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Showing papers in "Journal of Health Care for the Poor and Underserved in 2015"


Journal ArticleDOI
TL;DR: Indicators of potential opioid inappropriate use or prescribing among Medicaid enrollees are examined in the 2010 Truven Health MarketScan® Multi-State Medicaid database, which consisted of weighted and nationally representative data from 12 states.
Abstract: Recent state-based studies have shown an increased risk of opioid overdose death in Medicaid populations. To explore one side of risk, this study examines indicators of potential opioid inappropriate use or prescribing among Medicaid enrollees. We examined claims from enrollees aged 18–64 years in the 2010 Truven Health MarketScan® Multi-State Medicaid database, which consisted of weighted and nationally representative data from 12 states. Pharmaceutical claims were used to identify enrollees (n=359,368) with opioid prescriptions. Indicators of potential inappropriate use or prescribing included overlapping opioid prescriptions, overlapping opioid and benzodiazepine prescriptions, long acting/extended release opioids for acute pain, and high daily doses. In 2010, Medicaid enrollees with opioid prescriptions obtained an average 6.3 opioid prescriptions, and 40% had at least one indicator of potential inappropriate use or prescribing. These indicators have been linked to opioid-related adverse health outcomes, and methods exist to detect and deter inappropriate use and prescribing of opioids.

89 citations


Journal ArticleDOI
TL;DR: Further research and data disaggregation is needed to develop and strengthen population health strategies, interventions, and policies that address the underlying social conditions and cultural contexts of mental health disparities associated with depression and suicide among AA and NHPI youth.
Abstract: Suicide has become an increasing public health challenge, with growing incidence among Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) youth. Using an ecological framework, the purpose of this systematic review was to explicate risk and protective factors for depression or suicide among AA and NHPI youth from available peer reviewed research. The ecological framework provides a useful blueprint for translating social determinants of health to explain the experience of depression and suicidal behaviors among AA and NHPI youth. Sixty-six studies were extracted from PsychInfo, Ovid Med-line, EMBASE, CINAHL, and Web of Science. Policy and practice recommendations are offered in light of relevant themes that emerged. Further research and data disaggregation is needed to develop and strengthen population health strategies, interventions, and policies that address the underlying social conditions and cultural contexts of mental health disparities associated with depression and suicide among AA and NHPI youth.

86 citations


Journal ArticleDOI
TL;DR: A complex array of socio-cultural factors, including racism and discrimination, cultural mistrust, misdiagnosis and clinician bias, and informal support networks that contribute to treatment disparities are reviewed.
Abstract: A decade has passed since the National Institute of Mental Health initiated its landmark Real Men Real Depression public education campaign. Despite increased awareness, depressed African American men continue to underutilize mental health treatment and have the highest all-cause mortality rates of any racial/ethnic group in the United States. We review a complex array of socio-cultural factors, including racism and discrimination, cultural mistrust, misdiagnosis and clinician bias, and informal support networks that contribute to treatment disparities. We identify clinical and community entry points to engage African American men. We provide specific recommendations for frontline mental health workers to increase depression treatment utilization for African American men. Providers who present treatment options within a frame of holistic health promotion may enhance treatment adherence. We encourage the use of multidisciplinary, community-based participatory research approaches to test our hypotheses and engage African American men in clinical research.

70 citations


Journal ArticleDOI
TL;DR: Data from a multi-center community-based survey of homeless veterans who were not accessing available primary care to identify reasons for not getting this care as well as for not seeking health care when it was needed support the importance of considering health access within an expanded framework that includes perceived stigma, inflexible care systems and trust issues.
Abstract: We describe data from a multi-center community-based survey of homeless veterans who were not accessing available primary care to identify reasons for not getting this care as well as for not seeking health care when it was needed. Overall, 185 homeless veterans were interviewed: The average age was 48.7 years (SD 10.8), 94.6% were male, 43.2% were from a minority population. The majority identified a recent need for care and interest in having a primary care provider. Reasons for delaying care fell into three domains: 1) trust; 2) stigma; and 3) care processes. Identifying a place for care (OR 3.3; 95% CI: 1.4-7.7), having a medical condition (OR 5.5; 95% CI 1.9-15.4) and having depression (OR 3.4; 95% CI: 1.4-8.7) were associated with receiving care while not being involved in care decisions was associated with no care (OR 0.7; 95% CI 0.5-0.9). Our findings support the importance of considering health access within an expanded framework that includes perceived stigma, inflexible care systems and trust issues.

55 citations


Journal ArticleDOI
TL;DR: African Americans with mental illness who are homeless experience significant health risks and illnesses leading to high mortality and morbidity rates and a community-based participatory research team conducted a qualitative study to begin to describe these problems.
Abstract: African Americans with mental illness who are homeless experience significant health risks and illnesses leading to high mortality and morbidity rates. A community-based participatory research (CBPR) team conducted a qualitative study to begin to describe these problems. Results from focus groups and key informant interviews of 42 individuals yielded 98 themes which were sorted into three categories: problems, solutions, and peer navigators. Results included a review of the problems and solutions which the community or people might adopt. An additional goal was to understand and develop impact of peer navigators for addressing health problems in this group. Results yielded a list of values in hiring peer navigators as well as skills and resources they might need to successfully do their job. Findings from the study are currently being used by the CBPR team to develop a peer navigator program for this community.

52 citations


Journal ArticleDOI
TL;DR: The concepts and parallel approaches that underpin an integrative population health equity framework are described and the experience of NYU Center for the Study of Asian American Health in applying the framework to guide its work is presented.
Abstract: Eliminating health disparities in racial/ethnic minority and underserved populations requires a paradigm shift from biomedical approaches that are disease-focused to a health equity framework that aims to achieve optimal health for all by targeting social and structural determinants of health. We describe the concepts and parallel approaches that underpin an integrative population health equity framework and present the experience of NYU Center for the Study of Asian American Health (CSAAH) in applying the framework to guide its work. Applying an integrative framework has deepened our community engagement efforts, our understanding of the multi-level contextual factors that influence health, and our capacity to advance health equity for Asian American communities through action-oriented research and policy. This framework and experience is applicable to researchers and community members working with other underserved populations.

51 citations


Journal ArticleDOI
TL;DR: Neighborhood-level factors are associated with access to nearby behavioral health and primary care and additional behavioral health professionals are needed in racial/ethnic minority neighborhoods and rural areas to provide access to behavioral health services and to progress toward more integrated primary care.
Abstract: Background . Racial, ethnic, and geographical health disparities have been widely documented in the United States. However, little attention has been directed towards disparities associated with integrated behavioral health and primary care services. Methods . Access to behavioral health professionals among primary care physicians was examined using multinomial logistic regression analyses with 2010 National Plan and Provider Enumeration System, American Medical Association Physician Masterfile, and American Community Survey data. Results . Primary care providers practicing in neighborhoods with higher percentages of African Americans and Hispanics were less likely to have geographically proximate behavioral health professionals. Primary care providers in rural areas were less likely to have geographically proximate behavioral health professionals. Conclusion . Neighborhood-level factors are associated with access to nearby behavioral health and primary care. Additional behavioral health professionals are needed in racial/ethnic minority neighborhoods and rural areas to provide access to behavioral health services, and to progress toward more integrated primary care.

41 citations


Journal ArticleDOI
TL;DR: Assessment of agreement between census block-group and individual-level SES measures obtained from a caregiver telephone survey in Jackson County, Missouri found misclassification rates and an inverse association with LBW and smoking exposure.
Abstract: Area-level socioeconomic status (SES) measures have been used as a proxy in child health research when individual SES measures are lacking, yet little is known about their validity in an urban setting. We assessed agreement between census block-group and individual-level SES measures obtained from a caregiver telephone survey in Jackson County, Missouri. Associations with prevalence of childhood overweight (OW), low birth weight (LBW), and household smoking exposure were examined using logistic regression models. Seven hundred eighty-one households were surveyed: 49% male, 76% White, mean child age 9.4 years. We found misclassification rates of 20-35% between individual vs. area-level measures of education and income; Kappa indices ranged from 0.26-0.36 indicating poor agreement. Both SES measures showed an inverse association with LBW and smoking exposure. Area-level SES measures may reflect a construct inclusive of neighborhood resources; routine substitution of these measures should be interpreted with caution, despite similar correlations with health outcomes.

37 citations


Journal ArticleDOI
TL;DR: The authors explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study.
Abstract: Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community's HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors.

37 citations


Journal ArticleDOI
TL;DR: A review of data on alcohol, tobacco, and illicit drug use and related harms among Aboriginal populations in Canada between 2000 and 2014 reinforces concerns of many Aboriginal communities and organizations and highlights where prevention, programming, and policy efforts might be most effective.
Abstract: Background . There is evidence of increasing trends in substance use and related harms among Aboriginal populations in Canada. This paper provides a review of data on alcohol, tobacco, and illicit drug use and related harms. Methods . A comprehensive review of public data, journal publications, and grey literature published between 2000 and 2014 were reviewed if data included: people who self-identify as Aboriginal and who live in Canada; drug use; and morbidity and mortality related to drug use. Data were structured by major substance categories and compared with non-Aboriginal sample data where possible. Results . Over 100 documents were reviewed and revealed a disproportionate burden of substance use and harms, particularly among Aboriginal youth. Significant gaps in data exist, specifically, for urban populations. Conclusion . This review reinforces concerns of many Aboriginal communities and organizations in Canada as well as highlights where prevention, programming, and policy efforts might be most effective.

37 citations


Journal ArticleDOI
TL;DR: Ability to achieve diabetes goals in pregnancy is influenced by several social, cognitive, and knowledge-based factors, and understanding this complex interplay of factors impacting diabetes management may help providers work with patients in achieving healthy pregnancies.
Abstract: Objective. Diabetes in pregnancy is a significant problem for low- income, minor - ity women. We sought to evaluate barriers to diabetes self- care during pregnancy in an underserved population. Methods. Twenty- nine in-depth, semi- structured interviews were performed over 10 women's pregnancies to identify barriers to successful diabetes man- agement, using cognitive load theory to frame interview questions. Qualitative analysis of interview data used grounded theory techniques. Results. Fifty percent of this cohort of minority, low- income, public aid- supported women had pregestational diabetes. Six barrier domains were identified: diabetes novelty; social and economic chaos; nutrition challenges; psychological stressors; burden of disease management; and outcome expectation inability to promote behavior change. Conclusions. Low- income women face multiple barriers to successful diabetes self- care during pregnancy. Ability to achieve diabetes goals in pregnancy is influenced by several social, cognitive, and knowledge- based factors. Understanding this complex interplay of factors impacting diabetes management may help providers work with patients in achieving healthy pregnancies.

Journal ArticleDOI
TL;DR: Findings suggest this program, when compared with others, offered a more cost-effective approach for promoting cancer screening, and local health officials could use this information to guide decisions about reducing cancer disparities among recent immigrant women.
Abstract: Objective. The study's objectives were to calculate the costs and evaluate the cost- effectiveness of implementing a health literacy- focused intervention to promote breast and cervical cancer screenings among Korean American women overdue for these tests. Methods. Researchers estimated the costs of a cluster- randomized controlled trial that evaluated this intervention. Effectiveness was measured as the number of breast or cervical cancer screenings received by women in either the intervention and control arms of the study. Cost- effectiveness was calculated as the incremental cost of each additional screen- ing received by the intervention group. Results. Comparing the intervention and control group, the incremental cost- effectiveness ratio was estimated to be US$236 per screening, without program development costs. Conclusion. These findings suggest this program, when compared with others, offered a more cost- effective approach for promoting cancer screening. Local health officials could use this information to guide decisions about reduc- ing cancer disparities among recent immigrant women.

Journal ArticleDOI
TL;DR: Results showed that while most IRN-PHAs were proactive in improving their mental health, their attempts to obtain support were commonly undermined by service provider mistreatment, unavailability of appropriate services, and multiple access barriers.
Abstract: The demographic characteristics of people living with HIV/AIDS (PHAs) in Canada are increasingly diverse. Despite literature suggesting a potentially heightened mental health burden borne by racialized immigrant, refugee, and non-status PHAs (IRN-PHAs), researchers have hitherto paid insufficient attention to whether existing services adequately address this need and how services might be improved. Employing community-based research methodology involving PHAs from five ethnoracial groups in Toronto, Ontario, this study explored IRN-PHAs' mental health service-seeking behaviors, service utilization experiences, and suggestions for service improvements. Results showed that while most IRN-PHAs were proactive in improving their mental health, their attempts to obtain support were commonly undermined by service provider mistreatment, unavailability of appropriate services, and multiple access barriers. A three-pronged approach involving IRN-PHA empowerment, anti-stigma and cultural competence promotion, and greater service integration is proposed for improving IRN-PHAs' mental health service experience.

Journal ArticleDOI
TL;DR: There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.
Abstract: Objective. This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI). Methods. We analyzed quantita‑ tive survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in‑depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis. Results. A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identi‑ fied at the individual, relationship, and community levels. Conclusion . There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

Journal ArticleDOI
TL;DR: Clinicians serving primarily low-income families recommend screening but may underestimate the prevalence of ACEs in their practice and may not be equipped to screen or address these matters consistently.
Abstract: Objective . A recent policy statement from the American Academy of Pediatrics outlines the central role of pediatricians in screening for and addressing precipitants of toxic stress (e.g., adverse experiences). Despite these recommendations, it is unknown whether pediatricians are in fact screening for these precipitants. Methods . A sample of 210 pediatricians serving low-income children completed a survey regarding their responses to adverse childhood experiences (ACEs). Participants were asked to estimate the prevalence of ACEs in their practice, their current practices, and recommendations for screening. Results . For nearly all ACEs, pediatricians’ estimates of the prevalence in their practice were lower than state-reported prevalence. For many ACEs, the number of pediatricians who support the need for recommended screening was far higher than the number who reported actually screening. Conclusions . Our findings suggest clinicians serving primarily low-income families recommend screening but may underestimate the prevalence of ACEs in their practice and may not be equipped to screen or address these matters consistently.

Journal ArticleDOI
TL;DR: The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations and serve as a source for health care workforce diversity.
Abstract: The National Postbaccalaureate Collaborative (NPBC) is a partnership of Postbaccalaureate Programs (PBPs) dedicated to helping promising college graduates from disadvantaged and underrepresented backgrounds get into and succeed in medical school. This study aims to determine long-term program outcomes by looking at PBP graduates, who are now practicing physicians, in terms of health care service to the poor and underserved and contribution to health care workforce diversity. Methods . We surveyed the PBP graduates and a randomly drawn sample of non-PBP graduates from the affiliated 10 medical schools stratified by the year of medical school graduation (1996–2002). Results . The PBP graduates were more likely to be providing care in federally designated underserved areas and practicing in institutional settings that enable access to care for vulnerable populations. Conclusion . The NPBC graduates serve a critical role in providing access to care for underserved populations and serve as a source for health care workforce diversity.

Journal ArticleDOI
TL;DR: Practicalers should establish broader interventions to empower women with criminal justice histories to take control of their own cervical health and focus on communicating updated recommendations to improve cervical health understanding, beliefs, and practices among high-risk women.
Abstract: The objective of this study was to understand factors associated with women's ability to engage in cervical cancer prevention and follow-up care given ongoing criminal justice involvement. We conducted four focus groups with 45 incarcerated women to assess barriers to cervical health promotion, and used a grounded theory method to analyze data. We administered the Short Test of Functional Health Literacy in Adults to assess general health literacy as a standalone factor related to cervical health promotion. Ninety-one percent of participants had adequate health literacy scores. However, we found that the women had varying levels of cervical health literacy, which we operationalized as knowledge, beliefs, and self-efficacy related to cervical health promotion. Practitioners should establish broader interventions to empower women with criminal justice histories to take control of their own cervical health and focus on communicating updated recommendations to improve cervical health understanding, beliefs, and practices among high-risk women.

Journal ArticleDOI
TL;DR: The findings showed a statistically significant increase in Pap testing among intervention group than control group (significance p<.0001), and there still remains a gap to reach Healthy People 2020 goal of 93% screening rate.
Abstract: Vietnamese women experience a significant health disparity in incidence and mortality rates and screening of cervical cancer. This study is to evaluate the effectiveness of a multifaceted and culturally appropriate intervention in increasing Pap testing rates to reduce cervical cancer disparity in this high-risk population. Methods . A total of 30 Vietnamese community organizations were randomized to either intervention or control condition. Participants (n=1,416) completed 12-month follow-up of Pap testing, their self-reported and medical record data were collected and analyzed. Results . The findings showed a statistically significant increase in Pap testing among intervention group than control group (significance p Conclusion . Results indicate the screening rate was significantly higher in Vietnamese women in the intervention group compared with the control. Despite large intervention effect, there still remains a gap to reach Healthy People 2020 goal of 93% screening rate.

Journal ArticleDOI
TL;DR: The August 2014 strike adversely affected health services in Mombasa County and county governments should put in place mechanisms to avert future health workers’ strike.
Abstract: Introduction . Health workers are an essential part of the health system. Health workers in Mombasa County went on strike for two weeks in August 2014 due to nonpayment of salaries. This study analysed the impact of this strike. Methods . Monthly utilization of health services was accessed from the Kenya Health Information website. This was for general outpatient, special clinics, maternal and child health, inpatient services, maternity services, dental, and radiological services. For each indicator, monthly mean was calculated for January to July 2014. This was compared with the August monthly mean. Results . Outpatient attendance declined by 64.4%, special clinics attendance by 74.2%, and deliveries by 53.5%. Inpatient admissions declined by 57.8 % and inpatient deaths by 26.3%. Conclusion . The August 2014 strike adversely affected health services. County governments should put in place mechanisms to avert future health workers’ strike. The national government should also disburse funds to the counties on time.

Journal ArticleDOI
TL;DR: Norwalk Community Health Center (NCHC) adoption of diagnostic screening tools to detect relevant information in the fields of housing, intimate partner violence, alcohol misuse, illicit substance misuse, tobacco use, sexual activity, and mental health/ depression reaffirms the importance of detecting social factors that determine risk for illnesses and can have profound influence on treatment.
Abstract: people live: where they are born, grow up, work, and age. These conditions affect a person's health and vulnerability to disease, and very often vary by wealth, social status and gender. While all health practitioners have the potential to address socioeconomic status as a contributor to suboptimal health status, providers working in underserved communities are keenly familiar with the imperative to address the social determinants of health for their patients. Though the ethical and clinical imperatives to address these issues is appreciated by many, screening for conditions takes time, and the reality of limited time often competes with the urgency of a clinic visit or other evidence- based interventions delivered by the health care team at the time of an encounter. Therefore, screening for socioeconomic determinants of health, like many other routine clinical care tasks, must be as brief and evidence- based as possible, and shared by all members of the health care team. 3 The use of technology via clinical decision support systems (CDSS) to help the team remember to perform routine tasks has been shown to improve screening for many conditions, 4 and their use can also assist with screening for socioeconomic determinants of health. Finally, as is the case for any condition that is screened, a bona fide interven- tion should be available to address a positive screen. Using these overarching principles of thorough and efficient team- based care, a comprehensive system to screen for several socioeconomic determinants was implemented for an entire health center population. This ACU Column focuses on Norwalk Community Health Center's (NCHC's) adoption of diagnostic screening tools to detect relevant information in the fields of housing, intimate partner violence, alcohol misuse, illicit substance misuse, tobacco use, sexual activity, and mental health/ depression. By screening every patient with evidence- based, validated screening tools, NCHC reaffirms the importance of detecting social factors that determine risk for illnesses and can have profound influence on treatment.

Journal ArticleDOI
TL;DR: It is found that expansion of financial access to health care via the Patient Protection and Affordable Care Act coupled with recent funding cuts to the Supplemental Nutrition Assistance Program means that CHCs play an increasingly important role in addressing food insecurity.
Abstract: Objectives . This study explored the relationship between food insecurity, food assistance, and self-reported health status among community health center (CHC) clients. Methods . Using data from the 2009 Community Health Center Patient Survey ( n = 4,562), representing Federally Qualified Health Center clients, we conducted logistic regression analyses to identify the association between food insecurity and fair/poor health status, controlling for food assistance and sociodemographic factors. Results . Approximately 1/3 of the sample (31.9%) reported fair/poor health status, 10.9% reported food insecurity, and 52.6% reported public food assistance. Multivariate analyses revealed that, among women, those with food insecurity had significantly higher odds of reporting fair/poor health status (AOR = 2.14, 95% CI 1.20–3.82). Conclusions . Expansion of financial access to health care via the Patient Protection and Affordable Care Act coupled with recent funding cuts to the Supplemental Nutrition Assistance Program means that CHCs play an increasingly important role in addressing food insecurity.

Journal ArticleDOI
TL;DR: The frequent-user group had fewer visits with a final psychiatric diagnosis, lower rate of psychiatric admissions, and higher rate of visits resulting in a medical admission than the infrequent- user group.
Abstract: Study objective . The goal of this study was to evaluate demographic factors associated with increased emergency department use among people with psychiatric conditions. Methods . This was a retrospective cohort study of all patients presenting to an urban, academic emergency department with a history of at least one mental health-related final diagnosis. Results . A total of 569 people with psychiatric conditions were included in the study. Of this group, 22.1% had four or more visits within 2009. People with more than four annual visits were more likely to be over age 40, to have at least one chronic condition, to have Medicaid, and to be Black compared with those with fewer than four annual visits. Discussion . The frequent-user group had fewer visits with a final psychiatric diagnosis, lower rate of psychiatric admissions, and higher rate of visits resulting in a medical admission than the infrequent-user group.

Journal ArticleDOI
TL;DR: Two previously unreported barriers to participation in Medicaid emerged: 1) dentists’ perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred.
Abstract: Background . Finding dentists who treat Medicaid-enrolled children is a struggle for many parents. The purpose of this study was to identify non-reimbursement factors that influence the decision by dentists about whether or not to participate in the Medicaid program in Florida. Methods . Data from a mailed survey was analyzed using a logistic regression model to test the association of Medicaid participation with the Perceived Barriers and Social Responsibility variables. Results . General and pediatric dentists (n=882) who identified themselves as either Medicaid (14%) or Non-Medicaid (86%) participants responded. Five items emerged as significant predictors of Medicaid participation, with a final concordance index of 0.905. Two previously unreported barriers to participation in Medicaid emerged: 1) dentists’ perception of social stigma from other dentists for participating in Medicaid, and 2) the lack of specialists to whom Medicaid patients can be referred. Conclusions . This study provides new information about non-reimbursement barriers to Medicaid participation.

Journal ArticleDOI
TL;DR: A systematic review of the peer-reviewed literature to assess the characteristics of CHW programs for AA and NHPI communities in the U.s. and U.S. territories revealed gaps in the current literature and point towards recommendations for future CHW research, program, and policy efforts.
Abstract: Community health workers (CHWs) are frontline health workers who often serve socially and linguistically isolated populations, including Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) communities in the United States (U.S.) and U.S. territories. We conducted a systematic review of the peer-reviewed literature to assess the characteristics of CHW programs for AA and NHPI communities in the U.S. and U.S. territories, generating a total of 75 articles. Articles were coded using eight domains: ethnic group, health topic, geographic location, funding mechanism, type of analysis reported, prevention/management focus, CHW role, and CHW title. Articles describing results of an intervention or program evaluation, or cost-effectiveness analysis were further coded with seven domains: study design, intervention recruitment and delivery site, mode of intervention delivery, outcomes assessed, key findings, and positive impact. Results revealed gaps in the current literature and point towards recommendations for future CHW research, program, and policy efforts.

Journal ArticleDOI
TL;DR: The characteristics of traumatic brain injuries sustained among 229 Veterans seeking homeless services are described and suggest that future research should directly examine the potential bi-directional relationship between TBI and homelessness, as well as the impact of TBI-related deficits on Veterans’ ability to benefit from homeless services and/or maintain stable housing.
Abstract: This hypothesis-generating research describes the characteristics of traumatic brain injuries (TBIs) sustained among 229 Veterans seeking homeless services. Nearly all participants (83%) had sustained at least one TBI prior to their first episode of homelessness. Among participants with a TBI, assaults, transportation-related accidents, and falls were the most common causes of these injuries. Thirty percent of individuals sustained injuries with severity levels that would be expected to be associated with ongoing TBI-related deficits. Forty-three percent of the Veterans sustained at least one brain injury following their first episode of homelessness. Median lifetime number of TBIs was three. The severity of TBIs was similar among Veterans who sustained injuries before or after their first incident of homelessness. Findings suggest that future research should directly examine the potential bi-directional relationship between TBI and homelessness, as well as the impact of TBI-related deficits on Veterans’ ability to benefit from homeless services and/or maintain stable housing.

Journal ArticleDOI
TL;DR: Reducing potentially preventable hospitalizations would not only improve health equity, but could also relieve a large and disproportionate cost burden on some Pacific Islander and Asian American communities.
Abstract: We compared the cost burdens of potentially preventable hospitalizations for cardiovascular disease and diabetes for Asian Americans, Pacific Islanders, and Whites using Hawai'i statewide 2007-2012 inpatient data. The cost burden of the 27,894 preventable hospitalizations over six years (total cost: over $353 million) fell heavily on Native Hawaiians who had the largest proportion (23%) of all preventable hospitalizations and the highest unadjusted average costs (median: $9,117) for these hospitalizations. Diabetes-related amputations (median cost: $20,167) were the most expensive of the seven preventable hospitalization types. After adjusting for other factors (including age, insurance, and hospital), costs for preventable diabetes-related amputations were significantly higher for Native Hawaiians (ratio estimate:1.23; 95%CI:1.05-1.44), Japanese (ratio estimate:1.44; 95%CI:1.20-1.72), and other Pacific Islanders (ratio estimate:1.26; 95%CI:1.04-1.52) compared with Whites. Reducing potentially preventable hospitalizations would not only improve health equity, but could also relieve a large and disproportionate cost burden on some Pacific Islander and Asian American communities.

Journal ArticleDOI
TL;DR: Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations.
Abstract: Purpose . Assess relationships between having a patient-centered medical home (PCMH) and health care utilization among low-income children with chronic conditions using parent and practice perspectives. Methods . We analyzed data from 240 publicly insured children with chronic conditions. Parents completed surveys assessing PCMH access and their child’s primary care practice completed the Medical Home Index (MHI) self-assessment. Multivariate negative binomial analyses were conducted to investigate relationships between PCMH and service use. Results . Parent-report of a usual source of care was associated with lower rates of emergency care (ED) encounters and hospitalizations. Practice report of higher organizational capacity (e.g., communication, staff education) was associated with lower rates of ED visits and hospitalizations. Parent report of a PCMH was positively associated with practice MHI score. Conclusions . Among low-income children with chronic conditions, having a usual source of care and higher quality organizational capacity were associated with lower rates of ED visits and hospitalizations.

Journal ArticleDOI
TL;DR: Similar results across demographic groups suggest deliberation’s promise for obtaining input from a diverse public to inform health programs and policies.
Abstract: Objectives . Health care decision makers require public input to incorporate diverse values into programs and policies. Deliberation, one method for obtaining input, seeks to apply inclusive principles wherein diverse groups provide perspectives to inform decisions. We evaluate whether participants of different racial, ethnic, and educational backgrounds show differences in the effect of deliberation and the value placed on deliberation participation. Methods . We surveyed 907 participants before and after deliberation. Regression models examined associations between demographics and change in knowledge and attitudes, and perceived impact. Results . Changes in knowledge about using medical evidence in decision-making were not associated with race, ethnicity, or education. Changes in attitudes were not associated with these characteristics with one exception. African American, Hispanic, and participants with lower educational attainment reported more perceived impact. Conclusion . Similar results across demographic groups suggest deliberation’s promise for obtaining input from a diverse public to inform health programs and policies.

Journal ArticleDOI
TL;DR: Interventions designed to improve mammogram screening in formerly homeless women with SMI should address patients’ perception of personal risk and should target education and support systems as modifiable factors.
Abstract: Women with serious mental illness (SMI) have disproportionately worse breast cancer profiles than those of other women. The purpose of this project was to examine barriers to and facilitators of breast cancer screening, specifically in formerly homeless women with SMI using the participatory methodology of concept mapping. A series of three concept mapping focus groups were held with 27 women over the age of 40 with a diagnosis of a SMI who live in supportive housing programs, and with 16 housing program staff. Data from the focus groups were combined through multidimensional scaling to create a visual cluster map. Barriers and facilitators to mammography screening generated by the participants clustered into eight categories. Participants rated addressing educational issues as most important and feasible. Interventions designed to improve mammogram screening in this population should address patients' perception of personal risk and should target education and support systems as modifiable factors.

Journal ArticleDOI
TL;DR: Whether health belief model (HBM) constructs pertaining to CRC screening differ by race/ethnicity and primary language is explored to understand how different populations think about CRC screening may be critical in promoting screening in diverse populations.
Abstract: Colorectal cancer (CRC) is an important cause of cancer death in adults in the U.S.; screening is effective but underutilized, particularly among minorities. The purpose of this paper was to explore whether health belief model (HBM) constructs pertaining to CRC screening differ by race/ethnicity and primary language. Data were from the baseline surveys of 933 participants (93.5%) in a randomized trial promoting CRC screening in San Francisco. Composite scores for each construct were created from multiple items, dichotomized for analysis, and analyzed using multivariate logistic regression. Most participants were Asian (29.7%) or Hispanic (34.3%), and many were non-English speakers. Non-English speaking Hispanics (p<.001) and English-speaking Asians (p=.002) reported lower perceived susceptibility than non-Hispanic Whites (NHW). Non-English speaking Hispanics reported more and non-English speaking Asians fewer perceived barriers (psychological and structural) than NHW. Understanding how different populations think about CRC screening may be critical in promoting screening in diverse populations.