Showing papers in "Journal of Health Care for the Poor and Underserved in 2007"
TL;DR: This analysis analyzed over 400 internal tobacco industry documents to explore how, during the past several decades, the industry targeted inner cities populated predominantly by low-income African American residents with highly concentrated menthol cigarette marketing.
Abstract: Industry has played a complex role in the rise of tobacco-related diseases in the United States. The tobacco industry's activities, including targeted marketing, are arguably among the most powerful corporate influences on health and health policy. We analyzed over 400 internal tobacco industry documents to explore how, during the past several decades, the industry targeted inner cities populated predominantly by low-income African American residents with highly concentrated menthol cigarette marketing. We study how major tobacco companies competed against one another in menthol wars fought within these urban cores. Little previous work has analyzed the way in which the inner city's complex geography of race, class, and place shaped the avenues used by tobacco corporations to increase tobacco use in low-income, predominantly African American urban cores in the 1970s-1990s. Our analysis shows how the industry's activities contributed to the racialized geography of today's tobacco-related health disparities.
179 citations
TL;DR: The results suggest that women have conflicting feelings about research that cross ethnic lines and should be addressed by researchers.
Abstract: Minority and low socioeconomic status women are under-represented in clinical research due to logistical, informational, attitudinal, and sociocultural barriers. The primary objective of this study was to explore factors associated with research participation among African American and low socioeconomic status White women using the Theory of Planned Behavior. A secondary goal was to assess differences in barriers to research participation by age and race. A combination of qualitative (focus groups) and quantitative (trust scale) methodologies was employed. Ten focus groups were held, organized by age and race. Content analysis revealed three predominant themes: fear, distrust, and hope. Older women had higher trust; there was no difference in trust by race. The results suggest that women have conflicting feelings about research that cross ethnic lines and should be addressed by researchers. Effective strategies for overcoming barriers and increasing representation are those that establish ongoing relationships with relevant communities.
104 citations
TL;DR: This paper uses a site and situation approach to show how maps of the five main sources of disaster-related stress in New Orleans can be used to predict where counseling resources should be targeted.
Abstract: The immediate aftermath of Katrina focused the world's attention on the vulner - ability of the urban poor and racial/ethnic minority groups in New Orleans. This vulnerability can be viewed in terms of site, the proximity of a neighborhood to a hazard, and situation, the social context of that neighborhood. Vulnerabilities, associated with demographic char- acteristics such as being poor, being a member of a racial/ethnic minority group, and being female, will strengthen the force of a disaster. This paper uses a site and situation approach to show how maps of the five main sources of disaster-related stress in New Orleans can be used to predict where counseling resources should be targeted.
98 citations
TL;DR: Results indicate differences in crisis preparation and evacuation plans, with disabled subpopulations being more likely to prepare emergency supplies but less likely to have an evacuation plan.
Abstract: This study examined differences in evacuation, crisis preparation, information-seeking patterns, and media use among the communities of disabled and non-disabled evacuees in the aftermath of Hurricane Katrina. Surveys were collected from 554 Katrina evacuees temporarily relocated in different areas of the United States. Results indicate differences in crisis preparation and evacuation plans, with disabled subpopulations being more likely to prepare emergency supplies but less likely to have an evacuation plan. Differences between the disabled and non-disabled subpopulations also existed in information-seeking habits. Media use was similar between disabled and non-disabled respondents.
97 citations
TL;DR: This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences and concludes with lessons based on the Katrina experience.
Abstract: In the days after Hurricane Katrina struck and New Orleans's infrastructure failed, hospitals and other organizations that have custodial responsibility for human beings (such as nursing homes and jails) faced special difficulties. In some two dozen hospitals, patients had to be evacuated because of the loss of power, water, and sewage service, and many of these hospitals required external assistance, which was slow to arrive. Meanwhile, patients' needs for care continued unabated. Some hospitals evacuated all patients successfully, but by the end of that long week, some had become places of death. This paper explores what happened in New Orleans-area hospitals during and after Hurricane Katrina and why hospitals had such varied experiences. We conclude with lessons based on the Katrina experience.
94 citations
TL;DR: Findings regarding key messages and motivating factors can be used to develop clear, prioritized messages for communication regarding emergencies and emergency preparedness for Latin American immigrant communities in the U.S.
Abstract: This paper describes the level of public emergency knowledge and perceptions of risks among Latin American immigrants, and their preferred and actual sources of emergency preparedness information (including warning signals). Five Latino community member focus groups, and one focus group of community health workers, were conducted in a suburban county of Washington D.C. (N=51). Participants came from 13 Latin American countries, and 64.7% immigrated during the previous five years. Participants had difficulty defining emergency and reported a wide range of perceived personal emergency risks: immigration problems; crime, personal insecurity, gangs; home/traffic accidents; home fires; environmental problems; and snipers. As in previous studies, few participants had received information on emergency preparedness, and most did not have an emergency plan. Findings regarding key messages and motivating factors can be used to develop clear, prioritized messages for communication regarding emergencies and emergency preparedness for Latin American immigrant communities in the U.S.
91 citations
TL;DR: It is indicated that spirituality promotes emotional resilience in the aftermath of traumatic events such as Hurricane Katrina and the need for researchers to reconsider expressions of spirituality based solely on church membership/attendance and prayer, and to consider redefining spiritual coping as a form of cultural capital.
Abstract: Hurricane Katrina has drawn increased interest in coping strategies, spirituality, and mental health among low-income Blacks. Given the paucity of information available regarding the role of spirituality in surviving Hurricane Katrina, this qualitative study explores active coping strategies of older Blacks. Older respondents who were evacuated to a Texas retirement apartment complex participated in a series of three in-depth interviews (starting approximately three weeks after their arrival in the host state and continuing weekly). Without exception, the findings indicate that this population coped with Katrina and its aftermath through reliance on a Higher Power. The relationship to a Higher Power did not necessarily translate into church membership. The conclusions of the respondents' spiritual coping mechanisms revealed the following themes: 1) regular communication with a supernatural power; 2) miracles of faith through this source of guidance and protection; 3) daily reading of the Bible and various spiritual and devotional materials; and 4) helping others as a consequence of faith and devotion to a supreme being. This study indicates that spirituality promotes emotional resilience in the aftermath of traumatic events such as Hurricane Katrina. These findings also point to the need for researchers to reconsider expressions of spirituality based solely on church membership/attendance and prayer, and to consider redefining spiritual coping as a form of cultural capital.
82 citations
TL;DR: Community-based, culturally appropriate interventions for Vietnamese Americans and health care providers should increase screening and vaccination rates.
Abstract: Hepatitis B Virus (HBV) infection is a serious health problem among Asian Americans. Vietnamese Americans are disproportionately affected by liver cancer compared with other racial and ethnic groups. Vietnamese males have the highest incidence of liver cancer of any racial group; incidence of liver cancer among Vietnamese males is 11 times higher than among White males. Nearly 80% of liver cancer is attributed to HBV. This study measured knowledge, attitudes, and behaviors related to HBV screening and vaccination. The study was conducted among 256 Vietnamese Americans in the greater Philadelphia and New Jersey area, with a large number of underserved, recent immigrants with low socioeconomic status and limited English proficiency. Participants were recruited from Vietnamese community-based organizations. Overall, 46.3% of the sample had heard of HBV or knew about the availability of screening (32.6%) or vaccination (35.5%) while 7.5% were ever screened and 6.3% had been vaccinated. Community-based, culturally appropriate interventions for Vietnamese Americans and health care providers should increase screening and vaccination rates.
80 citations
TL;DR: The medical differences between children and adolescents with and without chronic conditions immediately following Katrina are unsurprising, and the other differences between the groups merit attention from policymakers and health care providers.
Abstract: Children with chronic conditions may be at risk of increased disruptions in health care following natural disasters such as Hurricane Katrina. The objective of this cross-sectional study was to evaluate differences between children and adolescents with and without chronic conditions immediately following Katrina. Of 531 participants, there were 79.8% younger than 13 years old, 50.5% male, 42.8% African American. Participants with pre-existing conditions (39.4% of the total sample) were more likely than those without to be at the clinic for a non-chronic health condition rather than another problem (43.5 vs. 16.2%), to take asthma medication (37.4 vs. 3.9%), to have asthma worsen (16.3 vs. 1.9%), to miss a visit (49.2 vs. 39.8%), to run out of medications (33.9 vs. 7.9%), to live with flood damage (19.7 vs. 11.3%) or mold (23.6 vs. 15.8%), and to experience disruption in care (58.4 vs. 38.3%) or negative psychological consequences (ranging from 2.5% to 12.9%). While the medical differences are unsurprising, given the groups being compared, the other differences between the groups merit attention from policymakers and health care providers. Children and adolescents with chronic conditions are at increased risk of adverse outcomes following a natural disaster. Providers may be able to reduce negative effects on this population by developing condition-specific preparedness care mechanisms.
79 citations
TL;DR: This study assesses the public health functions played by news information and social capital in the context of Hurricane Katrina by conducting in-depth interviews with hurricane shelter residents.
Abstract: This study assesses the public health functions played by news information and social capital in the context of Hurricane Katrina. In-depth interviews were conducted with 57 hurricane shelter residents between 4 and 6 weeks after the hurricane. Depression was more common for participants who relied more on news information than for other participants after the hurricane (adjusted odds ratio [AOR], 5.49; 95% CI, 1.29 to 23.35; p=.021). Depression was more common for participants with relatively low levels of pre-hurricane positive social interactions (AOR, .16; 95% CI, .02 to 1.83; p=.046) and post-hurricane positive social interactions (AOR, .02; 95% CI, .00 to .74; p=.033) and high levels of post-hurricane negative social interactions (AOR, 17.05; 95% CI, .92 to 315.64; p=.047). Illness and injury were more common for participants who had relied more on news information than for other participants after the hurricane (AOR, 1.13; 95% CI, 1.02 to 2.77; p=.046).
77 citations
TL;DR: Distrust of authorities seems likely to have played a role in New Orleans residents’ reactions to evacuation warnings and public health authorities’ advice, and distrust of authorities among New Orleans’ impoverished residents is rooted in local history.
Abstract: O August 29th, 2005, Hurricane Katrina made landfall just east of New Orleans, Louisiana. That night and the next day, levees in New Orleans collapsed, resulting in flooding of 80% of the city, with water levels reaching to the rooftops in many areas.1 Despite strong evacuation warnings, followed by a mandatory evacuation order,2 over 100,000 greater New Orleans residents failed to evacuate prior to the hurricane’s landfall.3 Distrust of authorities, among numerous other factors,4–5 seems likely to have played a role in New Orleans residents’ reactions to evacuation warnings and public health authorities’ advice. Prior to the hurricane, 72% of New Orleans residents were of minority race or ethnicity6 and there is a long history of minority groups in the United States distrusting the medical and public health leadership.7–9 Furthermore, distrust of authorities among New Orleans’ impoverished residents is rooted in local history. In 1927, The Great Mississippi Flood was threatening to destroy New Orleans, including its crucial downtown regional financial institutions. To avert the threat, and in part to stabilize the financial markets, it was decided to perform a controlled break of the New Orleans levees, thereby selectively flooding poor areas and saving financial institutions.10 This event lives on in the memories and oral history of the residents of the deliberately flooded areas.11 Faced with the knowledge that distrust hampers the success of recommended evacuations and other disaster responses, disaster and public health officials must
TL;DR: Eliminating unmet specialty, dental, and mental health care needs for all CSHCN, and especially minority CS HCN, may require greater efforts to reduce poverty and increase insurance coverage among CSHCNs, better mental health health care assessment of Black female CSHCn, and ensuring allCSHCN have a medical home.
Abstract: We examined racial/ethnic disparities in unmet specialty, dental, mental, and allied health care needs among children with special health care needs (CSHCN) using data on 38,866 children in the National Survey of CSHCN. Compared with White CSHCN, Black CSHCN had significantly greater unmet specialty (9.6% vs. 6.7%), dental (16% vs. 8.7%), and mental (27% vs. 17%) health care needs. Hispanic CSHCN had greater unmet dental care needs (15.8% vs. 8.7%). Black females had greater unmet mental health care needs than other groups (41% vs. 13-20%). Most disparities disappeared after multivari - ate adjustment. Significant risk factors for unmet health care needs included uninsurance, having no personal doctor/nurse, poverty, and condition stability and severity. Eliminat- ing unmet specialty, dental, and mental health care needs for all CSHCN, and especially minority CSHCN, may require greater efforts to reduce poverty and increase insurance coverage among CSHCN, better mental health care assessment of Black female CSHCN, and ensuring all CSHCN have a medical home.
TL;DR: Findings indicate that the current HPSA designation system does capture the significant differences between residents of HPSAs and residents of non-HPSAs in health status and medical services access.
Abstract: Although areas designated as Health Professional Shortage Areas (HPSAs) have fewer primary care physicians than non-HPSAs, few studies have tested whether HPSA designation is related to health status and medical service access This study examined whether residents living in HPSAs were more likely to report worse health status and to be more likely to have difficulty in getting access medical services than residents living in non-HPSAs, with survey data of 10,940 adult West Virginians Multiple regression results indicate that HPSA is associated with worse general health status and poor physical health, and less access to medical services (measured by had usual place for medical care, experienced not getting needed health care and had outpatient care) but not to inpatient care These findings indicate that the current HPSA designation system does capture the significant differences between residents of HPSAs and residents of non-HPSAs in health status and medical services access
TL;DR: A convenience sample of city-dwelling African American women was interviewed during each woman's postpartum stay at one of five hospitals in Washington, D.C. to determine their perceptions of factors influencing their prenatal care utilization.
Abstract: A convenience sample of city-dwelling African American women (n=246) was interviewed during each woman's postpartum stay at one of five hospitals in Washington, D.C. to determine their perceptions of factors influencing their prenatal care utilization. The Kotelchuck Adequacy of Prenatal Care Utilization Index was used to classify prenatal care utilization as either adequate (Adequate Plus and Adequate groups combined) or inadequate (Intermediate and Inadequate groups combined). Of the 246 women studied, 40% (99) had adequate prenatal care utilization. Using Classification and Regression Trees analysis, the following risk groups for inadequate prenatal care utilization were identified: women who reported psychosocial problems as barriers and who were not participants in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) (percent adequate=8.8); women who reported psychosocial problems as barriers, were participants of the WIC program, and reported substance use (percent adequate=13.8); and women who reported psychosocial problems as barriers, were participants of the WIC program, denied substance use, and reported childcare problems as barriers (percent adequate=20.0).
TL;DR: The pay-for-performance program appeared to improve compliance with HbA1c testing recommendations, but a more comprehensive strategy, including increased patient support, may be necessary to improve health outcomes in disadvantaged populations.
Abstract: Pay-for-performance programs are being developed to improve quality of care despite limited empirical evidence demonstrating their effectiveness, especially in underserved communities. Using data on 1,166 patients treated by 46 primary care physicians, this paper examines the effect of an innovative pay-for-performance program implemented in 2004 at the nation's largest federally qualified health center on hemoglobin A1c (HbA1c) testing and HbA1c scores. Univariate analysis and logistic regression results show that the pay-for-performance program significantly increased the likelihood that patients received two HbA1c tests per year as recommended by the American Diabetes Association. Ordinary least squares (OLS) regression results reveal that physicians' baseline performance was positively related to performance after program implementation. Finally, OLS regression results suggest that the program did not contribute to improved blood sugar control. The pay-for-performance program appeared to improve compliance with HbA1c testing recommendations, but a more comprehensive strategy, including increased patient support, may be necessary to improve health outcomes in disadvantaged populations.
TL;DR: Injection drug users were older and more frequently female, non-White, and publicly insured than non-IDUs and significantly more likely to have HIV-related morbidity.
Abstract: Background About one-third of HIV-infected people in the U.S. have a history of injection drug use (IDU). To examine disparities in health care, we compared health care utilization and morbidity of IDUs and non-IDUs. Methods A large national cohort of people receiving HIV care was used to compare IDU and non-IDU inpatient, outpatient, and emergency room (ER) visits and other standards of care. We also compared prevalence of HIV-related illnesses. Results Injection drug users were older and more frequently female, non-White, and publicly insured than non-IDUs. Injection drug users were more than twice as likely to have one or more ER visits annually and almost twice as likely to be hospitalized. CD4 and viral load testing was half as likely to be performed for IDUs in a six-month period. Injection drug users were significantly more likely to have HIV-related morbidity. Conclusions Health care associated with injection drug use may not be adequately addressed in the outpatient setting. The benefits of broadening the scope of primary HIV care should be examined.
TL;DR: The Rapid Assessment, Response, and Evaluation (RARE) portion of the CSAD Project in the Twin Cities was designed to identify barriers to care faced by African refugees and immigrants, and most of the issues identified were manifestations of stigma, gender, religion and/or faith.
Abstract: The Rapid Assessment, Response, and Evaluation (RARE) portion of the CSAD Project in the Twin Cities (Minneapolis-St. Paul, Minnesota) was designed to identify barriers to care faced by African refugees and immigrants. Data were collected from cultural experts and African people living with HIV (PLWH) who were out of care, who had newly entered care, or who were in and out of care. Findings from RARE can be categorized into five main themes: HIV/AIDS within the African context, experiences of African PLWH, unfamiliarity with HIV and support services that facilitate access to care, cultural and religious dilemmas in seeking or remaining in care, and accessing African PLWH and getting them into care. Most of the issues identified were manifestations of stigma, gender, religion and/or faith, as well as the two main underlying cross-cutting themes of knowledge and fear. The top barriers to care included fatalistic views about HIV, fear of isolation, fear of deportation, lack of knowledge of the care system and HIV-related services, and employment issues.
TL;DR: The development of a theory-based, data-driven replacement for the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation systems is described.
Abstract: This article describes the development of a theory-based, data-driven replacement for the Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) designation systems. Data describing utilization of primary medical care and the distribution of practitioners were used to develop estimates of the effects of demographic and community characteristics on use of primary medical care. A scoring system was developed that estimates each community's effective access to primary care. This approach was reviewed and contributed to by stakeholder groups. The proposed formula would designate over 90% of current geographic and low-income population HPSA designations. The scalability of the method allows for adjustment for local variations in need and was considered acceptable by stakeholder groups. A data-driven, theory-based metric to calculate relative need for geographic areas and geographically-bounded special populations can be developed and used. Its use, however, requires careful explanation to and support from affected groups.
TL;DR: It is suggested that homeless people have either a more rapid disease course, leading to earlier morbidity, or lower admission threshholds sufficient to generate hospital admission, among all diagnostic groups.
Abstract: Background Homelessness is associated with high rates of hospitalizations and age-adjusted mortality. Few studies have examined whether homeless people are admitted to the hospital at an earlier age than the general population or for different diagnoses. Methods We compared the age at admission and the primary discharge diagnoses in a national sample of 43,868 hospitalized veterans. Results The difference in median age between homeless and housed inpatients ranged from 10-18 years for medical-surgical diagnoses and 3-4 years for psychiatric and substance abuse diagnoses (p#.005 for all diagnoses). Homeless veterans were more likely to have been admitted for psychiatric and substance abuse diagnoses (79.9%), compared with housed veterans (29.1%). Conclusions Substance abuse and psychiatric illness account for the majority of admissions among homeless veterans. Among all diagnostic groups, homeless people were admitted at younger ages. Our findings suggest that homeless people have either a more rapid disease course, leading to earlier morbidity, or lower admission threshholds sufficient to generate hospital admission.
TL;DR: Data collected demonstrate that mobile medical units staffed by primary care clinicians experienced in dealing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.
Abstract: On August 29, 2005, Hurricane Katrina devastated the Gulf Coast Mississippi region, damaging health care infrastructure and adversely affecting the health of populations left behind. Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health, operated mobile medical units to provide health services to underserved populations in the affected areas. Data collected from all patient encounters from September 5-20, 2005 demonstrate that in addition to common respiratory illnesses, skin conditions, and minor injuries, a high proportion of visits were for vaccine administration and chronic medical problems including hypertension, diabetes, and asthma. Mobile medical units staffed by primary care clinicians experienced in deal - ing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.
TL;DR: The rate of current major depressive episodes in impoverished rural women seeking care in a community health center (CHC) in the rural South is investigated, estimating that 44.3% of the population of women using the CHC had MDE, underscore the need for mental health services in rural primary care, especially in facilities serving impoverished women.
Abstract: Women carry a disproportionate burden of depression in part because situational and other factors enhance their risk. Rural women may be at particular risk because of poverty and lack of treatment opportunities. For this study we investigated the rate of current major depressive episodes (MDE) in impoverished rural women seeking care in a community health center (CHC) in the rural South. We screened 982 women for MDE during a routine primary care visit: about half were positive for depressive symptoms. Of women positive at screening, 194 were then assessed for psychiatric disorder. A current MDE was observed in 14.3% of women screened for depression and 72.2% of women assessed for psychiatric disorder. Recognizing that neither of these percentages reflects the likely rate of MDE among the larger population of rural impoverished women, we used probability theory and binary logistic regression to estimate a depression rate that could be applied as one factor associated with unmet need in this population of women. We estimate that 44.3% of the population of women using the CHC had MDE. These findings underscore the need for mental health services in rural primary care, especially in facilities serving impoverished women.
TL;DR: This research study investigated the cross-cultural functioning of health-survey questions presented to four groups: Koreans who were monolingual in Korean; non-Korean native speakers of English; bilingual Koreans interviews in English, and bilingual Koreans interviewed in Korean.
Abstract: A persistent challenge to self-report data across racial, ethnic, or cultural groups is the inherent difficulty of attaining cross-cultural comparability of key measures The current research study investigated the cross-cultural functioning of health-survey questions presented to four groups: (1) Koreans who were monolingual in Korean; (2) non-Korean native speakers of English; (3) bilingual Koreans interviewed in English, and (4) bilingual Koreans interviewed in Korean This design allowed us to include those likely to be medically underserved, and to assess both linguistic and cultural barriers to collecting health survey data A total of 36 cognitive interviews were conducted to identify (a) translation problems; (b) problems of cultural adaptation that impede cross-cultural comparability; and (c) generic problems of questionnaire design that affect all groups An important category of problems was identified that appeared to result from the interaction of respondent and question characteristics Such problems can best be assessed through explicit consideration of the socio-cultural backgrounds of survey respondents, as opposed to the more usual focus on details of item translation and wording
TL;DR: The Photovoice approach, why the researchers chose it, how the researchers implemented it, what they learned, and the benefits derived for a larger service project are described.
Abstract: In a participatory action research program called Photovoice, Hispanic immigrants in a Midwestern community took photographs to provide researchers with insight regarding family planning. This report describes the Photovoice approach, why the researchers chose it, how they implemented it, what they learned, and the benefits derived for a larger service project.
TL;DR: Health concerns identified by Latinos who resided in the path of Hurricane Katrina in New Orleans and Mississippi are examined to inform emergency preparedness policy development and the planning and implementation of disaster-related health care services for Latinos and other minority and underserved groups.
Abstract: This article examines health concerns identified by Latinos who resided in the path of Hurricane Katrina in New Orleans and Mississippi. Data were collected for this qualitative descriptive study through individual, open-ended interviews with 93 Latino survivors and evacuees in Louisiana, Mississippi, and Georgia. Findings describe health concerns and experiences, including hunger, environmental health risks, sleep disturbances, and access to health care for acute and chronic conditions. Health and illness factored into personal and family decisions on whether or not to stay, evacuate, or return home following the storm. Problems accessing health care were compounded for the undocumented and uninsured. The findings have implications for further disaster research and may inform emergency preparedness policy development and the planning and implementation of disaster-related health care services for Latinos and other minority and underserved groups.
TL;DR: Some disparities are narrowing as the elderly and poor in need of access to public health insurance are searching for it online, however, people without Internet access and experience remain disadvantaged with respect to accessing critical information that can link them to needed health care services.
Abstract: This article explores e government inequalities to searching Medicare and Medicaid information online. Telehealth, a branch of e government, can bring public health service and insurance information to the citizen. The Centers for Medicare and Medicaid Services website, among others, has critical information for potential beneficiaries and recipients of services. Using Pew survey data and multivariate regression analysis we find people in most need of Medicare and Medicaid information online (the elderly and poor) are accessing it, and people with years of online experience are strong proponents of online searches. Despite being less likely to have broadband services, individuals in rural areas were not found to be less likely to search for information online. In conclusion, some disparities are narrowing as the elderly and poor in need of access to public health insurance are searching for it online. However, people without Internet access and experience (perhaps the oldest and poorest) remain disadvantaged with respect to accessing critical information that can link them to needed health care services.
TL;DR: Analysis of associations among employment and socioeconomic factors and the outcomes, current smoking, cigarette abstinence and former smoking among adult U.S. workers ages 18–64 suggests that socioeconomic factors are associated with long-term quitting.
Abstract: Purpose . This study examines the associations among employment and socioeco - nomic factors and the outcomes, current smoking, cigarette abstinence and former smoking among adult U.S. workers ages 18-64 (n5288,813). Methods . Multivariate logistic regres- sion was used to examine the associations among the variables using cross-sectional data from the 1998-1999 and 2001-2002 Tobacco Use Supplements to the Current Population Survey. Results . Lower odds of current smoking was observed among part-time workers compared to those working variable hours and multiple job holders compared to persons holding one job. The self-employed, part-time workers and multiple job holders had higher odds of former smoking than comparison groups. Employment factors were not associated with short-term abstinence or 12-month abstinence from smoking, but income, education, marital status, and duration of smoking were associated with 12-month abstinence. Conclu - sions . These data suggest that while employment factors are associated with current and former smoking, socioeconomic factors are associated with long-term quitting.
TL;DR: A structural analysis of data from eight focus groups of rural, southern African American men suggests that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.
Abstract: Physical, cultural, and social factors influence health risk and behavior, but few have explored how the environmental context affects African American men's prostate cancer screening and treatment. This paper describes a structural analysis of data from eight focus groups of rural, southern African American men (n=66). A structural approach highlights the interrelationships between individuals, the health service system, and community factors that directly and indirectly affect screening and treatment for prostate cancer. The availability of accurate and timely health information and health services, social norms regarding health and professional help-seeking, and the sociopolitical context shaped men's screening and treatment behaviors. These proximal and distal health factors affected men's prostate cancer knowledge, perceived risk, willingness to seek care and trust in the health service system. The findings suggest that prostate cancer screening and treatment occurs in a larger structural context that has important implications for help-seeking and health promotion.
TL;DR: The need for a national health plan that includes oral health care to promote social justice and oral health for all is championed.
Abstract: Former Surgeon General David Satcher's report, Oral Health in America, documents the higher burden of oral diseases and conditions borne by those with relatively low social standing at each stage of life. When an entire community suffers from a health concern, that concern becomes a social justice issue. Racial and ethnic minorities, prisoners, and seniors suffer disproportionately from oral diseases and conditions due to societal prejudices that place them at risk over and above any risk associated with their economic means. Community-based delivery models that involve the community in planning and implementation, build upon the existing health safety net to link oral health services with primary care, and change public or institutional policy to support the financing and delivery of oral health care have proven successful. Here we champion the need for a national health plan that includes oral health care to promote social justice and oral health for all.
TL;DR: Analysis of data linked to Medicare claims in New Mexico and Arizona among enrollees aged 65 and older found differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White women.
Abstract: Because racial/ethnic disparities in breast cancer survival have persisted, we investigated differences in breast cancer treatment among American Indian, Hispanic, and non-Hispanic White (NHW) women. Surveillance, Epidemiology and End Results data linked to Medicare claims in New Mexico and Arizona (1987-1997) among enrollees aged 65 and older were used to identify treatment, treatment interval, and mortality risk associated with delays in care. We identified 2,031 women (67 American Indian, 333 Hispanic and 1,631 NHW women with time to treatment information. Treatment intervals from diagnosis to surgery (all stages, 18 versus 4 days, p.
TL;DR: The findings indicate that the overall instability in the lives of many of the former inmates studied hampered their ability to attend to their HIV/AIDS-related health care needs.
Abstract: The research objectives of this study are to describe the re-entry experiences of people recently released from jail who were living with HIV/AIDS, and to identify factors that influence their access to primary care and adherence to a treatment regimen. The research used a mixed-method, qualitative and quantitative research design. The findings indicate that the overall instability in the lives of many of the former inmates studied hampered their ability to attend to their HIV/AIDS-related health care needs. Most former inmates returned to the community with co-occurring problems related to housing and substance abuse. Complicating their access to health care were fragmented health care and correctional systems. The study highlights the need for coordination and collaboration between correctional facilities and community-based health care and human service providers that leads to a deliberative and planned transition from jail to service systems in the community.