort study, data were extracted for all visits at one academic primary care clinic for all children aged 0-18 years whose parents/guardians had been screened for FI at least once between February 1, 2018 to February 28, 2019 (Year 1) and screened at least once between March 1, 2019 to February 28, 2020 (Year 2). Bivariate analyses tested for differences in FI and demographics using chi-square tests. Mixed effects logistic regression was used to assess change in FI between Years 1 and 2 with random intercept for participants controlling for covariates. The interaction between year and all covariates was evaluated to determine differences in FI change by demographics. RESULTS Of 6182 patients seen in Year 1, 3691 (59.7%) were seen at least once in Year 2 and included in this study. In Year 1, 19.6% of participants reported household FI, compared to 14.1% in Year 2. Of those with FI in Year 1, 40% had FI in Year 2. Of those with food security in Year 1, 92.3% continued with food security in Year 2. Compared to Hispanic/Latinx participants, African American/Black (OR: 3.53, 95% CI: 2.33, 5.34; p < 0.001) and White (OR: 1.88, 95% CI: 1.06, 3.36; p = 0.03) participants had higher odds of reporting FI. African American/Black participants had the largest decrease in FI between Years 1 and 2 (- 7.9, 95% CI: - 11.7, - 4.1%; p < 0.0001). CONCLUSIONS Because FI is transitional, particularly for racial/ethnic minorities, screening repeatedly can identify families situationally experiencing FI.
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Affiliation(s)
- Kimberly Montez
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Callie L. Brown
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Eunyoung Y. Song
- Department of Social Sciences and Health Policy, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
- Health Quality Partners, Doyleston, PA USA
| | - Alysha J. Taxter
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Joseph A. Skelton
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem, NC 27101 USA
| | - Laurie W. Albertini
- Department of Pediatrics, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
| | - Deepak Palakshappa
- Departments of Pediatrics and Internal Medicine, Wake Forest University Health Sciences, Winston-Salem, NC 27157 USA
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Fuentes-Afflick E, Perrin JM, Moley KH, Díaz Á, McCormick MC, Lu MC. Optimizing Health And Well-Being For Women And Children. Health Aff (Millwood) 2021; 40:212-218. [DOI: 10.1377/hlthaff.2020.01504] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Elena Fuentes-Afflick
- Elena Fuentes-Afflick is a professor of pediatrics and vice dean at the University of California San Francisco, in San Francisco, California
| | - James M. Perrin
- James M. Perrin is a professor of pediatrics at Harvard Medical School and holds the John C. Robinson Distinguished Chair in Pediatrics at MassGeneral Hospital for Children, both in Boston, Massachusetts
| | - Kelle H. Moley
- Kelle H. Moley is the deputy director of Global Health at the Gates Foundation in Seattle, Washington
| | - Ángela Díaz
- Ángela Díaz is a professor of pediatrics, environmental medicine, and public health at the Icahn School of Medicine at Mount Sinai, in New York, New York
| | - Marie C. McCormick
- Marie C. McCormick is the Sumner and Esther Feldberg Professor of Maternal and Child Health Emerita in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Michael C. Lu
- Michael C. Lu is the dean of the School of Public Health at the University of California Berkeley, in Berkeley, California
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Cholera R, Falusi OO, Linton JM. Sheltering in Place in a Xenophobic Climate: COVID-19 and Children in Immigrant Families. Pediatrics 2020; 146:peds.2020-1094. [PMID: 32345687 DOI: 10.1542/peds.2020-1094] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rushina Cholera
- National Clinician Scholars Program, Department of Pediatrics, Duke School of Medicine, and the Margolis Center for Health Policy, Duke University, Durham, North Carolina;
| | - Olanrewaju O Falusi
- Goldberg Center for General and Community Pediatrics, Child Health Advocacy Institute, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC; and
| | - Julie M Linton
- Department of Pediatrics, University of South Carolina School of Medicine Greenville, Greenville, South Carolina
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Russell EA, Tsai C, Linton JM. Children in Immigrant Families: Advocacy Within and Beyond the Pediatric Emergency Department. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020; 21:100779. [PMID: 32922213 PMCID: PMC7480259 DOI: 10.1016/j.cpem.2020.100779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In the United States, 1 in 4 children lives in an immigrant family. State and national policies have historically precluded equitable access to health care among children in immigrant families. More recently, increasingly restrictive policies, political rhetoric, and xenophobic stances have made immigrant families less able to access health care and less comfortable in attempting to do so, thus increasing the likelihood that patients will present to the emergency department. Once in the emergency department, language, cultural, and health literacy barriers make providing high-quality care potentially challenging for some families. Emergency care professionals can therefore glean critical insight regarding inequities from clinical work to inform advocacy and policy changes at institutional, community, regional, and national levels.
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Affiliation(s)
- Eric A Russell
- Department of Pediatrics, Section of Emergency Medicine, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Carmelle Tsai
- Department of Pediatrics, Division of Emergency Medicine, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie M Linton
- Department of Pediatrics and Assistant Dean for Admissions, University of South Carolina School of Medicine Greenville and Prisma Health Children's Hospital, Greenville, SC
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Raphael JL, Bloom SR, Chung PJ, Guevara JP, Jacobson RM, Kind T, Klein M, Li STT, McCormick MC, Pitt MB, Poehling KA, Trost M, Sheldrick RC, Young PC, Szilagyi PG. Racial Justice and Academic Pediatrics: A Call for Editorial Action and Our Plan to Move Forward. Acad Pediatr 2020; 20:1041-1043. [PMID: 32791317 PMCID: PMC7417277 DOI: 10.1016/j.acap.2020.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Jean L. Raphael
- Center for Child Health Policy and Advocacy, Baylor College of Medicine (JL Raphael), Houston, Tex,Section of Academic General Pediatrics, Baylor College of Medicine (JL Raphael), Houston, Tex,Address correspondence to Jean L. Raphael, MD, MPH, Texas Children's Hospital, Suite 1540.00, 6701 Fannin St, Houston, TX 77030
| | | | - Paul J. Chung
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine (PJ Chung), Pasadena, Calif
| | - James P. Guevara
- Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania (JP Guevara), Philadelphia, Pa
| | - Robert M. Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic (RM Jacobson), Rochester, Minn,Department of Health Sciences Research, Mayo Clinic (RM Jacobson), Rochester, Minn
| | - Terry Kind
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences (T Kind), Washington, DC
| | - Melissa Klein
- Division of General and Community Pediatrics, Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine (M Klein), Cincinnati, Ohio
| | - Su-Ting T. Li
- Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California Davis (S-TT Li), Sacramento, Calif
| | - Marie C. McCormick
- Department of Society, Human Development and Health, Harvard School of Public Health (MC McCormick), Boston, Mass
| | - Michael B. Pitt
- Department of Pediatrics, University of Minnesota (MB Pitt), Minneapolis, Minn
| | - Katherine A. Poehling
- Departments of Pediatrics and Epidemiology and Prevention, Wake Forest School of Medicine (KA Poehling), Winston-Salem, NC
| | - Margaret Trost
- Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of USC (M Trost), Los Angeles, Calif
| | - R. Christopher Sheldrick
- Department of Health Law, Policy and Management, School of Public Health, Boston University (RC Sheldrick), Boston, Mass
| | - Paul C. Young
- Department of Pediatrics, University of Utah (PC Young), Salt Lake City, Utah
| | - Peter G. Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles (PG Szilagyi)
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