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Lee JJ, Wang L, Vo K, Gonzalez C, Orellana ER, Kerani RP, Katz DA, Sanchez TH, Graham SM. Characterizing the Communication Networks of Spanish- and English-Speaking Latinx Sexual Minority Men and Their Roles in Pre-Exposure Prophylaxis Uptake. JOURNAL OF HEALTH COMMUNICATION 2024; 29:467-480. [PMID: 38872332 DOI: 10.1080/10810730.2024.2366498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
While pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV transmission, disparities in access persist in the United States, especially among Hispanic/Latinx sexual minority men (SMM). Language barriers and differences in how Latinx SMM obtain information may impact access to PrEP and HIV prevention. This study used data from the 2021 American Men's Internet Survey (AMIS) to examine differences in communication networks and PrEP use among Latinx SMM by primary language (Spanish vs. English). We examined the associations between Latinx SMM's individual- and meso-level communication networks and PrEP-related outcomes using modified Poisson regression with robust variances. Spanish-speaking Latinx SMM in the study were less likely to test for HIV, be aware of PrEP, and use daily PrEP, compared to English-speaking participants. Sexuality disclosure to a healthcare provider was positively associated with PrEP uptake among all participants and predicted STI testing over the past 12 months among English-speaking Latinx SMM. Findings highlight disparities in PrEP awareness and uptake among Latinx SMM, especially among those whose primary language is Spanish. Addressing these disparities through targeted interventions, including improved communication with healthcare providers, may help facilitate PrEP access and use in this population.
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Affiliation(s)
- Jane J Lee
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Liying Wang
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Katie Vo
- School of Public Health, University of Washington, Seattle, Washington, USA
| | - Carmen Gonzalez
- Department of Communication, University of Washington, Seattle, Washington, USA
| | - E Roberto Orellana
- School of Social Work, University of Washington, Seattle, Washington, USA
| | - Roxanne P Kerani
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - David A Katz
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Susan M Graham
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
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Puleo BK, Dillon FR, Ertl MM, Da Silva N, Cabrera Tineo YA, Verile M, De La Rosa M. Neighborhood Collective Efficacy: A Longitudinal Social Determinant of Access to Medical Care Among Recently Immigrated Latina Young Adults. HISPANIC HEALTH CARE INTERNATIONAL 2024; 22:83-91. [PMID: 37455338 DOI: 10.1177/15404153231187394] [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] [Indexed: 07/18/2023]
Abstract
The present longitudinal study examined changes in perceived access to health care among a recently immigrated cohort of Latina young adults who were assessed annually during their first 3 years in the United States. A parallel process growth model of perceived access to health care and neighborhood collective efficacy was examined, accounting for socioeconomic indicators and immigration status. Five hundred thirty Latina young adults (ages 18-23) participated at baseline assessment, and approximately 95% were retained over three annual assessment time points. Participants' mean level of perceived access to health care increased during their initial 3 years in the United States. Women who reported more of an increase in perceived access to health care tended to also indicate increased neighborhood collective efficacy relative to their peers during their first 3 years in the United States. Findings offer important information about the individual- and community-level factors that influence recently immigrated Latinas' health care access.
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Affiliation(s)
- Blair K Puleo
- School of Counseling and Counseling Psychology, Arizona State University, Tempe, AR, USA
| | - Frank R Dillon
- School of Counseling and Counseling Psychology, Arizona State University, Tempe, AR, USA
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Nicole Da Silva
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - Yajaira A Cabrera Tineo
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
| | - Michael Verile
- Department of Educational and Counseling Psychology, University at Albany - State University of New York, Albany, NY, USA
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David R, Baugher AR, Baker AD, Respress E. Comparing Socio-Demographics and HIV Testing and Prevention Outcomes Between Low-Income HIV-Negative Heterosexually Active Black Women and Men with Health Insurance. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01986-2. [PMID: 38744785 DOI: 10.1007/s40615-024-01986-2] [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: 11/28/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE This study is to compare socio-demographic, HIV testing, and prevention factors experienced by insured low-income heterosexual Black women and men. METHODS We examined cross-sectional data from Black women and men (n = 5837) recruited in 23 U.S. cities for National HIV Behavioral Surveillance June-December 2019. We compared socio-demographic and behavioral factors between groups using log-linked Poisson regression models, producing adjusted prevalence ratios and 95% confidence intervals. RESULTS Black women were less likely than Black men to have private insurance (aPR 0.61, 95% CI 0.50-0.74, p < 0.0001). Black women were more likely than Black men to have incomes at or below the poverty line (aPR 1.04, 95% CI 1.01-1.07, p = 0.02), be aware of PrEP (aPR 1.20, 95% CI 1.12-1.28, p < 0.0001), and have been recently tested for HIV (aPR 1.12, 95% CI 1.04, 1.20, p < 0.01). CONCLUSIONS Despite insured status, many Black women and men experienced suboptimal access to and utilization of HIV testing and prevention services. Understanding how social conditions produce differential access to care may help inform HIV prevention interventions.
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Affiliation(s)
- Rachel David
- Morehouse Public Health Sciences Institute, Atlanta, GA, USA
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy R Baugher
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Anna D Baker
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ebony Respress
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Moyce S, Sisson N, Metcalf M. Bridging the Gap: Addressing Immigrant Health Through Community-initiated Screening Events. Prog Community Health Partnersh 2024; 18:11-19. [PMID: 38661823 PMCID: PMC11229666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND In areas of new-immigrant population growth, medical and social infrastructure may be lagging behind the needs of those who do not identify with the majority culture or language. Subsequently, information regarding this population's health status and access to care is limited. Montana's Hispanic population is one such group. Despite its low total population, the state has experienced unprecedented growth in the number of Spanish-speaking individuals and families over the last decade. OBJECTIVES We utilized a community based participatory research framework to emphasize equal partnership between lay community members and researchers to ensure adherence to community priorities and strengthen trust between the two parties allowing for future collaboration. Based on community request, we designed four health screening events to provide needed health prevention services to the Hispanic community. METHODS Through collaboration with a Community Advisory Board, we created four health screening events to provide basic primary care services, including height and weight, blood pressure, diabetes, and mental health screenings. We partnered with a team of dental hygienists to provide oral preventive health. We conducted a cost-effectiveness analysis, comparing our approach to traditional health services. Study variables were analyzed using analysis of variance to examine differences in health outcomes between health screening events. RESULTS We screened 140 persons and found that 85.7% lacked health insurance and 80.7% lacked a usual source of care. We also found overweight and obesity in 47.1% and 27.1%, respectively, and hypertension in 63.6%. Services provided by the health screening events were up to $239 less expensive than comparable services provided at local health centers. CONCLUSIONS Working directly with the community, we designed and implemented health prevention events which served to meet a growing need and to identify and address health concerns among the Hispanic immigrant community.
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Cantor A, Radix A. The effect of psychosocial stress on prenatal care among Hispanic immigrant women. JAAPA 2023; 36:29-32. [PMID: 37751254 DOI: 10.1097/01.jaa.0000977736.78334.c6] [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: 09/27/2023]
Abstract
ABSTRACT This article explores the effect of psychosocial stress on Hispanic immigrant women, including access to and use of prenatal care and birth outcomes. In addition to highlighting the health effects for this growing population, the article outlines strategies for clinicians to improve access to adequate prenatal care and to cultivate a supportive environment to promote use of prenatal services.
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Affiliation(s)
- Aviva Cantor
- At Callen-Lorde Community Health Center in New York City, Aviva Cantor is HIV quality coordinator and Asa Radix is senior director of research and education. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Samari G, Wurtz HM, Karunaratne M, Coleman-Minahan K. Disruptions in Sexual and Reproductive Health Care Service Delivery for Immigrants During COVID-19. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:319-327. [PMID: 37476604 PMCID: PMC10354724 DOI: 10.1089/whr.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/22/2023]
Abstract
Purpose To provide perspectives from heterogenous cisgender immigrant women and service providers for immigrants in New York City (NYC) on how restrictive sexual and reproductive health (SRH) care delivery environments during COVID-19 shape immigrant's access to health care and health outcomes to generate insights for clinical practices and policies for immigrant women's health care needs. Methods A qualitative study was conducted in 2020 and 2021, including in-depth interviews with 44 immigrant women from different national origins and 19 direct service providers for immigrant communities in NYC to explore how immigrants adapted to and were impacted by pandemic-related SRH care service delivery barriers. Interviews were coded and analyzed using a constant comparative approach. Results Pandemic-related delays and interrupted health care, restrictive accompaniment policies, and the transition from in-person to virtual care compounded barriers to care for immigrant communities. Care delays and interruptions forced some participants to live with untreated health conditions, resulting in physical pain and emotional distress. Participants also experienced challenges within the health care system because of changes to visitor policies that restricted the accompaniment of family members or support persons. Some participants experienced difficulties accessing telehealth and technology, while others welcomed the flexibility given the demands of frontline work and childcare. Conclusions To mitigate the health and social implications of increasingly restrictive immigration, reproductive, and social policies, clinical practices like expanding access to care for all immigrants, engaging immigrant communities in health care institutions policies and practices, and integrating immigrant's support networks into care play an important role.
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Affiliation(s)
- Goleen Samari
- 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 and Human Rights, Human Rights Institute, University of Connecticut, Storrs, Connecticut, USA
- Population Studies and Training Center, Brown University, Providence, Rhode Island, USA
| | - Mihiri Karunaratne
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kate Coleman-Minahan
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Pineros-Leano M, Parchment TM, Calvo R. Family Interventions to improve mental, emotional, and behavioral health outcomes among Latinx youth: A systematic review. CHILDREN AND YOUTH SERVICES REVIEW 2023; 145:106756. [PMID: 36845407 PMCID: PMC9957186 DOI: 10.1016/j.childyouth.2022.106756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background The Latinx population is the largest and fastest-growing segment of the U.S. While the vast majority of Latinx children are U.S.-born, over half are growing up in a family where they live with at least one foreign-born parent. Despite research showing that Latinx immigrants are less likely to experience mental, emotional, and behavioral (MEB) health issues (e.g., depression, conduct disorder, substance misuse), their children have one of the country's highest rates of MEB disorders. To address the MEB health of Latinx children and their caregivers, culturally grounded interventions have been developed, implemented, and tested to promote MEB health. The purpose of this systematic review is to identify these interventions and summarize their findings. Methods We searched PubMed, PsycINFO, ERIC, Cochrane Library, Scopus, HAPI, ProQuest, and ScienceDirect databases from 1980 through January 2020 as part of a registered protocol (PROSPERO) following PRISMA guidelines. Our inclusion criteria were randomized controlled trials of family interventions among a predominantly Latinx sample. We assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool. Findings Initially, we identified 8,461 articles. After going through the inclusion criteria, 23 studies were included in the review. We found a total of 10 interventions, with Familias Unidas and Bridges/Puentes having the most information available. Overall, 96% of studies demonstrated their effectiveness in addressing MEB health, namely substance use, alcohol and tobacco use, risky sexual behaviors, conduct disorder, and internalizing symptoms among Latinx youths. Most interventions focused on improving parent-child relationships as the main mechanism to improve MEB health among Latinx youths. Discussion Our findings show that family interventions can be effective for Latinx youths and their families. It is likely that including cultural values such as familismo and issues related to the Latinx experience such as immigration and acculturation can help the long-term goal of improving MEB health in Latinx communities. Future studies investigating the different cultural components that may influence the acceptability and effectiveness of the interventions are warranted.
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Affiliation(s)
- María Pineros-Leano
- Boston College, School of Social Work. 140 Commonwealth Avenue, Chestnut Hill, MA 02467140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Tyrone M. Parchment
- Boston College, School of Social Work. 140 Commonwealth Avenue, Chestnut Hill, MA 02467140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
| | - Rocío Calvo
- Boston College, School of Social Work. 140 Commonwealth Avenue, Chestnut Hill, MA 02467140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA
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Dawson AZ, Walker RJ, Gregory C, Egede LE. Contributions of social determinants of health to systolic blood pressure in United States adult immigrants: Use of path analysis to validate a conceptual framework. Chronic Illn 2022; 18:757-769. [PMID: 33726528 PMCID: PMC8443685 DOI: 10.1177/17423953211000412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Validate a conceptual framework and identify pathways between antecedent (life-course socioeconomic status (L-SES)), predisposing (age, sex, married, homeless as a child), enabling (health literacy, acculturation), and need (disability) social determinants of health (SDoH) and systolic blood pressure (SBP) in US immigrants. METHODS 181 immigrants were enrolled in the study. Path analysis was used to identify paths by which SDoH influence SBP and to determine if antecedents, predisposing, enabling, and need factors have direct and indirect relationships with SBP. RESULTS The final model(chi2(5)=14.88, p = 0.011, RMSEA = 0.070, pclose = 0.17, CFI = 0.96) showed L-SES was directly associated with age (0.12, p = 0.019) and disability(0.17, p = 0.001); and indirectly associated with disability (0.29, p < 0.001) and SBP (0.31, p < 0.001). Age (0.31, p < 0.001) and sex(0.25, p < 0.001) were directly associated with SBP, and age was directly associated with disability (0.29, p < 0.001) and indirectly associated with SBP(0.14, p = 0.018). Other predisposing factors such as being married (-0.32, p < 0.001) and being homeless as a child alone (0.16, p < 0.001) were directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Enabling factor of health literacy (0.16, p = 0.001) was directly associated with disability and indirectly associated (0.14, p = 0.018) with SBP. Need factor of disability (0.14, p = 0.018) was directly associated with SBP. CONCLUSIONS This study provides the first validation of a conceptual model for the relationship between SDoH and SBP among immigrants and identifies potential targets for focused interventions.
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Affiliation(s)
- Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Chris Gregory
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
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Morales-Alemán MM, Ferreti G. Adding Nuance to our Understanding of Adolescent Reproductive Health Outcomes Among Women of Mexican Origin. J Adolesc Health 2022; 71:658-659. [PMID: 36403989 DOI: 10.1016/j.jadohealth.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Affiliation(s)
| | - Gwendolyn Ferreti
- Peace and Social Justice Studies Department, Berea College, Berea, Kentucky
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Caballero TM, Miramontes-Valdes E, Polk S. Mi Plan: Using a Pediatric-Based Community Health Worker Model to Facilitate Obtainment of Contraceptives Among Latino Immigrant Parents with Contraceptive Needs. Jt Comm J Qual Patient Saf 2022; 48:591-598. [PMID: 36100556 DOI: 10.1016/j.jcjq.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/27/2022] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Bilingual community health workers (CHWs) play an important role in helping Latino immigrants with limited English proficiency (LEP) access health care services and information. Contraceptive health care services and Spanish-language contraceptive information are particularly challenging to access for uninsured LEP immigrants. Contraceptive and reproductive care are longitudinal health needs, and pediatric settings pose a unique opportunity to address these needs among parents whose children access pediatric care. The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program. METHODS The research team conducted a retrospective analysis of demographic and contraceptive use data from a 15-month CHW pilot within an urban, primary care pediatrics clinic. The CHW provided contraceptive counseling, referral, and appointment coordination. The outcome was desired contraceptive method obtainment within three months of counseling. RESULTS All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact. CONCLUSION Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.
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Ramírez-Ortiz D, Seitchick J, Polpitiya M, Algarin AB, Sheehan DM, Fennie K, Cyrus E, Trepka MJ. Post-immigration factors affecting retention in HIV care and viral suppression in Latin American and Caribbean immigrant populations in the United States: a systematic review. ETHNICITY & HEALTH 2022; 27:1859-1899. [PMID: 34647837 PMCID: PMC9008069 DOI: 10.1080/13557858.2021.1990217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 10/01/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To reduce disparities in HIV care outcomes among Latin American and Caribbean (LAC) immigrants living with HIV in the U.S., it is necessary to identify factors influencing HIV care in this population. A systematic review that provides a comprehensive understanding of factors influencing retention in HIV care and viral suppression among LAC immigrants living with HIV in the U.S. is lacking. This systematic review used the Immigrant Health Services Utilization theoretical framework to provide an understanding of these factors. DESIGN We searched for peer-reviewed publications in MEDLINE, EMBASE, CINAHL, PsycINFO, and ASSIA, from January 1996 to June 2020. RESULTS A total of 17 qualitative (n = 10) and quantitative (n = 7) studies were included in the review. The most commonly reported general and immigrant-specific factors appearing in studies were undocumented immigration status, HIV stigma, homophobia, cultural norms, values and beliefs, family and social support, language barriers, structure, complexity and quality of the U.S. healthcare delivery system, and patient-provider relationship. CONCLUSION These findings highlight the importance of considering immigrant-specific factors along with general factors to improve the provision of HIV care services and HIV care outcomes among LAC immigrant populations.
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Affiliation(s)
- Daisy Ramírez-Ortiz
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
| | - Jessica Seitchick
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Medhani Polpitiya
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
| | - Angel B. Algarin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
- Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University, Miami, FL
| | | | - Elena Cyrus
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL
- Florida International University Research Center in Minority Institutions (FIU–RCMI), Miami, FL
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Petruzzi L, Vohra-Gupta S, Valdez C, Cubbin C. Nativity moderates the relationship between nationality and healthcare access for some Latinx women in the United States. ETHNICITY & HEALTH 2022; 27:1752-1768. [PMID: 34510969 PMCID: PMC10371217 DOI: 10.1080/13557858.2021.1976396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women's access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). DESIGN An outcome variable called 'any barriers to care' was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005-2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. RESULTS 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. CONCLUSIONS Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy.
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Affiliation(s)
- Liana Petruzzi
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
| | - Shetal Vohra-Gupta
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
| | - Carmen Valdez
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
- Population Health Department, Dell Medical School, Austin, USA
| | - Catherine Cubbin
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
- Population Health Department, Dell Medical School, Austin, USA
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Espinoza-Kulick MAV, Cerdeña JP. "We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12817. [PMID: 36232112 PMCID: PMC9565216 DOI: 10.3390/ijerph191912817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.
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Affiliation(s)
| | - Jessica P. Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
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Xu Y, Zeng W, Wang Y, Magaña S. Barriers to Service Access for Immigrant Families of Children With Developmental Disabilities: A Scoping Review. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:382-404. [PMID: 36162050 DOI: 10.1352/1934-9556-60.5.382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/16/2022] [Indexed: 06/16/2023]
Abstract
This scoping review explores (a) barriers faced by immigrant families of children with intellectual and developmental disabilities (IDD) when accessing healthcare-related services in the United States, (b) where research stands based on the health disparity research framework, and (c) implications for future health disparities research with this population. Our scoping review found 26 empirical studies published between 2000 and 2020 that met our inclusion criteria. Data were extracted and synthesized based on the stages of research outlined in the health disparity research framework. Overall, immigrant families experienced barriers on multiple levels including patient, provider, and healthcare system levels. Studies focusing on detecting and reducing disparities are emerging. We conclude with recommendations for future research and practice with immigrant families of children with IDD.
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Affiliation(s)
- Yue Xu
- Yue Xu, University of Illinois College of Medicine at Rockford
| | | | - Yao Wang
- Yao Wang, University of Maryland, Baltimore
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15
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Reyna M, Almeida R, Lopez-Macha A, Fuller S, Duron Y, Fejerman L. Training promotores to lead virtual hereditary breast cancer education sessions for Spanish-speaking individuals of Latin American heritage in California. BMC Womens Health 2022; 22:336. [PMID: 35941639 PMCID: PMC9358079 DOI: 10.1186/s12905-022-01902-y] [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: 04/28/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Awareness about hereditary breast cancer and the preventative steps to minimize disease risk is lower in Hispanic/Latina individuals than non-Hispanic White women in the United States. For this reason, we developed a promotor-based hereditary breast cancer education and risk identification program for self-identified Hispanic/Latina women, which included training promotores in basic genetics and hereditary breast cancer. This study explored promotores’ experiences receiving training and participating in virtual practice sessions as well as changes in knowledge about hereditary breast cancer.
Methods
A total of ten promotores underwent a two-week basic training led by the promotores organization and an eight-hour in person hereditary breast cancer training workshop. Demographic information along with pre- and post-training surveys were completed by ten promotores who participated in the training workshop. Surveys were given to determine changes in knowledge of hereditary breast cancer and genetics. Of the ten promotores, two were selected to lead community education sessions and participated in 6 semi-structured interviews. All interviews and practice sessions were conducted using a virtual platform.
Results
The data revealed that after the 8-h workshop and practice sessions, promotores felt confident about their ability to conduct virtual education sessions with the community. Interviews identified key facilitators to success such as a supportive environment, practice presentations, and personal motivation. Learning the online platform was considered the biggest challenge by the promotores, as opposed to learning complex genetics topics.
Conclusions
These results provide further evidence supporting promotores’ willingness and ability to provide health education on relatively complex topics. It also offers insight into the challenges of presenting information to vulnerable populations using an online platform and the additional support that is required to ensure a positive outcome.
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Rashoka FN, Kelley MS, Choi JK, Garcia MA, Chai W, Rashawka HN. “Many people have no idea”: a qualitative analysis of healthcare barriers among Yazidi refugees in the Midwestern United States. Int J Equity Health 2022; 21:48. [PMID: 35410348 PMCID: PMC8995685 DOI: 10.1186/s12939-022-01654-z] [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: 09/21/2021] [Accepted: 03/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 pandemic has shed new light on inequities in healthcare access faced by immigrant and refugee communities. To address ongoing disparities, there is an urgent need for ecological approaches to better understand the barriers that hinder and resources that facilitate access to healthcare. This study investigates barriers to healthcare system access faced by Yazidi refugees in the Midwestern United States. Methods Informed by the Interpretative Phenomenological Approach, three focus group meetings with a community advisory board were conducted between September 2019 and January 2020. The nine-member focus group included social workers, healthcare providers, and members of the Yazidi community. Meeting recordings were transcribed into English, coded for themes, and validated. Results We describe themes related to specific barriers to healthcare access; analyze the influence of relational dynamics in the focus group; explore experiential themes related to healthcare access in the Yazidi community, and finally interpret our findings through a social-ecological lens. Conclusion Community agencies, healthcare organizations, policymakers, and other stakeholders must work together to develop strategies to reduce systemic barriers to equitable care. Community representation in priority-setting and decision-making is essential to ensure relevance, acceptability, and utilization of developed strategies.
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Platt RE, Acosta J, Stellmann J, Sloand E, Caballero TM, Polk S, Wissow LS, Mendelson T, Kennedy CE. Addressing Psychosocial Topics in Group Well-Child Care: A Multi-Method Study With Immigrant Latino Families. Acad Pediatr 2022; 22:80-89. [PMID: 33992841 PMCID: PMC8589857 DOI: 10.1016/j.acap.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Group Well-Child Care (GWCC) has been described as providing an opportunity to enhance well-being for vulnerable families experiencing psychosocial challenges. We sought to explore benefits and challenges to the identification and management of psychosocial concerns in Group Well-Child Care (GWCC) with immigrant Latino families. METHODS We conducted a case study of GWCC at an urban academic general pediatric clinic serving predominantly Limited English Proficiency Latino families, combining visit observations, interviews, and surveys with Spanish-speaking mothers participating in GWCC, and interviews with providers delivering GWCC. We used an adapted framework approach to qualitative data analysis. RESULTS A total of 42 mothers and 9 providers participated in the study; a purposefully selected subset of 17 mothers was interviewed, all providers were interviewed. Mothers and providers identified both benefits and drawbacks to the structure and care processes in GWCC. The longer total visit time facilitated screening and education around psychosocial topics such as postpartum depression but made participation challenging for some families. Providers expressed concerns about the effects of shorter one-on-one time on rapport-building; most mothers did not express similar concerns. Mothers valued the opportunity to make social connections and to learn from the lived experiences of their peers. Discussions about psychosocial topics were seen as valuable but required careful navigation in the group setting, especially when fathers were present. CONCLUSIONS Participants identified unique benefits and barriers to addressing psychosocial topics in GWCC. Future research should explore the effects of GWCC on psychosocial disclosures and examine ways to enhance benefits while addressing the challenges identified.
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Affiliation(s)
- Rheanna E Platt
- Johns Hopkins School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center (RE Platt), Baltimore, Md.
| | - Jennifer Acosta
- Department of Pediatrics/Centro Sol, Johns Hopkins Bayview Medical Center (J Acosta, S Polk), Baltimore, Md; Maryland Department of Health, Center for HIV/STI Capacity Building and Integration (J Acosta), Baltimore, Md
| | - Julia Stellmann
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (J Stellman, CE Kennedy), Baltimore, Md
| | | | - Tania Maria Caballero
- Department of Pediatrics, Johns Hopkins Bayview Medical Center (TM Caballero), Baltimore, Md
| | - Sarah Polk
- Department of Pediatrics/Centro Sol, Johns Hopkins Bayview Medical Center (J Acosta, S Polk), Baltimore, Md
| | - Lawrence S Wissow
- University of Washington School of Medicine/Seattle Children's Hospital (L Wissow), Seattle, Wash
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health (T Mendelson), Baltimore, Md
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health (J Stellman, CE Kennedy), Baltimore, Md
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18
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Mi Familia Entera: Contraceptive Use Among Spanish-Speaking Mothers of Young Children. Matern Child Health J 2021; 26:139-148. [PMID: 34845572 DOI: 10.1007/s10995-021-03300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To characterize contraceptive method use and satisfaction among Spanish-speaking Latina immigrants who attend their child's well care visit. METHODS Spanish-speaking women whose youngest child was ≤ 4 years old completed an orally-administered Spanish-language survey in a pediatric clinic (N = 194). Survey items were based on previously published contraceptive use assessments among diverse populations. We used chi-square and Fisher exact test to describe maternal characteristics by contraceptive method effectiveness categories: Tier 1, most effective methods (hormonal implant, intrauterine device, tubal ligation, and vasectomy); Tier 2, very effective methods (hormonal injection, oral contraceptive pill, hormonal patch, and hormonal ring); Tier 3, effective methods (condoms), and no method. RESULTS 34% of women were using a Tier 1 method, 40% were using a Tier 2 method, and 17% had unmet contraceptive need (no pregnancy intention, no birth control); 84% were satisfied with their current method and 82% of women were uninsured. Tier 2 method or no method users were more likely than women using a Tier 1 method to have children < 9 months old (X2 (6, N = 190) = 20.4, p = .002). CONCLUSIONS Latina immigrants with young children who attend their child's pediatric visit are mostly using effective contraceptives and are satisfied with their method. A culturally supportive medical home and access to no-cost long-acting reversible contraceptives through a temporary private grant likely contributed to high contraceptive use and satisfaction in our study. Describing maternal contraceptive use among Latina immigrant mothers can inform future equitable, culturally tailored, approaches to pediatric maternal contraceptive need screening.
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19
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Jung J, Uejio CK, Adeyeye TE, Kintziger KW, Duclos C, Reid K, Jordan M, Spector JT, Insaf TZ. Using social security number to identify sub-populations vulnerable to the health impacts from extreme heat in Florida, U.S. ENVIRONMENTAL RESEARCH 2021; 202:111738. [PMID: 34331925 DOI: 10.1016/j.envres.2021.111738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Some socioeconomically vulnerable groups may experience disproportionately higher risk of extreme heat illness than other groups, but no study has utilized the presence/absence of a social security number (SSN) as a proxy for vulnerable sub-populations. METHODS This study focused on the warm season from 2008 to 2012 in Florida, U.S. With a total number of 8,256,171 individual level health outcomes, we devised separate case-crossover models for five heat-sensitive health outcomes (cardiovascular disease, dehydration, heat-related illness, renal disease, and respiratory disease), type of health care visit (emergency department (ED) and hospitalization), and patients reporting/not reporting an SSN. Each stratified model also considered potential effect modification by sex, age, or race/ethnicity. RESULTS Mean temperature raised the odds of five heat-sensitive health outcomes with the highest odds ratios (ORs) for heat-related illness. Sex significantly modified heat exposure effects for dehydration ED visits (Males: 1.145, 95 % CI: 1.137-1.153; Females: 1.110, 95 % CI: 1.103-1.117) and hospitalization (Males: 1.116, 95 % CI: 1.110-1.121; Females: 1.100, 95 % CI: 1.095-1.105). Patients not reporting an SSN between 25 and 44 years (1.264, 95 % CI: 1.192-1.340) exhibited significantly higher dehydration ED ORs than those reporting an SSN (1.146, 95 % CI: 1.136-1.157). We also observed significantly higher ORs for cardiovascular disease hospitalization from the no SSN group (SSN: 1.089, 95 % CI: 1.088-1.090; no SSN: 1.100, 95 % CI: 1.091-1.110). CONCLUSIONS This paper partially supports the idea that individuals without an SSN could experience higher risks of dehydration (for those 25-45 years), renal disease, and cardiovascular disease than those with an SSN.
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Affiliation(s)
- Jihoon Jung
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA.
| | | | - Temilayo E Adeyeye
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA; School of Public Health, University at Albany, Rensselaer, NY, USA
| | | | - Chris Duclos
- Florida Department of Health, Tallahassee, FL, USA
| | - Keshia Reid
- Florida Department of Health, Tallahassee, FL, USA
| | | | - June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Tabassum Z Insaf
- Bureau of Environmental and Occupational Epidemiology, New York State Department of Health, Albany, NY, USA; School of Public Health, University at Albany, Rensselaer, NY, USA
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20
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Held ML, Villarreal-Otálora T, Jennings-McGarity P. Latino Immigrant Service Provision in Tennessee and Georgia: Provider Perceptions. J Immigr Minor Health 2021; 24:875-888. [PMID: 34654993 DOI: 10.1007/s10903-021-01286-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/26/2022]
Abstract
Latinos and Latino immigrants are increasingly settling in new immigrant destinations, such as Tennessee and Georgia, that have historically lacked sufficient infrastructure for delivery of culturally and linguistically competent health and social services. This cross-sectional survey study was designed to assess providers' (n = 109) perspectives of the service provision landscape in each state. Descriptive analyses and t-tests (by state) were conducted to explore service concerns, access barriers, and organizational capacity to address concerns and barriers. Among most prevalently reported concerns were income/wages and fear of deportation. Key access barriers included language, lack of driver's license and insurance, and fear of deportation. Most (63%) organizations had sufficient Spanish language proficiency, though building trust was a notable barrier within 58% of organizations. Results provide meaningful data to inform existing strengths and service gaps in two exclusionary policy states. Future research should include perspectives of Latino community members.
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Affiliation(s)
- Mary Lehman Held
- College of Social Work, University of Tennessee, Knoxville, 193 Polk Avenue, Suite E, Nashville, TN, 37210, USA.
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21
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Rapp KS, Volpe VV, Neukrug H. State-Level Sexism and Women's Health Care Access in the United States: Differences by Race/Ethnicity, 2014-2019. Am J Public Health 2021; 111:1796-1805. [PMID: 34473559 PMCID: PMC8561184 DOI: 10.2105/ajph.2021.306455] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To quantify racial/ethnic differences in the relationship between state-level sexism and barriers to health care access among non-Hispanic White, non-Hispanic Black, and Hispanic women in the United States. Methods. We merged a multidimensional state-level sexism index compiled from administrative data with the national Consumer Survey of Health Care Access (2014-2019; n = 10 898) to test associations between exposure to state-level sexism and barriers to access, availability, and affordability of health care. Results. Greater exposure to state-level sexism was associated with more barriers to health care access among non-Hispanic Black and Hispanic women, but not non-Hispanic White women. Affordability barriers (cost of medical bills, health insurance, prescriptions, and tests) appeared to drive these associations. More frequent need for care exacerbated the relationship between state-level sexism and barriers to care for Hispanic women. Conclusions. The relationship between state-level sexism and women's barriers to health care access differs by race/ethnicity and frequency of needing care. Public Health Implications. State-level policies may be used strategically to promote health care equity at the intersection of gender and race/ethnicity. (Am J Public Health. 2021;111(10):1796-1805. https://doi.org/10.2105/AJPH.2021.306455).
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Affiliation(s)
- Kristen Schorpp Rapp
- Kristen Schorpp Rapp is with the Department of Sociology and Public Health, Roanoke College, Salem, VA. Vanessa V. Volpe and Hannah Neukrug are with the Department of Psychology, College of Humanities and Social Sciences, North Carolina State University, Raleigh
| | - Vanessa V Volpe
- Kristen Schorpp Rapp is with the Department of Sociology and Public Health, Roanoke College, Salem, VA. Vanessa V. Volpe and Hannah Neukrug are with the Department of Psychology, College of Humanities and Social Sciences, North Carolina State University, Raleigh
| | - Hannah Neukrug
- Kristen Schorpp Rapp is with the Department of Sociology and Public Health, Roanoke College, Salem, VA. Vanessa V. Volpe and Hannah Neukrug are with the Department of Psychology, College of Humanities and Social Sciences, North Carolina State University, Raleigh
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22
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Liu Y, Siddiqi KA, Cook RL, Bian J, Squires PJ, Shenkman EA, Prosperi M, Jayaweera DT. Optimizing Identification of People Living with HIV from Electronic Medical Records: Computable Phenotype Development and Validation. Methods Inf Med 2021; 60:84-94. [PMID: 34592777 PMCID: PMC8672443 DOI: 10.1055/s-0041-1735619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Electronic health record (EHR)-based computable phenotype algorithms allow researchers to efficiently identify a large virtual cohort of Human Immunodeficiency Virus (HIV) patients. Built upon existing algorithms, we refined, improved, and validated an HIV phenotype algorithm using data from the OneFlorida Data Trust, a repository of linked claims data and EHRs from its clinical partners, which provide care to over 15 million patients across all 67 counties in Florida. METHODS Our computable phenotype examined information from multiple EHR domains, including clinical encounters with diagnoses, prescription medications, and laboratory tests. To identify an HIV case, the algorithm requires the patient to have at least one diagnostic code for HIV and meet one of the following criteria: have 1+ positive HIV laboratory, have been prescribed with HIV medications, or have 3+ visits with HIV diagnostic codes. The computable phenotype was validated against a subset of clinical notes. RESULTS Among the 15+ million patients from OneFlorida, we identified 61,313 patients with confirmed HIV diagnosis. Among them, 8.05% met all four inclusion criteria, 69.7% met the 3+ HIV encounters criteria in addition to having HIV diagnostic code, and 8.1% met all criteria except for having positive laboratories. Our algorithm achieved higher sensitivity (98.9%) and comparable specificity (97.6%) relative to existing algorithms (77-83% sensitivity, 86-100% specificity). The mean age of the sample was 42.7 years, 58% male, and about half were Black African American. Patients' average follow-up period (the time between the first and last encounter in the EHRs) was approximately 4.6 years. The median number of all encounters and HIV-related encounters were 79 and 21, respectively. CONCLUSION By leveraging EHR data from multiple clinical partners and domains, with a considerably diverse population, our algorithm allows more flexible criteria for identifying patients with incomplete laboratory test results and medication prescribing history compared with prior studies.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Khairul A. Siddiqi
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Jiang Bian
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Patrick J. Squires
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, United States
| | - Elizabeth A. Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Mattia Prosperi
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Dushyantha T. Jayaweera
- Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida, United States
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Dawson AZ, Garacci E, Ozieh M, Walker RJ, Egede LE. The Relationship Between Immigration Status and Chronic Kidney Disease Risk Factors in Immigrants and US-Born Adults. J Immigr Minor Health 2021; 22:1200-1207. [PMID: 32686072 PMCID: PMC7686246 DOI: 10.1007/s10903-020-01054-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: To understand the relationship between nativity and measures of kidney function including estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). Methods: Seven waves of data from the National Health and Nutrition Examination Survey (2001 – 2014) was analyzed. General linear regression methods were used to assess the relationship between eGFR, ACR and nativity (foreign-born vs US-born). Models were adjusted for length of time in the US, demographic variables, comorbidities, lifestyle factors, and access to healthcare. Results: There were 27,111 individuals representing 217,842,257 US adults included in the study. Approximately 26.1% were immigrants, with 40.4% of immigrants having resided <15 years in the US. Among immigrants with <15 years of residence, 51% were Hispanic, and 54.4% had high school or below education. After controlling for demographics and length of time in the US, immigrants were 26% more likely to have an ACR >= 30mg/g (OR=1.26, 95% CI: 1.08 – 1.47); however, after controlling for demographics, length of time, comorbidities, and lifestyle factors the results were no longer significant. Immigrants were significantly less likely to have an eGFR < 60 (OR=0.42, 95%CI: 0.36 – 0.50), which remained after adjustment (OR=0.75, 95%CI: 0.61 – 0.93). Conclusions: Immigrants had significantly lower odds of having an eGFR < 60 compared to US-born adults. Additionally, immigrants with >= 15 years in the US had mean eGFR values that were less than immigrants < 15 years in the US, indicating that there is some decrease in kidney function as the length of US residence increases.
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Affiliation(s)
- Aprill Z Dawson
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Emma Garacci
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Mukoso Ozieh
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.,Division of Nephrology, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA.,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave., Milwaukee, WI, 53226, USA. .,Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
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24
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021; 26:443-452. [PMID: 33594785 DOI: 10.1002/onco.13729] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/29/2020] [Indexed: 12/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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25
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Kronenfeld JP, Graves KD, Penedo FJ, Yanez B. Overcoming Disparities in Cancer: A Need for Meaningful Reform for Hispanic and Latino Cancer Survivors. Oncologist 2021. [PMID: 33594785 DOI: 10.1002/onco.13729.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hispanic and Latino (HL) cancer survivors are at a critical disadvantage compared with non-Hispanic White (NHW) patients regarding sociodemographic adversities and access to equitable treatment options. By 2030, there will be about four million HL cancer survivors in the U.S., representing nearly 20% of survivors in this country. Hispanics and Latinos are subjected to significant challenges in accessing and receiving equitable care relative to NHWs. Hispanics and Latinos also experience lower rates of health insurance and financial resources, limiting health care options. These disparities often originate from disparate social determinants of health, including lower funding for education and school programs, greater neighborhood stressors and violence, lower access to healthy and affordable food, and greater barriers to community health and exercise opportunities. Even among HL cancer survivors with proper access to health care, they experience disparate treatment options, including low inclusion in clinical trials and/or access to experimental therapies. A solution to these barriers necessitates complex and systemic changes that involve, for example, investing in public health programs, increasing the diversity and cultural awareness of the medical workforce, and promoting research opportunities such as clinical trials that are inclusive of HLs. Only through meaningful reform will equitable cancer care be available for all in the U.S. regardless of racial and/or ethnic background. This article reviews some of the critical social determinants of health and biases relevant to HL cancer survivors and provides recommendations for achieving cancer health equity. IMPLICATIONS FOR PRACTICE: Hispanics and Latinos experience a significant and often disproportionate cancer-related burden compared with non-Hispanic and Latino White individuals and other racial and ethnic groups. Meaningful reform to achieve health equity in oncology should focus on approaches to gaining trust among diverse patients, cultural and community sensitivity and engagement in oncology care and research, diversifying the workforce, and improving inclusion in clinical trial participation. Taken together, these recommendations can lead to exemplary and equitable care for all patients.
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Affiliation(s)
- Joshua P Kronenfeld
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Kristi D Graves
- Georgetown University Lombardi Comprehensive Cancer Center, Washington, District of Columbia, USA
| | - Frank J Penedo
- University of Miami Miller School of Medicine & Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Betina Yanez
- Northwestern University Feinberg School of Medicine and Lurie Comprehensive Cancer Center, Chicago, Illinois, USA
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26
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Franke KB, Paton M, Weist M. Building Policy Support for School Mental Health in South Carolina. SCHOOL PSYCHOLOGY REVIEW 2020. [DOI: 10.1080/2372966x.2020.1819756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Evgin D, Muz G. Nursing students learning to care for refugee patients: a qualitative study †. Int Nurs Rev 2020; 68:341-348. [PMID: 33137217 DOI: 10.1111/inr.12641] [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] [Received: 03/05/2020] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nursing students should gain cultural knowledge and skills necessary for providing care to all types of patients. AIM This study aimed to determine problems faced by nursing students who care for refugee patients. METHOD The study used phenomenological qualitative design. The sample comprised 25 nursing students who cared for refugee patients in a clinic. Data were analysed using Colaizzi's seven-step method following focus group interviews. RESULTS Two themes were identified for the interviews: (i) language barrier: insufficient care and (ii) students' perspectives on being a refugee. Furthermore, three subthemes were also identified by analysis of the interviews: (i) superficial communication and insufficiency in psychological support, (ii) health problems in difficult living conditions and (iii) unchanged basic human needs and unmet care needs. CONCLUSIONS Nursing students find it difficult to care for refugee patients, but nursing education programmes based on culture care improve their knowledge and perceptions and the quality of care they provide to patients from different cultures. IMPLICATION FOR NURSING AND HEALTH POLICY In a multicultural society, nursing students must recognize cultural differences. Consequently, a multicultural education programme helps lay the groundwork for successful integration of nursing students in new cultures.
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Affiliation(s)
- D Evgin
- Department of Nursing, Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - G Muz
- Department of Nursing, Semra and Vefa Küçük Faculty of Health Sciences, Nevsehir Haci Bektas Veli University, Nevsehir, Turkey
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Arasteh K. Self-reported Hazardous Drinking, Hypertension, and Antihypertensive Treatment Among Hispanic Immigrants in the US National Health Interview Survey, 2016-2018. J Racial Ethn Health Disparities 2020; 8:638-647. [PMID: 32691328 DOI: 10.1007/s40615-020-00823-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/14/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
Compared to the US-born population, Hispanic immigrants are reported to have lower age-adjusted prevalence of hypertension. However, country of origin, race/ethnicity, and risk behaviors associated with acculturation, including hazardous drinking, can affect the prevalence of hypertension. Additionally, health disparities across immigration/nativity status may be associated with suboptimal antihypertensive treatment and control of hypertension. In the present study, population-based data from the years 2016 to 2018 of the National Health Interview Survey (NHIS) were analyzed to assess the association of nativity status and hazardous drinking with hypertension among US-born and foreign-born Hispanic populations. Age-adjusted prevalence of past-year hypertension among foreign-born Hispanics was lower than US-born Hispanics. However, the proportion of Hispanic immigrants who had their blood pressure checked by a healthcare professional was also smaller than US-born Hispanics, suggesting that the prevalence of hypertension among Hispanic immigrants may be underreported. Hazardous drinking was associated with decreased odds of antihypertensive treatment among the Hispanic immigrants.
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Affiliation(s)
- Kamyar Arasteh
- Department of Epidemiology, School of Global Public Health, New York University, 665 Broadway, Suite 800, New York, NY, 10012, USA.
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Al-Jumaili AA, Ahmed KK, Koch D. Barriers to healthcare access for Arabic-speaking population in an English-speaking country. Pharm Pract (Granada) 2020; 18:1809. [PMID: 32477432 PMCID: PMC7243745 DOI: 10.18549/pharmpract.2020.2.1809] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/10/2020] [Indexed: 11/14/2022] Open
Abstract
Objective: To identify barriers to healthcare access, to assess the health literacy levels of the foreign-born Arabic speaking population in Iowa, USA and to measure their prevalence of seeking preventive healthcare services. Methods: A cross-sectional study of native Arabic speaking adults involved a focus group and an anonymous paper-based survey. The focus group and the Andersen Model were used to develop the survey questionnaire. The survey participants were customers at Arabic grocery stores, worshippers at the city mosque and patients at free University Clinic. Chi-square test was used to measure the relationship between the characteristics of survey participants and preventive healthcare services. Thematic analysis was used to analyze the focus group transcript. Results: We received 196 completed surveys. Only half of the participants were considered to have good health literacy. More than one-third of the participants had no health insurance and less than half of them visit clinics regularly for preventive measures. Two participant enabling factors (health insurance and residency years) and one need factor (having chronic disease(s)) were found to significantly influence preventive physician visits. Conclusions: This theory-based study provides a tool that can be used in different Western countries where Arabic minority lives. Both the survey and the focus group agreed that lacking health insurance is the main barrier facing their access to healthcare services. The availability of an interpreter in the hospital is essential to help those with inadequate health literacy, particularly new arriving individuals. More free healthcare settings are needed in the county to take care of the increasing number of uninsured Arabic speaking patients.
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Affiliation(s)
- Ali A Al-Jumaili
- MPH, PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Kawther K Ahmed
- PhD. College of Pharmacy, University of Baghdad. Baghdad (Iraq).
| | - Dave Koch
- BS. Johnson County Public Health. Iowa City, IA (United States).
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Dawson AZ, Walker RJ, Gregory C, Egede LE. Examination of the Association Between Latent Variables for Social Determinants of Health and Blood Pressure Control in Immigrants using Structural Equation Modeling. J Natl Med Assoc 2020; 112:186-197. [PMID: 32169287 DOI: 10.1016/j.jnma.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hypertension is responsible for about 12.8% of deaths around the world. Immigrants' risk of developing hypertension increases with length of residency. There is limited work on the role of social determinants of health and blood pressure control in immigrants. We created a theory-based conceptual model for immigrant-specific and general social determinants variables and their relationship to blood pressure. PURPOSE Use a theory-based model to identify latent variables for immigrant-specific social determinants using confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test theoretical validity and relationship with blood pressure (BP). METHODS CFA was used to identify latent variables for global socioeconomic status, stressors of immigration, adaptation to immigration, acculturation, and burden of disease. SEM was used to test the structural relationships between latent variables and BP. RESULTS 181 immigrants were included in the analysis. The final model (chi2 (68, n = 181) = 149.87, p < 0.001, RMSEA = 0.055, CFI = 0.94, TLI = 0.91, CD = 0.99) found burden of disease was significantly related to BP (r = 0.35, p < 0.001). CONCLUSIONS One latent variable measuring need was significantly associated with BP in an immigrant sample. This suggests that interventions targeting burden of disease are likely to be effective in controlling blood pressure in immigrants.
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Affiliation(s)
- Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Chris Gregory
- College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA; Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
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Held ML, Nulu S, Faulkner M, Gerlach B. Climate of Fear: Provider Perceptions of Latinx Immigrant Service Utilization. J Racial Ethn Health Disparities 2020; 7:901-912. [PMID: 32086793 DOI: 10.1007/s40615-020-00714-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/24/2020] [Accepted: 01/27/2020] [Indexed: 10/25/2022]
Abstract
Latinx immigrants endure stressors throughout the immigration process that detrimentally impact their health and wellbeing. Yet, they also face substantial barriers to accessing and utilizing services. These barriers might be heightened under the Trump administration, which has implemented policies facilitating increased immigration enforcement and punitive immigration practices. This study utilizes data collected from providers who serve Latinx immigrants in the border state of Texas to better understand current immigrant service utilization behaviors. Individual interviews and focus groups were conducted shortly after the last presidential election to inquire about recruitment, retention, program completion, and resources to address key client risk factors. Applying grounded theory analysis strategies, interviews, and focus group recordings were coded for key themes. Data demonstrated central concerns held by providers serving immigrants, and especially those who are undocumented or in mixed-status families. Concerns were related to the following three themes: (1) undocumented immigrant stressors, (2) limited resources for undocumented immigrants, and (3) service utilization barriers. Lack of services for undocumented immigrants and fear related to service utilization were prominent subthemes. These findings extend our knowledge of stressors and barriers of access and utilization for immigrants during this time period of increased immigration enforcement which have valuable implications for practice and future research. Providers can take concrete actions to educate immigrants, regardless of documentation status, on how their clients' identities will be protected. In addition, intentional trust-building strategies are essential to help overcome fear of utilizing services. Future research should ascertain perspectives of immigrant families, as this study drew perspectives only from providers.
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Affiliation(s)
- Mary Lehman Held
- College of Social Work, University of Tennessee, Knoxville, TN, USA.
| | - Swetha Nulu
- Texas Institute for Child & Family Wellbeing, The University of Texas at Austin Steve Hicks School of Social Work, Austin, TX, USA
| | - Monica Faulkner
- Texas Institute for Child & Family Wellbeing, The University of Texas at Austin Steve Hicks School of Social Work, Austin, TX, USA
| | - Beth Gerlach
- Texas Institute for Child & Family Wellbeing, The University of Texas at Austin Steve Hicks School of Social Work, Austin, TX, USA
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Schwarz C. Thrifting for More: Savings and Aspirations in Health Care Sharing Ministries after the Affordable Care Act. Med Anthropol Q 2019; 33:226-241. [PMID: 30968439 DOI: 10.1111/maq.12515] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/10/2019] [Accepted: 02/15/2019] [Indexed: 11/27/2022]
Abstract
The Affordable Care Act (ACA) of 2010 includes health care sharing ministries (HCSMs) on the list of religious exemptions to the individual mandate. HCSMs are non-profit, faith-based organizations that share in the cost of medical bills but are not actually insurance. Precisely because HCSMs are not beholden to any of the ACA's insurance reforms, they have the advantage of costing less. Based primarily on in-depth interviews, I argue that thrift is the preeminent moral discourse that anchors the HCSM world. For members, thrift in health care is understood as a moral good and as a practice that offers possibilities for benefiting connected others and generating life fulfillment, or what Taylor refers to as "fullness." I suggest that a focus on thrift raises questions about how Americans make determinations about worth in health care and how they construct health care-seeking as deeply attached to their visions of how they want life to be.
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Fleming K, Simmons VN, Christy SM, Sutton SK, Romo M, Luque JS, Wells KJ, Gwede CK, Meade CD. Educating Hispanic Women about Cervical Cancer Prevention: Feasibility of a Promotora-Led Charla Intervention in a Farmworker Community. Ethn Dis 2018; 28:169-176. [PMID: 30038478 DOI: 10.18865/ed.28.3.169] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hispanic women suffer disproportionately from cervical cancer incidence and mortality compared with non-Hispanic Whites in the United States. Peer-led health education and coaching via charlas (talking circles) may improve cervical cancer screening and early detection rates among specific sub-groups such as farmworker communities. This pilot study sought to collect preliminary evaluation data about the feasibility of implementing a promotora-led cervical cancer education intervention among women from a farmworker community. The study took place between April 2014 and November 2014. Created based on an established network (Tampa Bay Community Cancer Network, TBCCN), in partnership with a local farmworker organization (Farmworkers Self-Help, Inc.), the project entailed refinement of a curriculum guide including Spanish-language educational resources (teaching cards). Social Cognitive Theory and the Health Belief Model provided the conceptual framework for the study. Six women from the farmworker community helped to refine the intervention and were trained as promotoras. They successfully delivered the program via charlas to a total of 60 participants who completed baseline and post-intervention measures on knowledge (cervical cancer/HPV), beliefs, self-efficacy, and intentions. Findings demonstrated gains in knowledge and self-efficacy among charla participants (P<.0001), and support the promise of a community-driven intervention that is delivered by promotoras who use their cultural knowledge and trustworthiness to educate women about cancer screening practices. Results also add to the literature on the use of a charla approach for cancer prevention education within a farmworker community to prompt discussions about health. Future research should evaluate peer-led programs on a larger scale and among other at-risk groups in other community settings.
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Affiliation(s)
- Khaliah Fleming
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Vani N Simmons
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Shannon M Christy
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.,Formerly with H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Steven K Sutton
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | - Kristen J Wells
- San Diego State University, San Diego, California.,University of California, San Diego Moores Cancer Center, San Diego, California
| | - Clement K Gwede
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Cathy D Meade
- Division of Population Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.,Morsani College of Medicine, University of South Florida, Tampa, Florida
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Peterson-Burch FM, Olshansky E, Abujaradeh HA, Choi JJ, Zender R, Montgomery K, Case A, Sorkin DH, Chaves-Gnecco D, Libman I, Lucas CT, Zaldivar F, Charron-Prochownik D. Cultural understanding, experiences, barriers, and facilitators of healthcare providers when providing preconception counseling to adolescent Latinas with diabetes. ACTA ACUST UNITED AC 2018; 5. [PMID: 31572615 PMCID: PMC6768083 DOI: 10.7243/2054-9865-5-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Latinas are at a higher risk than Caucasians for both type 1 and type 2 diabetes (DM), as well as DM-associated reproductive health (RH) complications. Healthcare providers (HCPs) should deliver culturally-sensitive care to enhance the care relationship between Latinos and HCPs and to improve patient outcomes. This study explored an expert panel's cultural understanding, experiences, barriers, and facilitators regarding RH and preconception counseling (PC) for adolescent Latinas with DM and their families. Methods This study used open-ended questions with a focus group of 8 HCPs from the mid-Atlantic, Southwest, and Northwest regions of the United States in a teleconference format. Two researchers transcribed and reviewed the transcript for accuracy. Using content analysis, four members of the team identified themes. All researchers discussed themes and a 100% consensus was reached. For confirmation, a coding protocol was created based on the emerging themes. Results Five themes related to cultural understanding and experiences were identified: 1) issues of identity; 2) acculturation; 3) stigma; 4) ambivalence toward birth control, RH education, and PC; and 5) cultural sensitivity vs. best practice. Four barriers were identified: 1) language; 2) religion; 3) access to healthcare, and 4) discomfort with discussion. Ten facilitators were identified: 1) the importance of support and support networks; 2) promoting trust among HCPs, daughters, and families; 3) assessing emotional development; 4) empowerment; 5) emphasizing safety; 6) communicating in patients' preferred language; 7) discussing RH-related topics and PC using cultural sensitivity; 8) importance of being ready/temporality/planning for the future; 9) the importance of family-centered care; and 10) variation in educational tailoring and dissemination/ care delivery. Conclusions Findings support the need for culturally sensitive and developmentally appropriate PC programs to empower adolescent Latinas with DM.
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Affiliation(s)
- Frances M Peterson-Burch
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street Pittsburgh, USA
| | - Ellen Olshansky
- Professor Emerita, University of California, Irvine Sue & Bill Gross School of Nursing 802 W Peltason Drive Irvine, CA 92697, USA
| | - Hiba A Abujaradeh
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street Pittsburgh, USA
| | - Jessica J Choi
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street Pittsburgh, USA
| | - Robynn Zender
- University of California, Irvine, Sue & Bill Gross School of Nursing, 802 W Peltason Drive Irvine, CA 92697, USA
| | | | - Amy Case
- Consortium for Independent Research, 512 E. 27th Street Vancouver, WA, USA
| | - Dara H Sorkin
- Department of Medicine 100 Theory, University of California, Irvine, Suite 110 Irvine, CA, USA
| | - Diego Chaves-Gnecco
- MD, MPH, FAAP UPMC Children's Hospital of Pittsburgh, Oakland Medical Building, 3420 Fifth Ave. Pittsburgh, PA, USA
| | - Ingrid Libman
- MD, MPH, FAAP UPMC Children's Hospital of Pittsburgh, Oakland Medical Building, 3420 Fifth Ave. Pittsburgh, PA, USA
| | - Candice Taylor Lucas
- University of California, Irvine School of Medicine, 333 The City Blvd. West, Suite 800 Orange, CA, USA
| | - Frank Zaldivar
- Department of Pediatrics University of California, Irvine, Pediatric Exercise and Genomics Research Center (PERC), UC Irvine School of Medicine, 101 Academy, Suite 150 Irvine, CA, USA
| | - Denise Charron-Prochownik
- University of Pittsburgh School of Nursing, 440 Victoria Building, 3500 Victoria Street Pittsburgh, USA
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