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Torres CIH, Gold R, Kaufmann J, Marino M, Hoopes MJ, Totman MS, Aceves B, Gottlieb LM. Social Risk Screening and Response Equity: Assessment by Race, Ethnicity, and Language in Community Health Centers. Am J Prev Med 2023; 65:286-295. [PMID: 36990938 PMCID: PMC10652909 DOI: 10.1016/j.amepre.2023.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/31/2023]
Abstract
INTRODUCTION Little has previously been reported about the implementation of social risk screening across racial/ethnic/language groups. To address this knowledge gap, the associations between race/ethnicity/language, social risk screening, and patient-reported social risks were examined among adult patients at community health centers. METHODS Patient- and encounter-level data from 2016 to 2020 from 651 community health centers in 21 U.S. states were used; data were extracted from a shared Epic electronic health record and analyzed between December 2020 and February 2022. In adjusted logistic regression analyses stratified by language, robust sandwich variance SE estimators were applied with clustering on patient's primary care facility. RESULTS Social risk screening occurred at 30% of health centers; 11% of eligible adult patients were screened. Screening and reported needs varied significantly by race/ethnicity/language. Black Hispanic and Black non-Hispanic patients were approximately twice as likely to be screened, and Hispanic White patients were 28% less likely to be screened than non-Hispanic White patients. Hispanic Black patients were 87% less likely to report social risks than non-Hispanic White patients. Among patients who preferred a language other than English or Spanish, Black Hispanic patients were 90% less likely to report social needs than non-Hispanic White patients. CONCLUSIONS Social risk screening documentation and patient reports of social risks differed by race/ethnicity/language in community health centers. Although social care initiatives are intended to promote health equity, inequitable screening practices could inadvertently undermine this goal. Future implementation research should explore strategies for equitable screening and related interventions.
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Affiliation(s)
| | - Rachel Gold
- Center for Health Research, Kaiser Permanente and OCHIN, Inc., Portland, Oregon
| | | | - Miguel Marino
- Department of Family Medicine, OHSU, Portland, Oregon
| | | | - Molly S Totman
- Quality, Community Care Cooperative, Boston, Massachusetts
| | - Benjamín Aceves
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California
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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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Chicas R, Xiuhtecutli N, Houser M, Glastra S, Elon L, Sands JM, McCauley L, Hertzberg V. COVID-19 and Agricultural Workers: A Descriptive Study. J Immigr Minor Health 2022; 24:58-64. [PMID: 34637039 PMCID: PMC8507360 DOI: 10.1007/s10903-021-01290-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/16/2022]
Abstract
Agricultural workers, designated as "essential" at the start of the COVID-19 pandemic, work in harsh labor conditions, and now have the added challenge of continuing to work during the COVID-19 pandemic. The aim of this study was to assess agricultural workers' COVID-19 related history, employer-based safety measures, individual preventive practices, and COVID-19 vaccination uptake. A questionnaire study was conducted among agricultural workers in Central Florida about COVID-19 during the month of June 2020 and again in July 2021. Among 92 agricultural workers in June 2020, 47% were obese; 11% had had a COVID-19 nasal test; 87% were able to social distance at work and 34% reported employer provided face masks; 15% reported not willing to get the COVID-19 vaccine and 25% were unsure. 40% could self-isolate if they contracted COVID-19. In a follow-up visit in July 2021, 53% of participants reported receiving a COVID-19 vaccine. Agricultural workers are particularly vulnerable to COVID-19 due to existing health risk factors and lack of essential protective resources. Occupational health protections social safety net programs are urgently needed to prevent infections in vulnerable workers, and reduce community spread, and increase COVID-19 vaccination rates.
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Affiliation(s)
- Roxana Chicas
- Division of Renal Medicine, Department of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Nezahualcoyotl Xiuhtecutli
- Anthropology Department, Tulane University, New Orleans, LA, USA
- Farmworker Association of Florida, Apopka, FL, USA
| | - Madelyn Houser
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Sanne Glastra
- Department of Quantitative Theory and Methods, Emory College of Arts and Science, Emory University, Atlanta, GA, USA
| | - Lisa Elon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jeff M Sands
- Division of Renal Medicine, Department of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, USA
| | - Linda McCauley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Vicki Hertzberg
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Mann-Jackson L, Simán FM, Hall MA, Alonzo J, Linton JM, Rhodes SD. State Preemption of Municipal Laws and Policies that Protect Immigrant Communities: Impact on Latine Health and Well-Being in North Carolina. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2022; 59:469580221087884. [PMID: 35343266 PMCID: PMC8961392 DOI: 10.1177/00469580221087884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Some U.S. municipalities have proclaimed themselves "sanctuary cities" and/or adopted laws and policies limiting local involvement in enforcement of federal immigration policies. Several states, however, have adopted laws that preempt municipal laws and policies designed to protect immigrants. We explored the consequences of House Bill (H.B.) 318, one such preemption law in North Carolina (NC), on the health and well-being of Latine immigrants. METHODS We conducted focus groups with Latine immigrants (n=49) and in-depth interviews with representatives from health, social service, and immigrant-serving organizations and local government (including law enforcement) (n=21) in NC municipalities that, before HB 318, adopted laws and policies supporting immigrants. Data were analyzed using constant comparison. RESULTS Twelve themes emerged, including the positive impacts of municipal sanctuary laws and policies are limited by preemption and other state and federal actions; laws and policies like HB 318 are confusing, have a chilling effect on health services use, and make life harder overall for Latine communities; intensified federal immigration enforcement has increased fear among Latine communities; Trump administration policies worsened anti-immigrant climates; and use of community identification cards and greater information dissemination and inter-organization coordination can lessen the consequences of preemption and other restrictive laws and policies. CONCLUSION State preemption of protective municipal laws and policies negatively and profoundly affects immigrant health and well-being. However, creative strategies have been implemented to respond to preemption. These findings provide critical data for decision-makers and community leaders regarding the detrimental impacts of preemption laws and mitigation of these impacts.
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Affiliation(s)
- Lilli Mann-Jackson
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | | | - Mark A. Hall
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- Wake Forest University School of
Law, Winston-Salem, NC, USA
| | - Jorge Alonzo
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
| | - Julie M. Linton
- University of South Carolina (UofSC)
School of Medicine Greenville, Greenville, SC, USA
- Prisma Health Upstate, Greenville, SC, USA
| | - Scott D. Rhodes
- Department of Social Sciences and
Health Policy, Wake Forest School of
Medicine, Winston-Salem, NC, USA
- CTSI Program in Community-Engaged
Research, Wake Forest School of
Medicine, Winston-Salem, NC, USA
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Lee J, Bruce J, Wang NE. Opportunities for Supporting Latino Immigrants in Emergency and Ambulatory Care Settings. J Community Health 2020; 46:494-501. [PMID: 32700173 PMCID: PMC7373833 DOI: 10.1007/s10900-020-00889-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
Abstract
Toughened immigration policies exacerbate barriers to public benefits and health care for immigrants. The objective of this study is to examine the impact of the immigration climate on the utilization of pediatric emergency and ambulatory care services and elucidate ways to best support Latino immigrant families. This is a cross-sectional study involving surveys and interviews with Latino parents (≥ 18 years) in the pediatric emergency department. Forty-five parents completed surveys and 40 were interviewed. We identified two themes on health care utilization: fear of detention and deportation in health care settings, and barriers to pediatric primary care; and two themes on how pediatric providers can best support Latinos: information and guidance on immigration policies, and reassurance and safety during visits. Despite immigration fears, Latino parents continue to seek health care for their children. This highlights the unique access that pediatric providers have to this vulnerable population to address immigration fears and establish trust in the health care system. Health care providers are also perceived as trusted figures from whom Latino families want more information on the latest immigration policies, immigration resources, and education on legal rights during medical visits.
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Affiliation(s)
- July Lee
- Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, X240, Stanford, CA, 94305, USA.
| | - Janine Bruce
- Department of Pediatrics, Stanford University School of Medicine, 1265 Welch Road, X240, Stanford, CA, 94305, USA
| | - Nancy Ewen Wang
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA, USA
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