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James TG, Sullivan MK, McKee MM, Rotoli J, Maruca D, Stachowiak R, Cheong J, Varnes JR. Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients. Health Expect 2023; 26:2374-2386. [PMID: 37555478 PMCID: PMC10632638 DOI: 10.1111/hex.13842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/20/2023] [Accepted: 07/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients. METHODS This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach. RESULTS Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes. CONCLUSIONS This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine. PATIENT OR PUBLIC CONTRIBUTION This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.
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Affiliation(s)
- Tyler G. James
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | | | - Michael M. McKee
- Department of Family MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Jason Rotoli
- Department of Emergency MedicineUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | | | | | - JeeWon Cheong
- Department of Health Education and BehaviorUniversity of FloridaGainesvilleFloridaUSA
| | - Julia R. Varnes
- Department of Health Services Research, Management, and PolicyUniversity of FloridaGainesvilleFloridaUSA
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Deaf Children Need Rich Language Input from the Start: Support in Advising Parents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111609. [PMID: 36360337 PMCID: PMC9688581 DOI: 10.3390/children9111609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 01/25/2023]
Abstract
Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.
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Moreland CJ, Meeks LM, Nahid M, Panzer K, Fancher TL. Exploring accommodations along the education to employment pathway for deaf and hard of hearing healthcare professionals. BMC MEDICAL EDUCATION 2022; 22:345. [PMID: 35524331 PMCID: PMC9073820 DOI: 10.1186/s12909-022-03403-w] [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: 08/19/2021] [Accepted: 04/24/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Deaf and hard of hearing (DHH) people are an underserved population and underrepresented among healthcare professionals. A major barrier to success for DHH healthcare professionals is obtaining effective accommodations during education and employment. Our objective: describe DHH individuals' experiences with accommodations in healthcare education. METHODS We used an online survey and multipronged snowball sampling to recruit participants who identify as DHH and who had applied to a U.S. health professional school (regardless of acceptance status). One hundred forty-eight individuals representing multiple professions responded; 51 had completed their training. Over 80% had been accepted to, were currently enrolled, or had completed health professions schools or residency programs, and/or were employed. The survey included questions addressing experiences applying to health professions programs and employment; satisfaction with accommodations in school and training; having worked with a disability resource professional (DRP); and depression screening. RESULTS Use and type of accommodation varied widely. While in school, respondents reported spending a mean of 2.1 h weekly managing their accommodations. Only 50% were highly satisfied with the accommodations provided by their programs. Use of disability resource providers (DRPs) for accommodations was highest during school (56%) and less frequent during post-graduate training (20%) and employment (14%). Respondents who transitioned directly from school to employment (versus via additional training) were more satisfied with their accommodations during school and were more likely to find employment (p = 0.02). Seventeen respondents screened positive for risk of depression; a positive screen was statistically associated with lower school accommodation satisfaction. CONCLUSIONS DHH people study and practice across many health professions. While respondents were mostly successful in entering health professions programs, accommodation experiences and satisfaction varied. Satisfaction with accommodations was related to successful employment and wellness. Low satisfaction was associated with higher likelihood of depression symptoms. To increase representation in the workforce, healthcare professional schools, training programs, and employers should enhance support for the learning and working climates for people with disabilities.
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Affiliation(s)
- C. J. Moreland
- Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, 1601 Trinity St, Bldg B, Austin, TX 78712 USA
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
| | - L. M. Meeks
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104-1213 USA
| | - M. Nahid
- General & Internal Medicine, Weil Cornell Medicine, 420 E 70th St., New York, NY 10021 USA
| | - K. Panzer
- Department of Family Medicine, University of Michigan Medical School, 1018 Fuller St., Ann Arbor, MI 48104-1213 USA
| | - T. L. Fancher
- Center for a Diverse Healthcare Workforce, University of California, Davis, School of Medicine, Sacramento, CA USA
- Department of Internal Medicine, UC Davis School of Medicine, 4610 X Street, #4101, Sacramento, CA 95817 USA
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Abstract
Hearing loss in adults is a significant public health problem throughout the world. Undiagnosed and untreated hearing loss causes a measurable impact on health and social, occupational, and emotional well-being of those affected. In spite of a wide array of health care resources to identify and manage hearing loss, there exist vast disparities in outcomes, as well as access to and utilization of hearing healthcare. Hearing rehabilitation outcomes may vary widely among different populations and there is a pressing need to understand, in a broader sense, the factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which is defined by the World Health Organization as "the conditions in which people are born, grow, work, live, and age." According to Healthy People 2030, these determinants can be broken into the following domains: healthcare access and quality, education access and quality, social and community context, economic stability, and neighborhood and built environment. This article defines these domains and examines the published research and the gaps in research of each of these domains, as it pertains to hearing health and healthcare. Herein, we review foundational sources on the social determinants of health and hearing-related research focused on the topic. Further consideration is given to how these factors can be evaluated in a systematic fashion and be incorporated into translational research and hearing health care.
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Schuh M, Bush ML. Defining Disparities in Cochlear Implantation through the Social Determinants of Health. Semin Hear 2021; 42:321-330. [PMID: 34912160 PMCID: PMC8660167 DOI: 10.1055/s-0041-1739282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants.
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Affiliation(s)
- Marissa Schuh
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky
| | - Matthew L Bush
- Department of Otolaryngology - Head and Neck Surgery, University of Kentucky Medical Center, Lexington, Kentucky
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James TG, Varnes JR, Sullivan MK, Cheong J, Pearson TA, Yurasek AM, Miller MD, McKee MM. Conceptual Model of Emergency Department Utilization among Deaf and Hard-of-Hearing Patients: A Critical Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182412901. [PMID: 34948509 PMCID: PMC8701061 DOI: 10.3390/ijerph182412901] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.
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Affiliation(s)
- Tyler G. James
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
- Correspondence:
| | - Julia R. Varnes
- Department of Health Services Research, Management, and Policy, University of Florida, P.O. Box 100185, Gainesville, FL 32610, USA;
| | | | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - Thomas A. Pearson
- Department of Epidemiology, University of Florida, P.O. Box 100231, Gainesville, FL 32610, USA;
| | - Ali M. Yurasek
- Department of Health Education and Behavior, University of Florida, Florida Gym Room 5, P.O. Box 118210, Gainesville, FL 32611, USA; (J.C.); (A.M.Y.)
| | - M. David Miller
- School of Human Development and Organizational Studies in Education, University of Florida, P.O. Box 117047, Gainesville, FL 32611, USA;
| | - Michael M. McKee
- Department of Family Medicine, School of Medicine, University of Michigan, 1018 Fuller St., Ann Arbor, MI 48104, USA;
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Engelman A, Paludneviciene R, Wagner K, Jacobs K, Kushalnagar P. Food Worry in the Deaf and Hard-of-Hearing Population During the COVID-19 Pandemic. Public Health Rep 2021; 136:239-244. [PMID: 33296264 PMCID: PMC8093837 DOI: 10.1177/0033354920974666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID) pandemic has highlighted preexisting health disparities, including food insecurity, in the deaf and hard-of-hearing (DHH) population. We examined factors associated with food worry during the COVID-19 pandemic. METHODS We collected survey data on worry about food shortages, worry about contracting COVID-19, and concerns about DHH people staying home and being lonely from April 17 through May 1, 2020, via a bilingual American Sign Language/English online survey platform. The sample consisted of 537 DHH adults living in the United States. We examined the relationship between demographic characteristics and food worry. We used logistic regression and model fitting to predict the likelihood of experiencing food worry. RESULTS The mean (SD) age of survey respondents was 47 (16), and 25% of the sample identified as people of color. Forty-two percent of survey respondents had a high level of food worry. Increased worry about contracting COVID-19 and concerns about DHH people staying home and being lonely among DHH younger adults or those without a college degree predicted food worry. Gender and race/ethnicity did not contribute to the model for food worry. CONCLUSIONS Food worry was explained by multiple, intersecting factors, including demographic variables, worry about contracting COVID-19, and concerns about loneliness. Interventions or programs implemented by DHH-serving organizations as well as government programs, social service providers, and food banks should be fully accessible to subgroups of DHH young adults without a college degree who are at risk for food insecurity.
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Affiliation(s)
- Alina Engelman
- Department of Health Sciences, California State University, East
Bay, Hayward, CA, USA
| | - Raylene Paludneviciene
- Department of Psychology, Gallaudet University, Washington, DC,
USA
- Center for Deaf Health Equity, Gallaudet University, Washington,
DC, USA
| | - Kathryn Wagner
- Department of Psychology, Gallaudet University, Washington, DC,
USA
| | - Katja Jacobs
- Department of Psychology, Gallaudet University, Washington, DC,
USA
| | - Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, DC,
USA
- Center for Deaf Health Equity, Gallaudet University, Washington,
DC, USA
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Kushalnagar P, Ryan C, Paludneviciene R, Spellun A, Gulati S. Adverse Childhood Communication Experiences Associated With an Increased Risk of Chronic Diseases in Adults Who Are Deaf. Am J Prev Med 2020; 59:548-554. [PMID: 32636047 PMCID: PMC7508773 DOI: 10.1016/j.amepre.2020.04.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/15/2020] [Accepted: 04/12/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This study explores adverse childhood communication experiences and its RRs for acquiring specific chronic diseases and mental health disorders in adults who are deaf and hard of hearing. METHODS A cross-sectional design with snowball sampling was used to recruit adults who were deaf and hard of hearing and were born or became deaf in both ears before age 13 years. Patient-reported outcomes surveys in American Sign Language and English were disseminated to collect data about early life communication experiences with caregivers. Modified Poisson regression with robust SEs was used to calculate RR estimates and 95% CIs for all medical conditions with early life communication experiences as main predictors. RESULTS Data collection occurred from May 2016 to July 2016, October 2016 to April 2018, and October 2018 to May 2019. The U.S. sample consisted of 1,524 adults who were born or became deaf early. After adjusting for parental hearing status and known correlates of medical conditions, poorer direct child-caregiver communication was significantly associated with an increased risk of being diagnosed with diabetes (RRR=1.12, 95% CI=1.01, 1.24), hypertension (RRR=1.10, 95% CI=1.03, 1.17), and heart disease (RRR=1.61, 95% CI=1.39, 1.87). Poor indirect family communication/inclusion increased risks for lung diseases (RRR=1.19, 95% CI=1.07, 1.33) and depression/anxiety disorders (RRR=1.34, 95% CI=1.24, 1.44). The absolute risk increase and number needed to harm are also reported. CONCLUSIONS Outcomes data reported by patients who were deaf and hard of hearing demonstrated that poorer direct child-caregiver communication and ongoing exclusion from incidental family communication were associated with increased risks for multiple chronic health outcomes. Practices should consider developing and utilizing an adverse childhood communication screening measure to prevent or remediate language deprivation and communication neglect in pediatric patients who were deaf and hard of hearing.
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Affiliation(s)
- Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, District of Columbia.
| | - Claire Ryan
- Department of Educational Psychology, University of Texas at Austin, Austin, Texas
| | | | - Arielle Spellun
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Sanjay Gulati
- UMass/Boston Children's Hospital, Waltham, Massachusetts
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Snoddon K, Paul JJ. Framing Sign Language as a Health Need in Canadian and International Policy. Matern Child Health J 2020; 24:1360-1364. [PMID: 32676931 DOI: 10.1007/s10995-020-02974-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although in Canada, hearing screening and early intervention are presented as a health need, we question whether young deaf and hard of hearing children's access to language is adequately supported by public health and children's services. The Ontario Infant Hearing Program has the stated mandate of supporting the language development of deaf and hard of hearing infants and young children. However, this program presents parents with early intervention service options involving either spoken or signed language, but not both together. This policy effectively restricts access to sign language learning for a majority of Ontario's deaf children. Consequently, some deaf children suffer language deprivation and its deleterious effects on cognition and emotional development. In support of our arguments, we refer to Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which Canada has signed and ratified. The CRPD supports recognition of deaf children's right to sign language as a health need because language deprivation occurs in many children who are not offered sign language, and this is a permanent impairment imposed on top of hearing loss. We conclude that in Canada, health services for deaf children do not align with accessibility and human rights legislation, thus creating a policy gap that leaves deaf children vulnerable to additional impairment.
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Affiliation(s)
- Kristin Snoddon
- School of Early Childhood Studies, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
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Kushalnagar P, Paludneviciene R, Kallen M, Atcherson S, Cella D. PROMIS-deaf profile measure: cultural adaptation and psychometric validation in American sign language. J Patient Rep Outcomes 2020; 4:44. [PMID: 32519000 PMCID: PMC7283401 DOI: 10.1186/s41687-020-00208-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - M Kallen
- Northwestern University, Feinberg School of Medicine, Evanston, IL, USA
| | - S Atcherson
- University at Arkansas for Medical Sciences, Little Rock, AR, USA
| | - D Cella
- Northwestern University, Feinberg School of Medicine, Evanston, IL, USA
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Keogh B, Kushalnagar P, Engelman A. Peer support and food security in deaf college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2020; 68:1-5. [PMID: 30365914 DOI: 10.1080/07448481.2018.1515750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/10/2018] [Accepted: 08/19/2018] [Indexed: 06/08/2023]
Abstract
Objective: The purpose of the study was to investigate whether peer support and demographic characteristics predicted food security among deaf college students. Participants: The sample included 166 deaf college students at Gallaudet University. Methods: Participants completed a bilingual online survey in American Sign Language (ASL) and English. This survey included USDA's 6-item food security survey, questions about peer support and socio-demographic characteristics. Results: Out of 166 students (mean age =23; SD = 6), 60.7% were food secure. About 26.4% were at-risk for low food security and another 12.9% had very low food security. The sample included respondents who identified as people of color (54%) and women (52%). Binary logistic regression revealed that compared to people who reported always receiving peer support, people who never received peer support were 16.3 times more likely to experience food insecurity (adj OR: 16.325, 95% CI 1.824-146.107). Conclusions: This study demonstrates a strong relationship between peer support and deaf college students' food security experiences.
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Affiliation(s)
- Brianna Keogh
- Department of Psychology and Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, DC, USA
| | - Poorna Kushalnagar
- Department of Psychology and Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, DC, USA
| | - Alina Engelman
- Department of Health Sciences, California State University, East Bay, Hayward, CA, USA
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Support for parents of deaf children: Common questions and informed, evidence-based answers. Int J Pediatr Otorhinolaryngol 2019; 118:134-142. [PMID: 30623850 DOI: 10.1016/j.ijporl.2018.12.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/15/2018] [Accepted: 12/27/2018] [Indexed: 11/20/2022]
Abstract
To assist medical and hearing-science professionals in supporting parents of deaf children, we have identified common questions that parents may have and provide evidence-based answers. In doing so, a compassionate and positive narrative about deafness and deaf children is offered, one that relies on recent research evidence regarding the critical nature of early exposure to a fully accessible visual language, which in the United States is American Sign Language (ASL). This evidence includes the role of sign language in language acquisition, cognitive development, and literacy. In order for parents to provide a nurturing and anxiety-free environment for early childhood development, signing at home is important even if their child also has the additional nurturing and care of a signing community. It is not just the early years of a child's life that matter for language acquisition; it's the early months, the early weeks, even the early days. Deaf children cannot wait for accessible language input. The whole family must learn simultaneously as the deaf child learns. Even moderate fluency on the part of the family benefits the child enormously. And learning the sign language together can be one of the strongest bonding experiences that the family and deaf child have.
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Biskupiak A, Smith S, Kushalnagar P. Pre-Exposure Prophylaxis Knowledge and Perceived Effectiveness to Prevent HIV Among Deaf Gay, Bisexual, and Queer Men. LGBT Health 2018; 5:469-476. [PMID: 30383466 DOI: 10.1089/lgbt.2018.0102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose: There have been recent advances to the adoption of pre-exposure prophylaxis (PrEP) as an effective human immunodeficiency virus (HIV) preventive treatment among men who have sex with men, but PrEP services and resources are often not accessible to those who are deaf and use American Sign Language (ASL). This article investigates PrEP knowledge among deaf gay, bisexual, and queer (GBQ) men and the contribution of social support to their perceptions regarding the effectiveness of PrEP at preventing HIV. Methods: An online health survey in ASL and English included questions about sexual orientation, HIV testing, PrEP knowledge and perceived effectiveness at preventing HIV, coming out to healthcare providers, and social support. We gathered data from 121 deaf GBQ men recruited from diverse cities in the United States, with 87% self-identifying as gay. Logistic regression analyses were used to examine the relationships between self-reported level of social support and perceived effectiveness of PrEP at preventing HIV after controlling for sociodemographic and health-related variables. Results: There was a significant relationship between meeting new lesbian, gay, bisexual, transgender, and queer (LGBTQ) friends online and PrEP knowledge (χ2 = 14.93; p < 0.001). After controlling for sociodemographic and health-related variables, those who discussed LGBT-related issues online and/or on a social networking site regularly were threefold more likely to perceive PrEP as being effective at preventing HIV than those who did not engage in online discussions (odds ratio = 3.12; 95% confidence interval: 1.12-8.75). Conclusion: For deaf GBQ men, PrEP knowledge might be attained through meeting and making new LGBTQ friends online. Active engagement in online discussions about LGBT-related issues might enhance perceptions regarding the effectiveness of PrEP to prevent HIV.
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Affiliation(s)
- Andrew Biskupiak
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, District of Columbia
| | - Scott Smith
- National Technical Institute for the Deaf, Rochester Institute of Technology, Rochester, New York
| | - Poorna Kushalnagar
- Deaf Health Communication and Quality of Life Center, Gallaudet University, Washington, District of Columbia.,Department of Psychology, Gallaudet University, Washington, District of Columbia
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Communication Barrier in Family Linked to Increased Risks for Food Insecurity among Deaf Adults who use American Sign Language - CORRIGENDUM. Public Health Nutr 2018; 21:2723. [PMID: 29789026 DOI: 10.1017/s1368980018001295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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