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Afable A, Salisu M, Blackwell T, Divittis A, Hoglund M, Lewis G, Boutin-Foster C, Douglas M. Community design of the Brooklyn Health Equity Index. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae112. [PMID: 39301412 PMCID: PMC11412247 DOI: 10.1093/haschl/qxae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/17/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
Health equity drives quality care. Few reliable metrics that capture patients' perceptions of health equity exist. We report on the development of a patient-centered metric for health systems change in central Brooklyn, which stands out as an outlier in New York City with a disproportionate burden of poverty, disease, and death. A community-engaged, sequential, mixed-methods research design was used. Qualitative interviews were conducted with 80 community and health care stakeholders across central Brooklyn. Candidate items were derived from qualitative themes and examined for face, interpretive validity, and language. Interitem reliability and confirmatory factor analysis was assessed using data collected via text and automated discharge calls among 368 patients from a local hospital. Qualitative data analysis informed the content of 11 draft questions covering 3 broad domains: trust-building, provider appreciation of social determinants of health, and experiences of discrimination. Psychometric testing resulted in a Cronbach's alpha of 0.774 and led to deletion of 1 item, resulting in a 10-item Brooklyn Health Equity Index (BKHI). The 10-item BKHI is a novel, brief, and reliable measure that captures patients' perceptions of inequities and offers a real-time measure for health systems and payors to monitor progress toward advancing health equity.
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Affiliation(s)
- Aimee Afable
- School of Public Health, Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Margaret Salisu
- Department of Medicine, Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Tenya Blackwell
- Arthur Ashe Institute for Urban Health, Brooklyn, NY 11203, United States
| | - Anthony Divittis
- Ambulatory Services, One Brooklyn Health, Brooklyn, NY 11238, United States
| | - Mark Hoglund
- School of Public Health, Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Gwendolyn Lewis
- Ambulatory Services, One Brooklyn Health, Brooklyn, NY 11238, United States
| | - Carla Boutin-Foster
- Department of Medicine, Downstate Health Sciences University, Brooklyn, NY 11203, United States
| | - Montgomery Douglas
- Department of Family and Community Medicine, Downstate Health Sciences University, Brooklyn, NY 11203, United States
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Cartwright AF, Braccia A, Chiu DW, Jones RK. Characteristics of foreign-born abortion patients in the United States, 2021-2022. Contraception 2024:110553. [PMID: 39089664 DOI: 10.1016/j.contraception.2024.110553] [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: 04/05/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study aimed to examine the characteristics of foreign-born abortion patients compared to those born in the Unites States and to explore whether barriers for foreign-born patients varied by state Medicaid coverage of abortion care. STUDY DESIGN We used data from the Guttmacher Institute's 2021-2022 Abortion Patient Survey, a national sample of patients obtaining clinic-based abortion care in the United States. We compared sociodemographic characteristics of foreign- and US born respondents, as well as barriers to care. Among foreign-born patients, we compared those in Medicaid coverage states vs states that restrict Medicaid coverage. RESULTS Some 12% of the 6429 respondents were born outside the United States. Compared to US born patients, they were less likely to have Medicaid coverage and more likely to be Asian/Native Hawaiian/Pacific Islander or Hispanic, to have no health insurance, and to have completed the survey in Spanish. In addition, foreign-born patients were more likely to report delays because they did not know where to get an abortion (18.3% vs. 12.6% for US born). Compared to foreign-born patients living in Medicaid coverage states, those in non-Medicaid states reported multiple barriers, particularly related to cost: respondents in non-Medicaid states were three times as likely to pay out of pocket for abortion (75.8% vs 27.4%) and five times more likely to rely on financial assistance (24.1% vs 4.8%). CONCLUSIONS Foreign-born abortion patients face knowledge and financial barriers to accessing abortion care compared to those who are US born, and these financial burdens are amplified for those living in non-Medicaid coverage states. IMPLICATIONS Abortion patients born outside the United States may have overcome many obstacles to obtain care. Expanding state Medicaid coverage of abortion could reduce cost burdens for foreign-born populations.
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Abularrage TF, Wurtz HM, Samari G. Responding to structural inequities: Coping strategies among immigrant women during COVID-19. SSM - MENTAL HEALTH 2024; 5:100293. [PMID: 38910842 PMCID: PMC11192517 DOI: 10.1016/j.ssmmh.2023.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Examining coping strategies and resilience among immigrant communities reflects a commitment to working with immigrant communities to understand their needs while also identifying and building upon their strengths. In the United States, the physical, emotional, and economic impacts of the COVID-19 pandemic intersected with existing structural inequities to produce distinct challenges and stressors related to the pandemic, immigration, caregiving responsibilities, and structural xenophobia. Leveraging an understanding of the multilevel effects of stress, this qualitative study explores individual, interpersonal, and community-level coping strategies immigrant women used to respond to, alleviate, or reduce distress related to these compounding stressors. Using semi-structured in-depth interviews conducted in 2020 and 2021 with 44 first- and second-generation cisgender immigrant women from different national origins and 19 direct service providers serving immigrant communities in New York City, data were coded and analyzed using a constant comparative approach. Four central themes were identified: caregiving as a source of strength, leveraging resources, social connections, and community support. While women described a range of coping strategies they used to manage stressors and challenges, perspectives from direct service providers also connect these coping strategies to the harm-generating institutions, policies, and structures that produce and uphold structural oppression and inequities. Accounts from service providers point to the detrimental long-term effects of prolonged coping, underscoring a duality between resilience and vulnerability. Exploring the coping strategies cisgender immigrant women used to ease distress and promote resilience during a period of heightened structural vulnerability is critical to centering the experiences of immigrant women while simultaneously directing attention towards addressing the fundamental causes of cumulative disadvantage and the systems and structures through which it is transmitted.
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Affiliation(s)
- Tara F. Abularrage
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Heather M. Wurtz
- Anthropology Department, University of Connecticut, Storrs, CT, USA
- Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, CT, USA
- Population Studies and Training Center, Brown University, Providence, RI, USA
| | - Goleen Samari
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Samari G, Wurtz HM, Desai S, Coleman-Minahan K. Perspectives from the pandemic epicenter: Sexual and reproductive health of immigrant women in New York City. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2024; 56:136-146. [PMID: 38571367 DOI: 10.1111/psrh.12260] [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] [Indexed: 04/05/2024]
Abstract
CONTEXT The United States' response to COVID-19 created a policy, economic, and healthcare provision environment that had implications for the sexual and reproductive health (SRH) of racialized and minoritized communities. Perspectives from heterogenous immigrant communities in New York City, the pandemic epicenter in the United States (US), provides a glimpse into how restrictive social policy environments shape contraception, abortion, pregnancy preferences, and other aspects of SRH for marginalized immigrant communities. METHODS We conducted in-depth interviews in 2020 and 2021 with 44 cisgender immigrant women from different national origins and 19 direct service providers for immigrant communities in New York City to explore how immigrants were forced to adapt their SRH preferences and behaviors to the structural barriers of the COVID-19 pandemic. We coded and analyzed the interviews using a constant comparative approach. RESULTS Pandemic-related fears and structural barriers to healthcare access shaped shifts in contraceptive use and preferences among our participants. Immigrant women weighed their concerns for health and safety and the potential of facing discrimination as part of their contraceptive preferences. Immigrants also described shifts in their pregnancy preferences as rooted in concerns for their health and safety and economic constraints unique to immigrant communities. CONCLUSION Understanding how immigrant women's SRH shifted in response to the structural and policy constraints of the COVID-19 pandemic can reveal how historically marginalized communities will be impacted by an increasingly restrictive reproductive health and immigration policy landscape.
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Affiliation(s)
- Goleen Samari
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Heather M Wurtz
- Anthropology Department, University of Connecticut, Storrs, Connecticut, USA
- Research Program on Global Health & Human Rights, Human Rights Institute, University of Connecticut, Storrs, Connecticut, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Sheila Desai
- Coalition to Expand Contraceptive Access, Oakland, California, USA
| | - Kate Coleman-Minahan
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Cleaveland C, Lee M, Gewa C. "I thought I was going to die there:" Socio-political contexts and the plight of undocumented Latinx in the COVID-19 pandemic. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100242. [PMID: 36846649 PMCID: PMC9938958 DOI: 10.1016/j.ssmqr.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/04/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
Since the beginning of the COVID-19 pandemic, certain U.S. population groups have suffered higher rates of infection and mortality than whites, including Latinx. Public health officials blamed these outcomes on overcrowded housing and work in essential industries prior to the vaccine's availability. We sought to illuminate the lived experience of these factors through a qualitative study of undocumented Latinx immigrant workers in the secondary economy (n = 34). This study focuses on the intersectionality of social locations for undocumented Latinx immigrants living in a relatively affluent suburb and working in the construction and service sectors prior to the pandemic. Their narratives revealed how the pandemic created financial precarity through prolonged periods of unemployment and food insecurity. Workers described worry over unpaid bills, and potentially catastrophic episodes in which they treated severe COVID-19 with home remedies. Long spells of unemployment, food insecurity, inability to pay bills and lack of access to healthcare emerged because of socio-political contexts including the nature of low-wage labor and lack of a safety net.
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Allen JD, Fu Q, Shrestha S, Nguyen KH, Stopka TJ, Cuevas A, Corlin L. Medical mistrust, discrimination, and COVID-19 vaccine behaviors among a national sample U.S. adults. SSM Popul Health 2022; 20:101278. [PMID: 36407121 PMCID: PMC9652159 DOI: 10.1016/j.ssmph.2022.101278] [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: 07/05/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background COVID-19 vaccine uptake has been suboptimal and disparities in uptake have exacerbated health inequities. It has been postulated that mistrust in the healthcare system and experiences of discrimination or unfair treatment in other settings may be barriers to uptake of the COVID-19 vaccine, although few studies to date have investigated medical mistrust and perceived discrimination together. Method We conducted a cross-sectional online survey between April 23-May 3, 2021, among a national sample of U.S. adults ages 18 years and older. We assessed receipt of and intention to be vaccinated for COVID-19 and associations with the validated Medical Mistrust Index and Everyday Discrimination Scale. Results 1449 individuals responded, of whom 70.2% either had ≥1 dose of COVID-19 vaccine or reported that they were 'very' or 'somewhat' likely to be vaccinated in the future. In bivariate analyses, vaccination status was significantly associated with age, race/ethnicity, education, income, employment, marital status, health insurance, and political party affiliation. In multivariable analyses comparing those who had ≥1 vaccine dose or were likely to get vaccinated in the future with those who had not had any vaccine doses or did not intend to be vaccinated, each additional point in the Medical Mistrust Index was independently associated with a 16% decrease in the odds of vaccination (adjusted odds ratio = 0.84; 95% confidence interval = 0.81, 0.86). Discriminatory experiences were not associated with vaccination behavior or intention in bivariate or multivariable analyses. Conclusions Medical mistrust is significantly associated with vaccination status and intentions. Increasing uptake of COVID-19 vaccines will likely require substantive efforts on the part of public health and healthcare officials to build trust with those who are not yet fully vaccinated. We recommend that these efforts focus on building the 'trustworthiness' of these entities, an approach that will require a paradigm shift away from a focus on correcting individual beliefs and knowledge, to acknowledging and addressing the root causes underlying mistrust.
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Affiliation(s)
- Jennifer D. Allen
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Shikhar Shrestha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Kimberly H. Nguyen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Thomas J. Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Adolfo Cuevas
- Department of Community Health, Tufts University, 574 Boston Ave, Medford, MA, 02155, USA
| | - Laura Corlin
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA
- Department of Civil and Environmental Engineering, Tufts University School of Engineering, 200 College Ave, Medford, MA, 02155, USA
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