Showing papers in "Journal of Health Care for the Poor and Underserved in 1996"
TL;DR: Analyzing the associations between personal characteristics and the use of Spanish as opposed to English reveals that monolingual Spanish speakers were more likely than others to be older, less educated, in poor health, uninsured, and in poverty.
Abstract: This study examines the role of spoken language in access to health care for Hispanic adults. Analyzing the associations between personal characteristics and the use of Spanish as opposed to English reveals that monolingual Spanish speakers were more likely than others to be older, less educated, in poor health, uninsured, and in poverty. Further, Spanish speakers were less likely than English-speaking Hispanics to have a usual source of health care. Persons with no usual source of care were least likely to have seen a physician or to have had their blood pressure checked, whereas those with a regular doctor appeared to have the greatest access. The authors conclude that, whereas language is certainly associated with many barriers to health care, both economic well-being and having a usual source of care are of paramount importance for the Hispanic American population.
92Â citations
TL;DR: Findings suggest that being married, having a higher income, more years of education, and longer U.S. residency predicted receipt of Pap smear, and women who performed BSE had higher incomes and were more likely to have been taught how to perform the procedure.
Abstract: This study was designed to identify determinants of breast and cervical cancer screening among rural, low-income Hispanic women using migrant health clinics in eastern Washington state. Five hundred and twelve foreign-born Hispanic women were interviewed. Odds ratios and 95 percent confidence intervals generated via logistic regression analysis were used to discern the influence of independent factors on use or nonuse of Papanicolaou (Pap) smear, breast self-examination (BSE), and mammography. Being married, having a higher income, more years of education, and longer U.S. residency predicted receipt of Pap smear. Women who performed BSE had higher incomes and were more likely to have been taught how to perform the procedure. Low concern for direct expenditure and increasing years of U.S. residency predicted receipt of mammogram. On the basis of these findings, implications for developing cancer-screening interventions using inreach and outreach strategies to target this high-risk subgroup are discussed.
58Â citations
TL;DR: Utilization of ambulatory care is lower among unstably housed persons with HIV disease, which may have led to their increased reliance upon emergency rooms and hospitals, and helping HIV-infected individuals maintain adequate housing could reverse this pattern.
Abstract: This study sought to identify the prevalence of unstable housing situations, and for whom they occurred, and to examine differences in health care utilization by housing status. Housing status and inpatient and outpatient health care utilization of 1,851 HIV-infected individuals was ascertained through interviews. Nine percent of respondents were in unstable housing situations. Unstable housing was associated with significantly lower functional status. The unstably housed were more likely to visit an emergency room (p < 0.05) and had fewer ambulatory visits than persons with stable housing (p < 0.03). They incurred nearly five more hospital days and their average hospitalization was approximately 1.5 days longer than the stably housed, although these differences were not significant. Utilization of ambulatory care is lower among unstably housed persons with HIV disease, which may have led to their increased reliance upon emergency rooms and hospitals. Helping HIV-infected individuals maintain adequate housing could reverse this pattern.
58Â citations
TL;DR: Examination of lower income African American households in the rural South for access to prescription drugs and coping strategies when households cannot afford prescription drugs finds households that could not afford prescriptions employed five strategies: financing, rationing, substituting, and postponing.
Abstract: African Americans have higher rates of nonprescription drug utilization than white Americans, but lower rates of prescription drug use. In light of this discrepancy, this study examines 281 lower income African American households in the rural South for access to prescription drugs and coping strategies when households cannot afford prescription drugs. About half of the households could not always afford needed prescriptions, and ability to pay was related positively to Medicaid coverage. Households that could not afford prescriptions employed five strategies: (1) prioritizing, (2) financing, (3) rationing, (4) substituting, and (5) postponing. Financing, postponing, and rationing were cited most frequently. The impact of culture and areas for future research are discussed.
44Â citations
TL;DR: Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.
Abstract: This study describes the rates of health care access among Mexican Americans with different health insurance coverage. An interview questionnaire was used to collect information regarding sociodemographics, perceived health status, health insurance coverage, and sources of health care from a random sample of 501 Mexican Americans from San Antonio, Texas. Health care access was determined more by having health insurance coverage than by health care needs. Poor Mexican Americans with health insurance had higher health care access rates than did poor Mexican Americans without health insurance. Health care access may improve health care outcomes, but more comprehensive community-based campaigns to promote health and better use of health services in underprivileged populations should be developed.
35Â citations
TL;DR: Reducing morbidity through health promotion and disease prevention could both improve the quality of elderly life and lessen the burden on the health care system, and it would seem reasonable that such efforts, including nutrition education, in minority elderly would be of benefit.
Abstract: Nutrition and aging are inseparably connected as eating patterns affect the progress of many degenerative diseases associated with aging. In turn, the nutritional status of the elderly, particularly minority elders (the most rapidly growing segment of the population in the United States), may be adversely affected by a number of factors associated either directly or indirectly with aging. Because reducing morbidity through health promotion and disease prevention could both improve the quality of elderly life and lessen the burden on the health care system, it would seem reasonable that such efforts, including nutrition education, in minority elderly would be of benefit. The extent of the potential value of such preventive programs, however, remains uncertain, and the task of determining nutrient needs of the elderly difficult. Special studies are required to describe the association of nutrition-related factors with chronic diseases, particularly those prevalent in minority elders.
25Â citations
TL;DR: Established in 1990, the NSI is to promote the incorporation of routine nutrition screening and nutritional care into America's health services delivery system and has devoted its activities toward increasing the awareness of nutritional factors as they relate to the older population.
Abstract: The recent dramatic growth in the population aged 65 and over is projected to continue well into the 21st century. While improved health status of most aging Americans is also expected, such is not the case in certain vulnerable subgroups at risk for poor health. This includes older women; minority groups; those aged 85 and above; older persons with limited economic resources, those isolated from family and friends; and older persons with impaired physical, cognitive, or emotional status. These factors, plus the cost implications of caring for a rapidly aging population, provided the impetus for the development of the Nutrition Screening Initiative (NSI). Established in 1990, the goal of the NSI is to promote the incorporation of routine nutrition screening and nutritional care into America's health services delivery system. The NSI has devoted its activities toward increasing the awareness of nutritional factors as they relate to the older population.
24Â citations
TL;DR: Compared with native-born populations and those with permanent residency status (insured by Medicaid or of uninsured status) admitted to the same hospital, undocumented immigrants had a higher Case Mix Severity Index but a lower adjusted average length of stay.
Abstract: Data collected from a large county hospital in Miami, Florida were used to study the severity of illness (using the Case Mix Severity Index) and resource use (measured by average length of stay, procedures, and/or diagnostic tests performed) of undocumented persons from Dade County, Florida in an inpatient setting. Compared with native-born populations and those with permanent residency status (insured by Medi- caid or of uninsured status) admitted to the same hospital, undocumented immigrants had a higher Case Mix Severity Index but a lower adjusted average length of stay. Undocumented immigrants and uninsured resi- dents of the United States had a similar number of adjusted proce- dures/tests performed, but less than Medicaid beneficiaries. Policy issues are discussed.
23Â citations
TL;DR: The relationship between the primary service area of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed and only poverty level and infant mortality were useful discriminating parameters.
Abstract: The relationship between the primary service area (PSA) of an urban community health center (CHC) program and a federally defined "medically underserved area" (MUA) was assessed. Federal guidelines that most reliably predicted medical underservice were identified. The service area was statistically defined by census tract penetration rates. The MUA was defined by an index of medical underservice (IMU) according to federal parameters of physician supply, poverty level, percentage elderly persons, and infant mortality. An index score was calculated for the country, service area, and each census tract. Analysis by tract determined the most significant discriminating parameters. By excluding two tracts concentrated with managed-care physicians, the service area qualified as an MUA. Tracts that fulfilled MUA and service area criteria were highly associated (p < 0.0001). Only poverty level and infant mortality were useful discriminating parameters. Federal indicators of demand (elderly population) and supply (physicians) did not adequately address issues to access for the medically underserved in urban neighborhoods. Other parameters that might serve as proxies of care access and underserved are discussed.
22Â citations
20Â citations
TL;DR: The longevity advantage of women (particularly women of color) and its implications for economic insecurity, underinsurance of health care, health status, functional disability, access to care, and service use are discussed.
Abstract: The U.S population is becoming increasingly older due to steady increases in longevity, especially among women. Statistics show that older women, those 65 and over, outnumber older men by three to two. It is likely that as this trend in longevity continues, older women will continue to outnumber older men. The health care system must respond to these changes in the population by incorporating appropriate modifica- tions into every aspect of the system, including financing mechanisms, service organization and delivery, consumer-centered care approaches, quality assurance mechanisms, and health promotion efforts. This article discusses the longevity advantage of women (particularly women of color) and its implications for economic insecurity, underinsurance of health care, health status, functional disability, access to care, and service use. The article concludes with a discussion of the challenges and opportunities presented as health care reform and the devolution of federal roles continue to unfold.
TL;DR: A comprehensive epidemiological and sociodemographic profile of Latinos in the United States is presented in the book "Latino Health in the U.S: A Growing Challenge" as discussed by the authors.
Abstract: Despite the dramatic growth of the Latino population in the United States and the increasing importance of Latinos' presence in all facets of American life, traditionally little has been pubUshed regarding the health profile of Latinos in the United States. Latino Health in the U.S.: A Growing Challenge, edited by Carlos W. Molina and Marilyn Aguirre-Molina, clearly succeeds in reversing that tradition by presenting a comprehensive epidemiological and sociodemographic profile of Latinos in the United States. The book is organized into seven sections, all of which describe and analyze different important dimensions of Latino health. Each of these sections is divided into chapters written by a diverse group of nationally recognized Latino researchers, scholars, educators, and activists such as Fernando M. Trevino, PhD, of the American Public Health Association. The first section presents a broad introduction to Latino health, defining who Latinos are, what the historical and cultural roots of the main Latino population subgroups are, and what role culture, class, and socioenvironmental factors play on their health. The introductory chapters of the book also provide a general epidemiological profile of Latinos. The second section describes and analyzes Latino health issues with regard to the U.S. health care system, addressing concerns related to structural and social barriers that affect access to care and health care use. The third and fourth sections examine health
TL;DR: In this article, the authors compared the use of eight hospital-based procedures (appendectomy, cesarean section, coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy, hysterectoma, mastectomy, and transurethral prostate resection) in South Central Los Angeles (SCLA) to the remainder of Los Angeles County.
Abstract: The purpose of this study was to compare the use of eight hospital-based procedures (appendectomy, cesarean section, coronary artery angioplasty (PTCA), coronary artery bypass grafting (CABG), carotid endarterectomy, hysterectomy, mastectomy, and transurethral prostate resection) in South Central Los Angeles (SCLA) to the remainder of Los Angeles County. The authors used age- and gender-adjusted procedure rates and population-weighted multivariate regression techniques, adjusting for illness proxies, physician distribution, hospital distance, income, and ethnicity variation to quantitate the effect of SCLA residence. Four procedures were performed at significantly lower rates among residents of SCLA: PTCA, CABG, carotid endarterectomy, and cesarean section. In multivariate regression models, SCLA was also a significant predictor for appendectomy, mastectomy, and transurethral prostatectomy (TURP). The SCLA effect was diminished but not eliminated when ethnicity variables were incorporated into regression models. The use of selected procedures by residents of SCLA frequently differs from that of residents of the remainder of Los Angeles Country. Some differences are not attributable to level of health, income, ethnicity, or the availability of medical resources.
TL;DR: This intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants and illustrated the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.
Abstract: A low-intensity exercise demonstration project was developed jointly by researchers, social service practitioners, and program participants to actively involve frail older people in their own health maintenance. This article describes this collaborative process and its impact on the success of the health promotion program, which was conducted at three senior centers serving a low-income, urban elderly population. Participants were predominantly sedentary women over age 70 with multiple chronic conditions. The program was conducted with peer leaders to facilitate its continuation after the research demonstration phase. In addition to positive health outcomes related to functional mobility, blood pressure maintenance, and overall well-being, this intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants. The planning, implementation, and outcomes of this project illustrate the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.
TL;DR: Follow-up in severe hypertensives was poor, and a mailed postcard reminder had no effect in a walk-in setting, in a single-blinded, randomized trial.
Abstract: A single-blinded, randomized trial was conducted to determine whether a mailed postcard improved follow-up in uncontrolled hypertensives. One hundred and seven patients with a systolic blood pressure (BP) of 180 or more or a diastolic blood pressure of 110 or more at an inner-city, hospital-based walk-in clinic were enrolled; mean age was 56 years, 95 percent were African American, 73 percent were female, and mean BP was 193/106. Patients were required to be aware of their diagnosis and to have been informed of their need for medication at least a month before the trial. Of those who received postcard reminders, 45 percent followed up within 10 days, compared with 47 percent of controls (p = 0.93). At 30 days, 64 percent of the intervention group followed up, compared with 55 percent of controls (p = 0.36). In an adjusted logistic regression model, there was no difference in follow-up. Correlates of appointment noncompliance at one month included alcoholism and lack of insurance in an adjusted logistic regression model. Follow-up in severe hypertensives was poor, and a mailed postcard reminder had no effect in a walk-in setting.
TL;DR: A comparison of dietary intake patterns of low-income white and African American women showed a trend toward poorer dietary habits among the white women, which implies that disease prevention and health promotion programs should include efforts to increase awareness and practice of healthy diet habits among all low- Income women.
Abstract: Information concerning nutritional status and factors influencing dietary intakes among underserved populations is scarce To obtain this information, data on nutritional status in a group of 726 white and African American women of low education and low income who were inner-city dwellers were analyzed Dietary habits in all subjects were characterized by high intakes of fat, saturated fat, cholesterol, and salt and low intakes of fiber and folate A comparison of dietary intake patterns of low-income white and African American women showed a trend toward poorer dietary habits among the white women It is suggested that differences between African Americans and whites in most nutrient intakes were due to factors such as low levels of education and income rather than racial background alone Results imply that disease prevention and health promotion programs should include efforts to increase awareness and practice of healthy diet habits among all low-income women
TL;DR: The sensitivity of obesity as a screening tool for hypercholesterolemia was better than that for positive family history (42 vs. 24 percent, respectively) and combining the two improved the sensitivity to 49 percent.
Abstract: Screening only those with a positive family history misses many children with hypercholesterolemia. This study investigated whether sensitivity improved by adding obesity as a criterion when screening children for cholesterol. During a two-year period screenings were conducted on 506 inner-city subjects aged 5-19. Demographic, clinical, and dietary information was also recorded. Mean age of participants was 11 +/- 4 years; 52 percent were female, 53 percent black, 39 percent Hispanic, and 8 percent other. Mean cholesterol level was 4.14 mmol/l (160 mg/dl). In multivariate analysis obesity was an independent risk factor for hypercholesterolemia, F = 13.14, p < 0.001. The sensitivity of obesity as a screening tool for hypercholesterolemia was better than that for positive family history (42 vs. 24 percent, respectively). Combining the two improved the sensitivity to 49 percent. The authors recommend expanding the indications for screening children to include obesity, in addition to positive family history of hypercholesterolemia or premature cardiovascular disease.
TL;DR: This strategy was based on the ecological disease theory and action research methodology and intended to encourage HIV risk-reduction behaviors among the patients, to encourage the HIV testing of those who may be at risk for HIV, and to facilitate access to services for those found to be infected.
Abstract: Few HIV prevention efforts have focused on Asian Pacific Islander communities in the United States. Prevention messages developed for the general U.S. population have failed to reach many Asian Pacific Islanders. This article describes the development of an HIV prevention strategy for Asian Pacific Islanders through health care workers. This strategy was based on the ecological disease theory and action research methodology. The prevention program comprised four components: (1) a symposium for the health care workers, (2) a culturally sensitive and appropriate HIV-related video for the health care workers and their patients, (3) ongoing training of the health care providers, and (4) ongoing liaison and consultative services for the health care providers. The intervention is intended to encourage HIV risk-reduction behaviors among the patients, to encourage the HIV testing of those who may be at risk for HIV, and to facilitate access to services for those found to be infected.
TL;DR: Differences between male and female physical activity and smoking behaviors of African Americans aged 50 to 61 are compared to highlight a clear pattern of socioeconomic differences with current male smokers, who are more likely to be unmarried and in the lower income and educational levels.
Abstract: Little effort has been expended on the examination of systematic health risk behaviors among adult African Americans by gender. Using data from the national Health and Retirement Study (HRS), this article compares differences between male and female physical activity and smoking behaviors of African Americans aged 50 to 61. The analysis highlights a clear pattern of socioeconomic differences with current male smokers, who are more likely to be unmarried and in the lower income and educational levels. Among women, the relationship between smoking patterns, income, and education is less definitive and consistent. Our findings, confirmed by earlier studies, indicate that the largest percentage of the study population, both male and female, are not engaged in any form of regular physical exercise. Thus human service providers must be more attentive to gender and sociodemographic differences in smoking habits and patterns of physical activities to tailor policies and programs accordingly.
TL;DR: In this paper, women with major psychiatric disorders were divided into three groups: abortion, relinquishment, and no children, and demographic, diagnostic, and birth control data showed that those who aborted or relinquished custody of their children were likely to come from ethnic minority populations and have a history of substance abuse.
Abstract: Rising fertility rates among the severely and persistently mentally ill require a better understanding of the family planning needs of this population. In the present study, 82 women hospitalized for major psychiatric disorders were divided into three groups: abortion (n = 22), relinquishment (n = 28), and no children (h = 32). Statistical analyses of demographic, diagnostic, and birth control data showed that those who aborted or relinquished custody of their children were likely to come from ethnic minority populations and have a history of substance abuse. More than 70 percent of the women who had abortions reported sexual and/or physical assaults as either children or adults. Only 34 percent of all participants indicated that they used contraceptives. Increased awareness of reproductive histories and family planning needs of women with major psychiatric disorders is suggested. Current conception and birth rates of women with severe and persistent mental disorders appear to approximate those of the general popula- tion,1,2,3 suggesting the need to address the family planning needs of these individuals.4,5'6 Studies concerning the reproductive behavior of hospitalized psychiatric patients have been minimal, ' often centering on ways to restrict sexual activities in institutional settings.9 Literature concerning women with major psychiatric disorders who voluntarily abort or relinquish custody of their children is also scant. This apparent shortfall prompted the current study, in which demographic, diagnostic, and birth control variables among psychi-
TL;DR: Any reorganized health care system should assure health care coverage for all children, health insurance plans must guarantee access and adequate coverage for important medical needs of children, and out-of-pocket expenditures must not discourage the use of effective health care for children.
Abstract: Many children in the United States live in poverty, lack health insurance, and receive inadequate health care. Current methods of financing health care fail to adequately provide for the needs of children. On the basis of the moral principles of beneficence and justice, adult members of society have a duty to assure that all children receive at least a basic level of health care. Any reorganized health care system should assure health care coverage for all children, health insurance plans must guarantee access and adequate coverage for important medical needs of children, and out-of-pocket expenditures must not discourage the use of effective health care for children.
TL;DR: A set of indicators that are related to the uninsured rate are presented and prediction models from surveys taken two years apart in the same counties are developed.
Abstract: Uninsured rates of all counties in an area can be predicted by combining survey data from a subset of area counties and secondary data on economic indicators that are available for all counties. The authors present a set of indicators that are related to the uninsured rate and develop prediction models from surveys taken two years apart in the same counties. The accuracy and stability of the prediction models are assessed. Accuracy levels are highest when contemporaneous rates are predicted, but accuracy deteriorates when rates in a later time period are predicted using models from a prior period.
TL;DR: Data is used to describe the income, health status, and prior insurance of small group employees who enrolled in prepaid health plans through Health Care Group of Arizona (HCGA), and compares employee enrollees to nonenrollees along these dimensions.
Abstract: The ongoing health care reform discussion has highlighted the problems of insuring small group employees. Several state and private initiatives have attempted to address some of these problems through the formation of voluntary small group purchasing arrangements. This article uses data from one such initiative, Health Care Group of Arizona (HCGA), to describe the income, health status, and prior insurance of small group employees who enrolled in prepaid health plans through HCGA. It also compares employee enrollees to nonenrollees along these dimensions. The findings suggest that HCGA enrollees had relatively low incomes and that about three-quarters were without health insurance prior to enrollment. Higher income employee enrollees were more likely to report health conditions at enrollment even after controlling for other factors including age. Enrollees were less likely than nonenrollees to have prior health insurance but were more likely to be drawn from lower income groups and to report recent health conditions.