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Chang E, Davis TL, Berkman ND. Delayed and Forgone Health Care Among Adults With Limited English Proficiency During the Early COVID-19 Pandemic. Med Care 2024; 62:367-375. [PMID: 38054852 PMCID: PMC11081476 DOI: 10.1097/mlr.0000000000001963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
BACKGROUND Individuals with limited English proficiency (LEP) have long faced barriers in navigating the health care system. More information is needed to understand whether their care was limited further during the early period of the COVID-19 pandemic. OBJECTIVE To assess the impact of English proficiency on delayed and forgone health care during the early COVID-19 pandemic. RESEARCH DESIGN Multivariate logistic regression analysis of National Health Interview Survey data (July-December 2020; n=16,941). Outcomes were self-reported delayed and forgone health care because of cost or the COVID-19 pandemic. Delayed health care included medical, dental, mental health, and pharmacy care. Forgone health care also included care at home from a health professional. RESULTS A greater percentage of LEP adults reported delayed (49%) and forgone (41%) health care than English-proficient adults (40% and 30%, respectively). However, English proficiency was not significantly associated with delayed or forgone health care, after adjusting for demographic, socioeconomic, and health factors. Among LEP adults, multivariate models showed that being uninsured, having a disability, and having chronic conditions increased the risk of delaying and forgoing health care. LEP adults of Asian race and Hispanic ethnicity were also more likely to forgo health care while those with 65+ years were less likely to forgo health care. CONCLUSIONS Adults with LEP were more likely to experience challenges accessing health care early in the pandemic. Delayed and forgone health care were explained by low socioeconomic status and poor health. These findings highlight how during a period of limited health resources, deficiencies in the health care system resulted in an already disadvantaged group being at greater risk of inequitable access to care.
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Affiliation(s)
- Eva Chang
- Advocate Aurora Research Institute, Advocate Health, Milwaukee, WI
| | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
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2
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Vázquez E, Juturu P, Burroughs M, McMullin J, Cheney AM. Continuum of Trauma: Fear and Mistrust of Institutions in Communities of Color During the COVID-19 Pandemic. Cult Med Psychiatry 2024; 48:290-309. [PMID: 37776491 PMCID: PMC11217119 DOI: 10.1007/s11013-023-09835-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/02/2023]
Abstract
Historical, cultural, and social trauma, along with social determinants of health (SDOH), shape health outcomes, attitudes toward medicine, government, and health behaviors among communities of color in the United States (U.S.). This study explores how trauma and fear influence COVID-19 testing and vaccination among Black/African American, Latinx/Indigenous Latin American, and Native American/Indigenous communities. Leveraging community-based participatory research methods, we conducted 11 virtual focus groups from January to March of 2021 with Black/African American (n = 4), Latinx/Indigenous Latin American (n = 4), and Native American/Indigenous (n = 3) identifying community members in Inland Southern California. Our team employed rapid analytic approaches (e.g., template and matrix analysis) to summarize data and identify themes across focus groups and used theories of intersectionality and trauma to meaningfully interpret study findings. Historical, cultural, and social trauma induce fear and mistrust in public health and medical institutions influencing COVID-19 testing and vaccination decisions in communities of color in Inland Southern California. This work showcases the need for culturally and structurally sensitive community-based health interventions that attend to the historical, cultural, and social traumas unique to racial/ethnic minority populations in the U.S. that underlie fear and mistrust of medical, scientific, and governmental institutions.
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Affiliation(s)
- Evelyn Vázquez
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA
| | - Preeti Juturu
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michelle Burroughs
- Center for Healthy Communities, University of California, Riverside, USA
| | - Juliet McMullin
- Department of Family Medicine, School of Medicine, University of California, Irvine, USA
| | - Ann M Cheney
- Department of Social Medicine, Population and Public Health, School of Medicine, University of California, 900 University Avenue, Riverside, CA, 92521-9800, USA.
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3
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Torres JR, Taira BR, Bi A, Gomez AV, Delgado C, Vera S, Rodriguez RM. COVID-19 Vaccine Uptake in Undocumented Latinx Patients Presenting to the Emergency Department. JAMA Netw Open 2024; 7:e248578. [PMID: 38669022 PMCID: PMC11053375 DOI: 10.1001/jamanetworkopen.2024.8578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
This cross-sectional study examines COVID-19 infection status, vaccination uptake, and perceptions about the vaccine among Latinx patients presenting to the emergency department in California.
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Affiliation(s)
- Jesus R. Torres
- David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Los Angeles, California
| | - Breena R. Taira
- David Geffen School of Medicine, University of California, Los Angeles
- Olive View-UCLA Medical Center, Los Angeles, California
| | - Angela Bi
- David Geffen School of Medicine, University of California, Los Angeles
| | | | | | - Stephanie Vera
- School of Medicine, University of California, San Francisco
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4
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Kuroda M, Shaw AV, Campagna CD. The experiences of community health workers when communicating with refugees about COVID-19 vaccines in Syracuse, NY: A qualitative study. Heliyon 2024; 10:e26136. [PMID: 38434037 PMCID: PMC10906162 DOI: 10.1016/j.heliyon.2024.e26136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 02/06/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Refugees are among the most health-vulnerable members of society. Despite the importance of vaccination to mitigate the risks associated with COVID-19 infection, ensuring adequate access and uptake of the COVID-19 vaccine remains a pressing concern for refugee populations. Research has suggested that community-oriented approaches and open communication with trusted individuals are essential to address this challenge. Vaccine outreach efforts were performed in Syracuse, NY, by Community Health Workers (CHWs) as trusted refugee community members. This study explored CHWs' experiences during vaccine outreach and perceptions about COVID-19 vaccine hesitancy and acceptance among refugees, including barriers and facilitators to vaccination. Methods A qualitative study was performed using thematic analysis following six semi-structured interviews with CHWs. Results Four main themes supported by 16 sub-themes were extracted. CHWs described the (1) diverse beliefs and attitudes of refugees by ethnic group, with most having low vaccine acceptance at first. (2) Barriers included contextual barriers, lack of awareness, misinformation, and withdrawal when forced from vaccine mandates. However, CHWs also identified numerous (3) facilitators to vaccination, including the internal processing and eventual vaccine acceptance, supported by external messaging by CHWs and time. Culturally sensitive intervention strategies occurred through (4) CHW team efforts and their provision of reliable information to refugee clients, with openness and over time. The team efforts of CHWs significantly contributed to refugee acceptance and uptake of the COVID-19 vaccine. Conclusions This study revealed how the refugee population changed their belief towards the COVID-19 vaccine through trust, time, and reliable information provided by CHWs and describes culturally sensitive strategies for vaccine uptake by refugees. CHWs' reflection on COVID-19 vaccine hesitancy and acceptance among refugees during outreach efforts is an essential perspective when implementing future public health interventions.
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Affiliation(s)
- Moe Kuroda
- Norton College of Medicine, MPH Program, SUNY Upstate Medical University, Syracuse, NY, USA
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of General Medicine, Toyama University Hospital, Toyama, Japan
| | - Andrea V. Shaw
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Pediatrics, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christina D. Campagna
- Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Public Health & Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
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5
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Irizar P, Pan D, Taylor H, Martin CA, Katikireddi SV, Kannangarage NW, Gomez S, La Parra Casado D, Srinivas PN, Diderichsen F, Baggaley RF, Nellums LB, Koller TS, Pareek M. Disproportionate infection, hospitalisation and death from COVID-19 in ethnic minority groups and Indigenous Peoples: an application of the Priority Public Health Conditions analytical framework. EClinicalMedicine 2024; 68:102360. [PMID: 38545088 PMCID: PMC10965404 DOI: 10.1016/j.eclinm.2023.102360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 04/21/2024] Open
Abstract
The COVID-19 pandemic has resulted in disproportionate consequences for ethnic minority groups and Indigenous Peoples. We present an application of the Priority Public Health Conditions (PPHC) framework from the World Health Organisation (WHO), to explicitly address COVID-19 and other respiratory viruses of pandemic potential. This application is supported by evidence that ethnic minority groups were more likely to be infected, implying differential exposure (PPHC level two), be more vulnerable to severe disease once infected (PPHC level three) and have poorer health outcomes following infection (PPHC level four). These inequities are driven by various interconnected dimensions of racism, that compounds with socioeconomic context and position (PPHC level one). We show that, for respiratory viruses, it is important to stratify levels of the PPHC framework by infection status and by societal, community, and individual factors to develop optimal interventions to reduce inequity from COVID-19 and future infectious diseases outbreaks.
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Affiliation(s)
- Patricia Irizar
- Faculty of Humanities, School of Social Sciences, University of Manchester, UK
| | - Daniel Pan
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
- Li Ka Shing Centre for Health Information and Discovery, Oxford Big Data Institute, University of Oxford, UK
| | - Harry Taylor
- Department of Global Health and Social Medicine, King’s College London, UK
| | - Christopher A. Martin
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
| | | | | | | | | | | | | | - Rebecca F. Baggaley
- Leicester NIHR Biomedical Research Centre, UK
- Development Centre for Population Health, University of Leicester, UK
- Department of Population Health Sciences, University of Leicester, UK
| | - Laura B. Nellums
- Lifespan and Population Sciences, School of Medicine, University of Nottingham, UK
| | | | - Manish Pareek
- Department of Respiratory Sciences, University of Leicester, UK
- Leicester NIHR Biomedical Research Centre, UK
- Department of Infectious Diseases and HIV Medicine, University Hospitals of Leicester NHS Trust, UK
- Development Centre for Population Health, University of Leicester, UK
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6
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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7
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Masciale M, DiValerio Gibbs K, Asaithambi R, Murillo MC, Espinoza-Candelaria G, Jaramillo M, Domínguez J, Haq H, Fredricks K, Lopez MA, Bocchini C. Qualitative Study of Barriers and Facilitators to Care Among Children in Immigrant Families. Hosp Pediatr 2023; 13:1087-1096. [PMID: 37986609 DOI: 10.1542/hpeds.2023-007276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVES Children in immigrant families comprise ∼25% of US children and live in families with high levels of poverty and food insecurity. Studies suggest a decline in public benefit enrollment among children in immigrant families. We aimed to explore perspectives on barriers and facilitators in accessing care among immigrant caregivers of hospitalized children. METHODS With a general qualitative descriptive design, we developed a semistructured interview guide using an iterative process informed by literature and content expertise. Using purposive sampling, we recruited immigrant caregivers of hospitalized children in March 2020 and conducted interviews in English or Spanish. Interviews were recorded, transcribed, and translated to English. Three authors coded transcripts using Dedoose and identified themes via thematic analysis. RESULTS Analysis of 12 caregiver interviews revealed barriers and facilitators in accessing healthcare and public benefit use. Barriers included healthcare system barriers, immigration-related fear, and racism and discrimination. Within healthcare system barriers, subthemes included language barriers, cost, complexity of resource application, and lack of guidance on available benefits. Within immigration-related fear, subthemes included fear of familial separation, fear of deportation, fear that benefit use affects immigration status, and provider distrust. Healthcare system facilitators of resource use included recruiting diverse workforces, utilizing language interpretation, guidance on benefit enrollment, legal services, and mental health services. Participants also recommended hospital partnership with trusted information sources, including media stations and low-cost clinics. CONCLUSIONS Immigrant caregivers of hospitalized children identified barriers and facilitators in access to care. Further research is needed to assess the efficacy of caregiver-suggested interventions.
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Affiliation(s)
- Marina Masciale
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Rathi Asaithambi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | | | | | - José Domínguez
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Karla Fredricks
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Michelle A Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
| | - Claire Bocchini
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Center for Child Health Policy and Advocacy, Texas Children's Hospital, Houston, Texas
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8
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Hernández-Vásquez A, Bendezu-Quispe G, Azañedo D. Migration Status and Utilization of Healthcare Services Among Venezuelan Immigrants in Peru. J Community Health 2023; 48:1031-1037. [PMID: 37642829 DOI: 10.1007/s10900-023-01276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND In general, migrants in illegal situations encounter a greater barrier to accessing medical care because of their migration status due to not having the required documentation to be able to obtain insurance in the receiving country. OBJECTIVE To evaluate the association between migration status and the use of health services in the Venezuelan population residing in Peru. METHODS Data from the second Survey Directed to the Venezuelan Population Residing in Peru (ENPOVE) of 2022 were analyzed. The dependent variable was use of health services in the last month. The exposure variable was migration status (legal/illegal). Generalized linear models of the Poisson family with link log function were used to obtain crude and adjusted prevalence ratios (aPR), for potential confounding variables. Additionally, we evaluated the association of interest, stratified by gender. FINDINGS Data from 1569 migrants were analyzed. Participants with illegal migration status represented 32.4% (men: 24.3%; women: 36.7%); likewise, 58.1% did not use health services. Illegal migration status was associated with lower health care use (aPR: 0.75; 95%CI: 0.61-0.92). Likewise, after stratifying by sex, the association was maintained only in male migrants (aPR: 0.53; 95%CI: 0.39-0.82) but not in women (aPR: 0.84; 95%CI: 0.67-1.05). CONCLUSION 58.1% of Venezuelan migrants in Peru did not seek medical attention despite having health problems. Having an illegal immigration status leads to a lower probability of using these services, especially in men.
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Affiliation(s)
- Akram Hernández-Vásquez
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, 550 La Fontana Ave, La Molina, 15024, Peru.
| | | | - Diego Azañedo
- Faculty of Health Sciences, Universidad Científica del Sur, Lima, Peru
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9
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Pratt S, Hagan-Haynes K. Applying a Health Equity Lens to Work-Related Motor Vehicle Safety in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6909. [PMID: 37887647 PMCID: PMC10606728 DOI: 10.3390/ijerph20206909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/06/2023] [Indexed: 10/28/2023]
Abstract
Motor vehicle crashes (MVCs) are the leading cause of fatal work-related injuries in the United States. Research assessing sociodemographic risk disparities for work-related MVCs is limited, yet structural and systemic inequities at work and during commutes likely contribute to disproportionate MVC risk. This paper summarizes the literature on risk disparities for work-related MVCs by sociodemographic and employment characteristics and identifies worker populations that have been largely excluded from previous research. The social-ecological model is used as a framework to identify potential causes of disparities at five levels-individual, interpersonal, organizational, community, and public policy. Expanded data collection and analyses of work-related MVCs are needed to understand and reduce disparities for pedestrian workers, workers from historically marginalized communities, workers with overlapping vulnerabilities, and workers not adequately covered by employer policies and safety regulations. In addition, there is a need for more data on commuting-related MVCs in the United States. Inadequate access to transportation, which disproportionately affects marginalized populations, may make travel to and from work less safe and limit individuals' access to employment. Identifying and remedying inequities in work-related MVCs, whether during the day or while commuting, will require the efforts of industry and multiple public sectors, including public health, transportation, and labor.
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Affiliation(s)
- Stephanie Pratt
- National Institute for Occupational Safety and Health, Division of Safety Research, Morgantown, WV 26505, USA;
- Strategic Innovative Solutions, LLC, Clearwater, FL 33760, USA
| | - Kyla Hagan-Haynes
- Injury and Violence Prevention Center, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- National Institute for Occupational Safety and Health, Western States Division, Denver, CO 80225, USA
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10
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James PB, Gatwiri K, Mwanri L, Wardle J. Impacts of COVID-19 on African Migrants' Wellbeing, and Their Coping Strategies in Urban and Regional New South Wales, Australia: a Qualitative Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01806-z. [PMID: 37768537 DOI: 10.1007/s40615-023-01806-z] [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: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
AIM As the COVID-19 pandemic response continues to evolve, the need to protect more vulnerable populations in society becomes more apparent. Studies are still emerging on how different population groups have been impacted by the COVID-19 pandemic. Our study explored the impact of COVID-19 for African migrants in New South Wales, Australia, and their coping strategies. METHODS We employed inductive, exploratory qualitative interpretive research design using individual semi-structured in-depth interviews with 21 African migrants. RESULTS COVID-19 lockdowns disrupted the African sense of community. Social isolation, financial insecurity due to joblessness, or reduced working hours led to stress, frustration, anxiety, sadness, loneliness, and depression. On the other hand, COVID-19 lockdowns allowed for more family time, reflecting, and appreciating the gift of life and personal intellectual growth. Despite such challenges, there was much community support, especially from religious organisations. Support from government agencies was available, but access was hampered by misinformation, digital literacy, and immigration status. Holding on to religion and faith was a key coping mechanism, followed by indulging in self-care practices such as healthy eating, exercise, Yoga, meditation, sleep, and limited interaction with social media. CONCLUSION The COVID-19 lockdown disrupted the collectivist culture of African migrants and had untoward socioeconomic impacts that affected their wellbeing, many of which reflect an exacerbation of pre-existing inequities. To ensure that African migrant COVID-19-related health and wellbeing needs are met, the African migrant community must be actively involved in every facet of the NSW COVID-19 and other future outbreak response efforts.
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Affiliation(s)
- Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia.
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Kathomi Gatwiri
- Centre for Children & Young People, Faculty of Health, Southern Cross University, Gold Coast, Australia
| | - Lillian Mwanri
- Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, SA, 5000, Australia
| | - Jon Wardle
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW, 2480, Australia
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11
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Kelly MS, Mohammed A, Okin D, Alba GA, Jesudasen SJ, Flanagan S, Dandawate NA, Gavralidis A, Chang LL, Moin EE, Witkin AS, Hibbert KA, Kadar A, Gordan PL, Bebell LM, Hauptman M, Valeri L, Lai PS. Preferred Language Mediates Association Between Race, Ethnicity, and Delayed Presentation in Critically Ill Patients With COVID-19. Crit Care Explor 2023; 5:e0927. [PMID: 37332365 PMCID: PMC10270487 DOI: 10.1097/cce.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
Which social factors explain racial and ethnic disparities in COVID-19 access to care and outcomes remain unclear. OBJECTIVES We hypothesized that preferred language mediates the association between race, ethnicity and delays to care. DESIGN SETTING AND PARTICIPANTS Multicenter, retrospective cohort study of adults with COVID-19 consecutively admitted to the ICU in three Massachusetts hospitals in 2020. MAIN OUTCOME AND MEASURES Causal mediation analysis was performed to evaluate potential mediators including preferred language, insurance status, and neighborhood characteristics. RESULTS Non-Hispanic White (NHW) patients (157/442, 36%) were more likely to speak English as their preferred language (78% vs. 13%), were less likely to be un- or under-insured (1% vs. 28%), lived in neighborhoods with lower social vulnerability index (SVI) than patients from racial and ethnic minority groups (SVI percentile 59 [28] vs. 74 [21]) but had more comorbidities (Charlson comorbidity index 4.6 [2.5] vs. 3.0 [2.5]), and were older (70 [13.2] vs. 58 [15.1] years). From symptom onset, NHW patients were admitted 1.67 [0.71-2.63] days earlier than patients from racial and ethnic minority groups (p < 0.01). Non-English preferred language was associated with delay to admission of 1.29 [0.40-2.18] days (p < 0.01). Preferred language mediated 63% of the total effect (p = 0.02) between race, ethnicity and days from symptom onset to hospital admission. Insurance status, social vulnerability, and distance to the hospital were not on the causal pathway between race, ethnicity and delay to admission. CONCLUSIONS AND RELEVANCE Preferred language mediates the association between race, ethnicity and delays to presentation for critically ill patients with COVID-19, although our results are limited by possible collider stratification bias. Effective COVID-19 treatments require early diagnosis, and delays are associated with increased mortality. Further research on the role preferred language plays in racial and ethnic disparities may identify effective solutions for equitable care.
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Affiliation(s)
- Michael S Kelly
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Adna Mohammed
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Daniel Okin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - George A Alba
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Shelby Flanagan
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- New England Pediatric Environmental Health Specialty Unit, Boston, MA
| | - Nupur A Dandawate
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Alexander Gavralidis
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Leslie L Chang
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emily E Moin
- Division of Pulmonary, Allergy and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Alison S Witkin
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Kathryn A Hibbert
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aran Kadar
- Division of Pulmonary Medicine and Critical Care, Newton-Wellesley Hospital, Newton, MA
| | - Patrick L Gordan
- Division of Pulmonary, Critical Care and Sleep Medicine, Salem Hospital, Salem, MA
| | - Lisa M Bebell
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Marissa Hauptman
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - Peggy S Lai
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
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12
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Stantliff TM, Housel L, Goswami R, Millow S, Cook G, Knapmeyer R, Easton C, Stryker SD, Williams KM, Walter M, Mooney J, Huaman MA. The Latent Tuberculosis Infection Cascade of Care During The COVID-19 Pandemic Response in a Mid-Sized US City. J Clin Tuberc Other Mycobact Dis 2023; 31:100367. [PMID: 37034439 PMCID: PMC10066584 DOI: 10.1016/j.jctube.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
Background The COVID-19 pandemic response may unintentionally disrupt multiple public health services, including tuberculosis control programs. We aimed to assess differences in the cascade of care for latent tuberculosis infection (LTBI) in a Midwest U.S. city during the COVID-19 pandemic response. Methods We conducted a retrospective cohort study of adult patients who presented for LTBI evaluation at the Hamilton County Public Health Tuberculosis Clinic in Ohio between 2019 and 2020. The pre-COVID-19 response period was defined as 01/2019 to 02/2020, and the COVID-19 pandemic response period (first wave) was defined as 04/2020 to 12/2020. We reviewed electronic medical records to extract sociodemographic information, medical history, follow-up and treatment data to define steps within the LTBI cascade of care. Logistic regressions were used to assess factors associated with LTBI treatment acceptance and completion, adjusted by potential confounders and COVID-19 period. Results Data from 312 patients were included. There was a significant decrease in the number of monthly LTBI referrals (median, 18 vs. 8, p = 0.02) and LTBI evaluations (median, 17.5 vs. 7, p < 0.01) during the first wave of COVID-19. The proportion for whom immigration was listed as the indication for LTBI testing also declined (30% vs. 9%; p < 0.01) during COVID-19. More LTBI diagnoses were based on interferon-gamma release assay (IGRA; 30% vs. 49%; p < 0.01) during the COVID-19 response period. The proportion of people in the clinic for whom treatment for LTBI was recommended was similar before and during COVID-19 (76% vs. 81%, p = 0.41), as was LTBI treatment acceptance rates (56% vs. 64%, p = 0.28), and completion rates (65% vs. 63%, p = 0.85). In multivariate analysis, LTBI treatment acceptance was associated with Hispanic ethnicity, younger age, male sex, IGRA being used for diagnosis, and non-healthcare occupation, independent of COVID-19 period. LTBI treatment completion was associated with taking a rifamycin-containing regimen, independent of COVID-19 period. Conclusion We observed a significant decline in the number of monthly LTBI referrals and evaluations during the first wave of COVID-19, revealing an unintended negative impact of the COVID-19 response in our region. However, LTBI treatment acceptance and completion rates were not affected during COVID-19.
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13
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Rafieifar M, Potocky M, Huang H, Beaulaurier RL, Bruan Lorenzini S. Experiences of Undocumented Parents Reuniting with Children Who Entered the United States as Unaccompanied Minors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20054496. [PMID: 36901505 PMCID: PMC10002079 DOI: 10.3390/ijerph20054496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 05/13/2023]
Abstract
In 2021, the United States saw an exponential influx of unaccompanied migrant children crossing the U.S.-Mexico border. Upon apprehension at the border, unaccompanied children are placed in the Office of Refugee Resettlement (ORR) temporary shelter facilities. The ORR is responsible for locating, vetting, and releasing the children to their family, guardians, or a suitable sponsor. Undocumented parents seeking reunification may fear cross-examination and background checks. This study aimed to explore the experiences of undocumented families reunified with their children with the help of a community-based organization (CBO). A collective case study method was used to collect qualitative data from seven parents. Respondent parents expressed their rationale for allowing their children to cross the U.S.-Mexico border, their experience with the ORR, and the reasons they pursued community-based guidance. The results document the depth of trauma and difficulties parents of unaccompanied migrant children face with American service providers. It is recommended that immigration-related government agencies form relationships with culturally diverse organizations that are trusted by immigrant communities.
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Affiliation(s)
- Maryam Rafieifar
- Department of Social Work and Child Advocacy, Montclair State University, Montclair, NJ 07043, USA
- Correspondence:
| | - Miriam Potocky
- School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Hui Huang
- School of Social Work, University of Texas in Arlington, Arlington, TX 76019, USA
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14
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Adkins-Jackson PB, Vázquez E, Henry-Ala FK, Ison JM, Cheney A, Akingbulu J, Starks C, Slay L, Dorsey A, Marmolejo C, Stafford A, Wen J, McCauley MH, Summers L, Bermudez L, Cruz-Roman ZL, Castillo I, Kipke MD, Brown AF. The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic. Health Promot Pract 2023; 24:232-243. [PMID: 36419256 PMCID: PMC9703012 DOI: 10.1177/15248399221132581] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.
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Affiliation(s)
| | | | | | | | - Ann Cheney
- University of California, Riverside, Riverside, CA, USA
| | | | | | - Lindsay Slay
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Alexander Dorsey
- Mending Minds Professional Clinical Counseling, Inc, Los Angeles, CA, USA
| | | | | | - James Wen
- St. John's Cathedral, Los Angeles, CA, USA
| | | | - Latrese Summers
- St. John's Well Child and Family Center, Inc., Los Angeles, CA, USA
| | | | | | | | | | - Arleen F Brown
- University of California, Los Angeles, Los Angeles, CA, USA
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Pilato TC, Taki F, Sbrollini K, Purington Drake A, Maley B, Yale-Loehr S, Powers JL, Bazarova NN, Bhandari A, Kaur G. Knowledge of legal rights as a factor of refugee and asylum seekers' health status: a qualitative study. BMJ Open 2023; 13:e063291. [PMID: 36764728 PMCID: PMC9923268 DOI: 10.1136/bmjopen-2022-063291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES To examine health behaviours of refugees and asylum seekers, in relation to their knowledge of public benefits and legal rights. DESIGN Qualitative study, utilising an open-ended, semi-structured interview guide to ensure information-rich data collection. Thematic content was analysed using qualitative research software. SETTING Participants were drawn from the Weill Cornell Center for Human Rights (WCCHR) in New York City, a single-center, human rights clinic with a globally representative patient population. All interviews were conducted at the Weill Cornell Medicine Clinical and Translational Science Center, a multidisciplinary space within an urban academic medical center. PARTICIPANTS Twenty-four refugees and asylum seekers currently living in the greater New York City area. Eligible participants were 18 years of age or older and had previously sought services from the WCCHR. The recruitment rate was 55%. PRIMARY AND SECONDARY OUTCOME MEASURES Themes and concepts in participants' health, knowledge, perceptions of and experiences with accessing healthcare and public benefits programmes. RESULTS Twenty-four participants represented 18 countries of origin and 11 primary languages. Several impediments to accessing healthcare and public benefits were identified, including pragmatic barriers (such as prohibitive costs or lack of insurance), knowledge gaps and mistrust of healthcare systems. CONCLUSIONS There is low health engagement by refugees and asylum seekers, as a result of multiple, complex factors impeding the ability of refugee and asylum seekers to access healthcare and other public benefits for which they are eligible-with resultant detrimental health effects. However, there is an opportunity to utilise novel approaches, such as digital technologies, to communicate relevant information regarding legal rights and public benefits to advance the health of vulnerable individuals such as refugees and asylum seekers.
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Affiliation(s)
- Tara C Pilato
- Emergency Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Faten Taki
- Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Kaitlyn Sbrollini
- Department of Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
| | - Amanda Purington Drake
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, New York, USA
| | - Brian Maley
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, New York, USA
| | | | - Jane L Powers
- Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, New York, USA
| | | | | | - Gunisha Kaur
- Anesthesiology, Weill Cornell Medicine, New York City, New York, USA
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16
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Patel I, Dev A. What is prenatal stress? A scoping review of how prenatal stress is defined and measured within the context of food insecurity, housing instability, and immigration in the United States. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231191091. [PMID: 37596926 PMCID: PMC10440065 DOI: 10.1177/17455057231191091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/20/2023] [Accepted: 07/13/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Stress during pregnancy can lead to significant adverse outcomes for maternal mental health. Early evaluation of prenatal stress can help identify treatment needs and appropriate interventions. Disparities in the social determinants of health can contribute to stress, but what constitutes stress during pregnancy within the social determinants of health framework is poorly understood. OBJECTIVE To scope how prenatal stress is defined and measured among pregnant people exposed to three prominent social stressors in the United States: insecurity pertaining to food, housing, and immigration. ELIGIBILITY CRITERIA We included all studies that focused on stress during pregnancy in the context of food insecurity, housing instability, and immigration, given their recent policy focus due to the COVID-19 pandemic and ongoing political discourse, in addition to their importance in American College of Obstetricians and Gynecologists (ACOG's) social determinants of health screening tool. SOURCES OF EVIDENCE We searched PubMed, Scopus, and Web of Science for articles published between January 2012 and January 2022. CHARTING METHODS Using a piloted charting tool, we extracted relevant study information from the selected articles and analyzed the content pertaining to stress. RESULTS An initial search identified 1,023 articles, of which 24 met our inclusion criteria. None of the studies defined prenatal stress, and only one used the Prenatal Distress Questionnaire, a prenatal stress-specific tool to measure it. The Perceived Stress Scale was the most common instrument used in seven studies. Fifteen studies measured over 25 alternative exposures that researchers theorized were associated with stress, and 4 of the 15 studies did not explain the association between the measure and stress. CONCLUSIONS Our findings demonstrate a fundamental inconsistency in how prenatal stress is defined and measured in the context of social determinants of health, limiting the comparison of results across studies and the potential development of effective interventions to promote better maternal mental health.
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Affiliation(s)
- Ishani Patel
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, USA
| | - Alka Dev
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Hanover, IL, USA
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17
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Damle M, Wurtz H, Samari G. Racism and health care: Experiences of Latinx immigrant women in NYC during COVID-19. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100094. [PMID: 35578651 PMCID: PMC9095080 DOI: 10.1016/j.ssmqr.2022.100094] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 01/12/2023]
Abstract
The COVID-19 pandemic has disproportionately affected minoritized racial groups, especially Latinx immigrants, evidenced by the high rates of COVID-19 infections, hospitalizations, and deaths among this population. With increasing xenophobia and anti-immigrant sentiment in parallel to the pandemic, it is critical to understand the perspectives of Latinx populations. This study explores Latinx immigrant women's perceptions of racism and xenophobia in their health care experiences in New York City (NYC) during the COVID-19 pandemic and, further, seeks to understand the role of perceived discrimination in health care settings and on health care access. Data were analyzed using a constant comparative method of analysis from twenty-one in-depth interviews conducted with foreign-born women in the five boroughs of New York City from diverse countries across Latin America. Four central themes emerged including: structural inequalities, discriminatory health care experiences, victimization in public institutions, and overcoming discrimination in health care settings. Latinx immigrant women described the ways in which perceptions and experiences of discrimination shaped their capacity to address health-related needs during the COVID-19 pandemic. This study provides evidence to a growing body of literature suggesting that structural racism and xenophobia and perceptions of anti-immigrant discrimination, including resulting structural inequalities, may have a negative effect on individuals' ability to access and engage the health care system, resulting in avoidance of health care services - a critical need during a global pandemic. Scholars, policymakers, and practitioners alike should be mindful of how racism and xenophobia shape Latinx immigrant communities' engagement with the health care system.
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Affiliation(s)
- Monika Damle
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Heather Wurtz
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Goleen Samari
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
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18
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Madimenos FC, Gildner TE, Eick GN, Sugiyama LS, Snodgrass JJ. Bringing the lab bench to the field: Point-of-care testing for enhancing health research and stakeholder engagement in rural/remote, indigenous, and resource-limited contexts. Am J Hum Biol 2022; 34:e23808. [PMID: 36166487 DOI: 10.1002/ajhb.23808] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
Point-of-care testing (POCT) allows researchers and health-care providers to bring the lab bench to the field, providing essential health information that can be leveraged to improve health care, accessibility, and understanding across clinical and research settings. Gaps in health service access are most pronounced in what we term RIR settings-rural/remote regions, involving Indigenous peoples, and/or within resource-limited settings. In these contexts, morbidity and mortality from infectious and non-communicable diseases are disproportionately higher due to numerous geographic, economic, political, and sociohistorical factors. Human biologists and global health scholars are well-positioned to contribute on-the-ground-level insights that can serve to minimize global health inequities and POCT has the potential to augment such approaches. While the clinical benefits of POCT include increasing health service access by bringing testing, rapid diagnosis, and treatment to underserved communities with limited pathways to centralized laboratory testing, POCT also provides added benefits to both health-focused researchers and their participants. Through portable, minimally invasive devices, researchers can provide actionable health data to participants by coupling POCT with population-specific health education, discussing results and their implications, creating space for participants to voice concerns, and facilitating linkages to treatment. POCT can also strengthen human biology research by shedding light on questions of evolutionary and biocultural importance. Here, we expand on the epidemiological and research value, as well as practical and ethical challenges of POCT across stakeholders (i.e., participant, community, health researcher, and trainee). Finally, we emphasize the immense opportunities of POCT for fostering collaborative research and enhancing access to health delivery and information and, by extension, helping to mitigate persistent global health inequities.
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Affiliation(s)
- Felicia C Madimenos
- Department of Anthropology, Queens College (CUNY), New York, USA.,New York Consortium of Evolutionary Primatology (NYCEP), CUNY Graduate Center, New York, USA
| | - Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | | | - James J Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA.,Global Station for Indigenous Studies and Cultural Diversity, Hokkaido University, Sapporo, Japan
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19
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Reproducibility and implementation of a rapid, community-based COVID-19 "test and respond" model in low-income, majority-Latino communities in Northern California. PLoS One 2022; 17:e0276257. [PMID: 36301834 PMCID: PMC9612491 DOI: 10.1371/journal.pone.0276257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate implementation of a community-engaged approach to scale up COVID-19 mass testing in low-income, majority-Latino communities. METHODS In January 2021, we formed a community-academic "Latino COVID-19 Collaborative" with residents, leaders, and community-based organizations (CBOs) from majority-Latinx, low-income communities in three California counties (Marin/Merced/San Francisco). The collaborative met monthly to discuss barriers/facilitators for COVID-19 testing, and plan mass testing events informed by San Francisco's Unidos en Salud "test and respond" model, offering community-based COVID-19 testing and post-test support in two US-census tracts: Canal (Marin) and Planada (Merced). We evaluated implementation using the RE-AIM framework. To further assess testing barriers, we surveyed a random sample of residents who did not attend the events. RESULTS Fifty-five residents and CBO staff participated in the Latino collaborative. Leading facilitators identified to increase testing were extended hours of community-based testing and financial support during isolation. In March-April 2021, 1,217 people attended mass-testing events over 13 days: COVID-19 positivity was 3% and 1% in Canal and Planada, respectively. The RE-AIM evaluation found: census tract testing coverage of 4.2% and 6.3%, respectively; 90% of event attendees were Latino, 89% had household income <$50,000/year, and 44% first-time testers (reach), effectiveness in diagnosing symptomatic cases early (median isolation time: 7 days) and asymptomatic COVID-19 (41% at diagnosis), high adoption by CBOs in both counties, implementation of rapid testing (median: 17.5 minutes) and disclosure, and post-event maintenance of community-based testing. Among 265 non-attendees surveyed, 114 (43%) reported they were aware of the event: reasons for non-attendance among the 114 were insufficient time (32%), inability to leave work (24%), and perceptions that testing was unnecessary post-vaccination (24%) or when asymptomatic (25%). CONCLUSION Community-engaged mass "test and respond" events offer a reproducible approach to rapidly increase COVID-19 testing access in low-income, Latinx communities.
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20
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Afzal MHB. The effects of the global health crisis on U. S. immigration policies: shifting political agenda-setting and the mobility crisis of immigrants. SN SOCIAL SCIENCES 2022; 2:185. [PMID: 36093426 PMCID: PMC9446627 DOI: 10.1007/s43545-022-00486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022]
Abstract
The continuing health crisis (COVID-19) reinforces a historical pattern in which partisan-elected officials engage as legislative policy entrepreneurs (LPE) and use the health crisis time as a policy window to advance specifically restricted agendas by (re)introducing immigration bills on the House and Senate. The current exploratory qualitative study utilizes the theoretical underpinning of Kingdon’s Multiple Streams Framework (MSF) to analyze the US House immigration bills from 2013 to 2021. The qualitative method of content relational analysis was applied in this research to capture the shifts and changes in (re)introduced immigration bills (n = 904) in the US House of Representatives for the 113th, 114th, 115th, and 116th sessions. Capturing and examining the underlying tone, word choices, and proposed measures in these immigration bills during health and non-health crisis periods received special attention. The qualitative relational content analysis revealed three major themes: (1) During public health crises (Ebola, Zika, and the first two years of COVID-19), restrictive House immigration bills tend to rise sharply; (2) Elected representatives from the Southern States are more likely to introduce restrictive immigration bills during health crises; and (3) Restrictive immigration bills are more likely to receive partisan support (bill co-sponsors) during health crises. The findings emphasize the need for inclusive agenda-setting during health crises and provide light on adaptive measures for supporting underprivileged immigrant communities with increased access to healthcare and public support.
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21
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Ro A, Bruckner TA, Huynh MP, Du S, Young A. Emergency Department Utilization Among Undocumented Latino Patients During the COVID-19 Pandemic. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01382-8. [PMID: 35982287 PMCID: PMC9388205 DOI: 10.1007/s40615-022-01382-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
Objective To determine whether Latino undocumented immigrants had a steeper decline in Emergency Department (ED) utilization compared to Latino Medi-Cal patients in a Los Angeles safety-net hospital, March 13, 2020, to May 8, 2020. Study Design The data were extracted from patient medical records for ED visits at LAC + USC Medical Center from January 2018 to September 2020. We analyzed weekly ED encounters among undocumented Latino patients in the nine-week period after COVID was declared a national emergency. We applied time-series routines to identify and remove autocorrelation in ED encounters before examining its relation with the COVID-19 pandemic. We included Latino patients 18 years of age and older who were either on restricted or full-scope Medi-Cal (n = 230,195). Results All low-income Latino patients, regardless of immigration status, experienced a significant decline in ED utilization during the first nine weeks of the pandemic. Undocumented patients, however, experienced an even steeper decline. ED visits for this group fall below expected levels between March 13, 2020, and May 8, 2020 (coef. = − 38.67; 95% CI = − 71.71, − 5.63). When applied to the weekly mean of ED visits, this translates to a 10% reduction below expected levels in ED visits during this time period. Conclusion Undocumented immigrants’ health care utilization was influenced by external events that occurred early in the pandemic, such as strict stay-at-home orders and the public charge rule change. Health care institutions and local policy efforts could work to ensure that hospitals are safer spaces for undocumented immigrants to receive care without immigration concerns.
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Affiliation(s)
- Annie Ro
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA.
| | - Tim A Bruckner
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Michael Pham Huynh
- Department of Health, Society, and Behavior, Anteater Instruction and Research Building (AIRB), UC Irvine Program in Public Health, 653 E. Peltason Road, Irvine, CA, 92697, USA
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Andrew Young
- Division of Geriatric, Hospital, Palliative and General Internal Medicine, Department of Medicine, Keck School of Medicine, Los Angeles, CA, USA
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22
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Shankar Mishra P, Jamadar M, Tripathy A, Anand A. Understanding the Socio-Economic Vulnerability in Child Malnutrition Between Migrants and Non-Migrants Children (12-59 Months) in India: Evidence from a Cross-Sectional Study. CHILD INDICATORS RESEARCH 2022; 15:1871-1888. [PMID: 35601140 PMCID: PMC9108133 DOI: 10.1007/s12187-022-09943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
India has witnessed increasing trends in internal migration over the last three decades. In India, migrant children are not a homogeneous group and their reasons for movement and vulnerabilities vary across socio-economic stratum. For some children, migration may open possibilities and is associated with expanding social and economic spheres, but for many others, it may bring serious risks. Therefore, the study has been carried out to understand socio-economic vulnerability in child nutrition with migration status and other contributing factors in India. This study used data from the National Family Health Survey, the fourth in the NFHS series which was conducted in 2015-2016 (NFHS-4). We were interested in looking at the children age 12-59 months for their nutritional indicators such as stunting and underweight across migrants and non-migrants children. This resulted in a sample of 199,448 children in selected age group and among them 33.1% children belongs to the migrant family as compared to 67% of non-migrant children. Overall, 44.2% of children were stunted and 39.5% were underweight among non-migrant children as compared to 37.4% & 32.8% of migrant children were stunted and underweight respectively. Further, the results showed that among the social groups, scheduled caste children were found a high variation in underweight (34% vs. 41.6%) and stunting (36% vs. 46%) between migrants and non-migrants children. Similar trend of malnourishment is found in the poor wealth quintile, for rural residents and low educated women with non-migrant status. Those children who were poor but non-migrant were more likely to be malnourished as underweight [aOR; 1.15, CI: 1.11-1.18] and stunted [aOR; 1.17, CI:1.13-1.20] as compared to migrant status children in the same category of the household. Similarly in reference to scheduled caste migrant group, the scheduled caste non-migrant were more likely to be underweight [aOR; 1.15, CI: 1.09-1.20] and stunted [aOR; 1.18, CI: 1.12-1.23] than the children with migrant status. There were huge differences between migrant and non-migrant children in nutritional statuses. Education, caste and wealth index are found to be an important variables to explain the differential between migrants and non-migrants in child's nutritional aspects. Children associated with poor socio-economic vulnerability and non-migrant category need to be taken care of more and a community targeted approach is required to understand the gaps. The programs such as ICDS, and Poshan Abhiyan need to be revamped adding the migration aspect of the families and children in terms of their health and nutritional aspects.
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Affiliation(s)
- Prem Shankar Mishra
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
| | - Mudassar Jamadar
- Centre for Research in Urban Affairs, Institute for Social and Economic Change, Bangalore, 560072 Karnataka India
| | - Abhipsa Tripathy
- Department of Statistics, Utkal University, Bhubaneswar, Odisha 751004 India
| | - Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
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Barriers and Facilitators to Prevention and Care of COVID-19 Infection in Cincinnati Latinx Families: a Community-Based Convergent Mixed Methods Study. J Racial Ethn Health Disparities 2022; 10:1067-1085. [PMID: 35411496 PMCID: PMC8999990 DOI: 10.1007/s40615-022-01294-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/08/2022] [Accepted: 03/25/2022] [Indexed: 11/25/2022]
Abstract
Background Latinx populations have experienced disproportionately high case rates of COVID-19 across the USA. Latinx communities in non-traditional migration areas may experience greater baseline day-to-day challenges such as a lack of resources for immigrants and insufficient language services. These challenges may be exacerbated by the COVID-19 pandemic. Objective This article describes the results of an initial community health needs assessment to better understand the prevention and care of COVID-19 infection in the Cincinnati Latinx community. Methods We used convergent mixed methods to examine barriers and facilitators to COVID-19 prevention and care for those with infection. Results Latinx adults ≥ 18 years old completed 255 quantitative surveys and 17 qualitative interviews. Overarching mixed methods domains included knowledge, prevention, work, challenges, and treatment. Quantitative results largely reinforced qualitative results (confirmation). Certain quantitative and qualitative results, however, diverged and expanded insights related to caring for COVID-19 infection among Latinx adults (expansion). There were infrequent contradictions between quantitative and qualitative findings (discordance). Primary barriers for the Latinx community during the COVID-19 pandemic included insecurities in food, jobs, housing, and immigration. Key facilitators included having trusted messengers of health-related information. Conclusion Public health interventions should be centered on community partnerships and the use of trusted messengers. Wraparound services (including resources for immigrants) are essential public health services. Close partnership with employers is essential as lack of sick leave and mask supplies were more frequent barriers than knowledge. These findings emerged from experiences during the COVID-19 pandemic but likely generalize to future public health crises. Supplementary Information The online version contains supplementary material available at 10.1007/s40615-022-01294-7.
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Systemic Racism and Undocumented Latino Migrant Laborers during COVID-19: A Narrative Review and Implications for Improving Occupational Health. J Migr Health 2022; 5:100106. [PMID: 35434678 PMCID: PMC9004221 DOI: 10.1016/j.jmh.2022.100106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
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25
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Blukacz A, Cabieses B, Mezones-Holguín E, Cardona Arias JM. Healthcare and social needs of international migrants during the COVID-19 pandemic in Latin America: analysis of the Chilean case. Glob Health Promot 2022; 29:119-128. [PMID: 35311402 PMCID: PMC9607989 DOI: 10.1177/17579759211067562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
International migrants are a particularly vulnerable group in the context of the coronavirus disease 2019 (COVID-19) pandemic. Immigrants in Chile tend to experience multidimensional poverty and layers of social vulnerability. Our analysis aims to describe the perceived social and health-related needs of international migrants during the COVID-19 pandemic in Chile in terms of migration as a social determinant of health and layered social vulnerability. We carried out a qualitative analysis of responses to an open-ended question focused on the social and health-related needs linked to the pandemic included in an online questionnaire disseminated during April 2020 aimed at international migrants residing in Chile. The information gathered was thematically analysed. We included 1690 participants. They expressed needs related to health and others linked to the overall socio-economic and political response, employment, material conditions and psychosocial aspects. They also reported needs related to ‘being a migrant’. Additionally, some participants described situations of vulnerability. We analysed their needs and situations of vulnerability identified around the following emerging frames: (a) work and living conditions, (b) regularisation traps and perceived lack of support and (c) and physical and mental health needs. International migrants in Chile report experiencing interrelated layers of social vulnerability during the COVID-19 pandemic, where ‘being a migrant’ exacerbates physical and mental health risks. The issues revealed are immediate and direct public health challenges, as well as different aspects of social vulnerability linked to migratory status, employment and barriers to accessing healthcare that should be addressed through comprehensive policies and measures.
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Affiliation(s)
- Alice Blukacz
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
| | - Báltica Cabieses
- Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
| | - Edward Mezones-Holguín
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola (USIL), La Molina, Lima, Peru
- Epi-gnosis Solutions, Piura, Peru
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(Not That) Essential: A Scoping Review of Migrant Workers' Access to Health Services and Social Protection during the COVID-19 Pandemic in Australia, Canada, and New Zealand. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052981. [PMID: 35270672 PMCID: PMC8909973 DOI: 10.3390/ijerph19052981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 11/22/2022]
Abstract
Migrant workers have been disproportionately affected by the COVID-19 pandemic. To examine their access to health services and social protection during the pandemic, we conducted an exploratory scoping review on experiences of migrant workers in three countries with comparable immigration, health, and welfare policies: Australia, Canada, and New Zealand. After screening 961 peer-reviewed and grey literature sources, five studies were included. Using immigration status as a lens, we found that despite more inclusive policies in response to the pandemic, temporary migrant workers, especially migrant farm workers and international students, remained excluded from health services and social protection. Findings demonstrate that exploitative employment practices, precarity, and racism contribute to the continued exclusion of temporary migrant workers. The interplay between these factors, with structural racism at its core, reflect the colonial histories of these countries and their largely neoliberal approaches to immigration. To address this inequity, proactive action that recognizes and targets these structural determinants at play is essential.
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Mann‐Jackson L, Ravindran S, Perez A, Linton JM. Navigating immigration policy and promoting health equity: Practical strategies for clinicians. J Hosp Med 2022; 17:220-224. [PMID: 35504526 PMCID: PMC9305560 DOI: 10.1002/jhm.12792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Lilli Mann‐Jackson
- Department of Social Sciences and Health Policy, CTSI Program in Community-Engaged ResearchWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Senthuran Ravindran
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Alexander Perez
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
| | - Julie M. Linton
- Departments of Medicine and PediatricsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
- Department of PediatricsPrisma Health UpstateGreenvilleSouth CarolinaUSA
- Office of Student Affairs and AdmissionsUniversity of South Carolina School of Medicine GreenvilleGreenvilleSouth CarolinaUSA
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COVID-19 vaccination intention and behavior in a large, diverse, U.S. refugee population. Vaccine 2022; 40:1231-1237. [PMID: 35125223 PMCID: PMC8806127 DOI: 10.1016/j.vaccine.2022.01.057] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/08/2022] [Accepted: 01/26/2022] [Indexed: 11/23/2022]
Abstract
Introduction Refugees often face increased risk of exposure to COVID-19 due to their disproportionate representation in the essential workforce and crowded household conditions. There is a paucity of data about risk factors for under-immunization for COVID-19 among refugees. Methods Refugees were surveyed in two phases that corresponded to before and after wide availability of COVID-19 vaccines. Participants were asked about their attitudes, and perceptions about COVID-19, previous acceptance of vaccines, sources utilized to obtain trusted health information, and intent to get vaccinated. The overall participant vulnerability was assessed using the social vulnerability index. In-depth semi-structured interviews were completed with key stakeholders through snowball sampling. Results Of 247 refugees, 244 agreed to participate in the initial survey. Among those, 140 (57.4%) intended to get vaccinated, 43 (17.6%) were unsure, and 61 (25%) did not intend to get vaccinated. In the follow up survey, all 215 who were reached, agreed to provide information about their vaccination status. Among those respondents, 141 (65.6%) were either vaccinated or expressed intent to do so, and 74 (34.4%) remained hesitant. We did not observe any significant correlation between socio-demographic variables, country of origin, and vaccination status/intent. Among those who initially intended to get vaccinated, nearly 1 in 5 changed their mind and decided to forego vaccination, and among those who initially did not plan getting vaccinated, 1 in 3 changed their mind and got vaccinated. Fears related to the vaccine, concerns that the vaccine is religiously prohibited, “wait and see” how others did with the vaccine, communication and transportation barriers were commonly cited as reason not to get vaccinated. Conclusions Over a third of refugees in our study were hesitant to get vaccinated. Refugees desired additional education about the benefits and safety of vaccines along with easier access to vaccination clinics in their communities.
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Berardi C, Lee ES, Wechtler H, Paolucci F. A vicious cycle of health (IN)equity: Migrant inclusion in light of COVID-19. HEALTH POLICY AND TECHNOLOGY 2022; 11:100606. [PMID: 35194550 PMCID: PMC8853963 DOI: 10.1016/j.hlpt.2022.100606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives Methods Results Conclusions
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Affiliation(s)
- Chiara Berardi
- Newcastle Business School, University of Newcastle, 409 Hunter Street, Newcastle, NSW, Australia
| | - Eun Su Lee
- Newcastle Business School, University of Newcastle, 409 Hunter Street, Newcastle, NSW, Australia
| | - Heidi Wechtler
- Newcastle Business School, University of Newcastle, 409 Hunter Street, Newcastle, NSW, Australia
| | - Francesco Paolucci
- Newcastle Business School, University of Newcastle, 409 Hunter Street, Newcastle, NSW, Australia
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Hasan Bhuiyan MT, Mahmud Khan I, Rahman Jony SS, Robinson R, Nguyen USDT, Keellings D, Rahman MS, Haque U. The Disproportionate Impact of COVID-19 among Undocumented Immigrants and Racial Minorities in the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12708. [PMID: 34886437 PMCID: PMC8656825 DOI: 10.3390/ijerph182312708] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/22/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), has had an unprecedented effect, especially among under-resourced minority communities. Surveillance of those at high risk is critical for preventing and controlling the pandemic. We must better understand the relationships between COVID-19-related cases or deaths and characteristics in our most vulnerable population that put them at risk to target COVID-19 prevention and management efforts. Population characteristics strongly related to United States (US) county-level data on COVID-19 cases and deaths during all stages of the pandemic were identified from the onset of the epidemic and included county-level socio-demographic and comorbidities data, as well as daily meteorological modeled observation data from the North American Regional Reanalysis (NARR), and the NARR high spatial resolution model to assess the environment. Advanced machine learning (ML) approaches were used to identify outbreaks (geographic clusters of COVID-19) and included spatiotemporal risk factors and COVID-19 vaccination efforts, especially among vulnerable and underserved communities. COVID-19 outcomes were found to be negatively associated with the number of people vaccinated and positively associated with age, the prevalence of cardiovascular disease, diabetes, and the minority population. There was also a strong positive correlation between unauthorized immigrants and the prevalence of COVID-19 cases and deaths. Meteorological variables were also investigated, but correlations with COVID-19 were relatively weak. Our findings suggest that COVID-19 has had a disproportionate impact across the US population among vulnerable and minority communities. Findings also emphasize the importance of vaccinations and tailored public health initiatives (e.g., mask mandates, vaccination) to reduce the spread of COVID-19 and the number of COVID-19 related deaths across all populations.
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Affiliation(s)
- Mohammad Tawhidul Hasan Bhuiyan
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Irtesam Mahmud Khan
- Department of Computer Science and Engineering, United International University, Dhaka 1212, Bangladesh;
| | - Sheikh Saifur Rahman Jony
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Renee Robinson
- Department of Pharmacy Practice and Administration, University of Alaska Anchorage/Idaho State University, Anchorage, AK 99508, USA;
| | - Uyen-Sa D. T. Nguyen
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76177, USA;
| | - David Keellings
- Department of Geography, University of Florida, Gainesville, FL 32611, USA;
| | - M. Sohel Rahman
- Department of Computer Science & Engineering, Bangladesh University of Engineering & Technology, West Palasi, Dhaka 1205, Bangladesh; (M.T.H.B.); (S.S.R.J.); (M.S.R.)
| | - Ubydul Haque
- Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX 76177, USA;
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Ma KPK, Bacong AM, Kwon SC, Yi SS, Ðoàn LN. The Impact of Structural Inequities on Older Asian Americans During COVID-19. Front Public Health 2021; 9:690014. [PMID: 34490181 PMCID: PMC8417937 DOI: 10.3389/fpubh.2021.690014] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/21/2021] [Indexed: 12/27/2022] Open
Abstract
Structural racism manifests as an historical and continued invisibility of Asian Americans, whose experiences of disparities and diverse needs are omitted in research, data, and policy. During the pandemic, this invisibility intersects with rising anti-Asian violence and other persistent structural inequities that contribute to higher COVID-19 mortality in older Asian Americans compared to non-Hispanic whites. This perspective describes how structural inequities in social determinants of health-namely immigration, language and telehealth access, and economic conditions-lead to increased COVID-19 mortality and barriers to care among older Asian Americans. Specifically, we discuss how the historically racialized immigration system has patterned older Asian immigrant subpopulations into working in frontline essential occupations with high COVID-19 exposure. The threat of "public charge" rule has also prevented Asian immigrants from receiving eligible public assistance including COVID-19 testing and vaccination programs. We highlight the language diversity among older Asian Americans and how language access remains unaddressed in clinical and non-clinical services and creates barriers to routine and COVID-19 related care, particularly in geographic regions with small Asian American populations. We discuss the economic insecurity of older Asian immigrants and how co-residence in multigenerational homes has exposed them to greater risk of coronavirus transmission. Using an intersectionality-informed approach to address structural inequities, we recommend the disaggregation of racial/ethnic data, meaningful inclusion of older Asian Americans in research and policy, and equitable investment in community and multi-sectoral partnerships to improve health and wellbeing of older Asian Americans.
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Affiliation(s)
- Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Adrian Matias Bacong
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Simona C. Kwon
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Stella S. Yi
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
| | - Lan N. Ðoàn
- Department of Population Health, Section for Health Equity, New York University Grossman School of Medicine, New York, NY, United States
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Mukumbang FC. Pervasive systemic drivers underpin COVID-19 vulnerabilities in migrants. Int J Equity Health 2021; 20:146. [PMID: 34158073 PMCID: PMC8217782 DOI: 10.1186/s12939-021-01487-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
Asylum seekers, refugees and undocumented foreign nationals have always been identified as a vulnerable population owing to the longstanding structural barriers and inequalities that they continually face. Their vulnerabilities have become more conspicuous and exacerbated since the advent of the Coronavirus disease of 2019 (COVID-19) pandemic. The plights of these migrants around the world, in the COVID-19 era, are therefore underpinned by not-so-new but enforced, re-emerging and adapting pre-existing systemic inequality drivers. Long-standing and pre-existing systemic drivers such as nationalism and anti-migrant or xenophobic stigma, in the context of the COVID-19 pandemic, have metamorphosed into COVID-19 nationalism and COVID-19-related xenophobic stigma respectively, fomenting discriminatory and segregation-laden policies and programmes. Transformative changes of asylum policies taking holistic and systematic perspectives while fostering the involvement of migrants in government planning and policy processes to redesign better policies are required to tackle the pervasive systemic drivers that underpin COVID-19 vulnerabilities in the identified migrant groups.
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Affiliation(s)
- Ferdinand C Mukumbang
- Department of Global Health, School of Medicine, University of Washington, Seattle, USA.
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