Journal of Health Care for the Poor and Underserved最新文献

Human subjects research and drug and device development currently base their findings largely on the genetic data of the non-Hispanic White population, excluding People of Color. This practice puts People of Color at a distinct and potentially deadly disadvantage in being treated for sickness, disability, and disease, as seen during the COVID-19 pandemic. Major disparities exist in all chronic health conditions, including cancer. Data show that less than 2% of genetic information being studied today originates from people of African ancestry. If genomic datasets do not adequately represent People of Color, new drugs and genetic therapies may not work as well as for people of European descent. Addressing the urgent concern that historically marginalized people may again be excluded from the next technological leap affecting human health and the benefits it will bring will requires a paradigm shift. Thus, on behalf of underserved and marginalized people, we developed the Together for CHANGE (T4C) initiative as a unique collaborative public-private partnership to address the concern. The comprehensive programs designed in the T4C initiative, governed by the Diaspora Human Genomics Institute founded by Meharry Medical College, will transform the landscape of education and health care and positively affect global Black communities for decades to come.

Community health worker career paths that include policy, system change, program and process development, and advocacy will increase job satisfaction and sustainability. Community health workers employed at an organizational level can be liaisons between public health and community organizations to improve relationships and develop system-level culturally and linguistically appropriate services, information, resources, and policies.

Emergency medical retrieval services (EMRS) in remote Indigenous islands is rarely investigated. We analyzed the characteristics of patients who underwent EMRS in Lanyu, an offshore island of Taiwan, from January 1, 2014 to December 31, 2021. The need for EMRS for Lanyu Indigenous residents (N=132, 3.83‰) was almost 1.5-fold and 100-fold for non-Indigenous residents (N=16, 2.64‰) and tourists (N=40, 0.04‰), respectively. The resident group had a longer hospitalization (12.0 ± 12.9 vs. 5.9 ± 11.7 days, p=.007). The tourist group had more near-drowning or decompression sickness (44.0% vs. 3.0%, p<.001) and secondary transfers (20.0% vs. 5.4%, p=.003). All the patients (N=12) that required multiple retrievals were Lanyu Indigenous residents. The Lanyu Indigenous residents, compared with the non-Indigenous residents, had fewer admissions to intensive care units (47.7% vs. 80.0%) and more in-hospital mortalities (10.6% vs. 0.0%). Multifaceted approaches should be initiated to improve the health care system in remote Indigenous islands.

In Jamaica and the wider Caribbean, the legal system allows for discrimination based on gender and sexual identity with impunity. This exposes trans people to disparate risks of violence and barriers to accessing social services such as health care. In this paper we assess the social determinants of health in the Jamaican trans population using a modified social-ecological model of transgender stigma and stigma interventions. To conduct this assessment, we situated the findings of the 2021 Jamaican Trans Health Needs Assessment and Trans Health Strategy within the socio-ecological framework with direct application to rights-based health services as well as the Jamaican legal system to develop a model for understanding the socio-legal determinants of health. The social determinants of health identified within the Jamaican trans community are all influenced by a lack of legal protection suggesting a need for legal reform toward nondiscrimination of sexual and gender-diverse populations.

The mental health burden is increasing among the young adolescent population worldwide, with more reports of sadness and mental illness diagnoses. This study explored how African American adolescent girls use religious and spiritual practices to cope with stressful experiences. A qualitative descriptive design was used to interview 22 African American adolescent girls. Data were analyzed using content analysis and constant comparison technique. The following themes emerged related to prayer, scripture, and songs: 1) Healing for themselves or others, 2) instructions on how to live, 3) provision from God, 4) protection during dangerous situations, 5) strength to endure, and 6) connectedness to God, self, and others. Adolescent girls used spirituality and religion as coping mechanisms during various life stressors while healing, reframing thoughts to a positive mindset, and seeking direction and protection. Future studies should consider incorporating spiritual and religious coping mechanisms as a mental health intervention, particularly for this population.

This Report from the Field chronicles the establishment of Georgetown University's Perinatal Legal Assistance and Wellbeing Project, a medical-legal partnership in Washington, D.C. It describes foundational steps, implementation strategies, and lessons learned, and reflects on impacts of addressing the unmet legal needs of birthing individuals.

Access to accurate Native Hawaiian and Pacific Islander (NHPI) social drivers of health (SDOH) data is crucial for understanding health needs and shaping effective public health strategies. However, this data often gets obscured within broader racial and ethnic categories making NHPI issues invisible. Moreover, NHPI communities face barriers when published data formats are inaccessible to community-based organization staff. To tackle these challenges, we initiated the Assessing Social Determinants of Health Data Through Local Data Intermediaries Initiative (AHEAD), supported by the federal Office of Minority Health. We developed two community-centered resources:1. The NHPI Data Policy Platform, shaped by 138 NHPI community leaders from 13 states and Washington, D.C., representing nine NHPI subgroups. This platform highlights NHPI priority issues and provides equitable data policy recommendations for advocates and policymakers.2. An NHPI SDOH Dashboard for California Counties, tailored to offer accessible data for community-based organization staff, ensuring better-informed interventions and support.

Objectives: To explore the prevalence of Multiracial/ethnic identity and its association with mental health among high school students.

Methods: The 2021 national Youth Risk Behavior Survey (N=17,232) data were used. Respondents were classified as monoracial/ethnic or Multiracial/ethnic.

Results: Overall, 21.5% of students were Multiracial/ethnic. Multiracial/ethnic status was most prevalent among students who identify as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and Hispanic or Latino. Logistic regression models showed Multiracial/ethnic classification was associated with persistent feelings of sadness or hopelessness among students identifying as American Indian or Alaska Native, Asian, Black, and White. Multiracial/ethnic Asian students had significantly higher odds of all four indicators of poor mental health compared with monoracial/ethnic Asian students.

Conclusion: Multiracial/ethnic students constitute a heterogenous group. This study found important subgroup differences in indicators of mental health that might be missed when Multiracial/ethnic groups are considered in aggregate.

The Indian Health Service (IHS) faces severe workforce shortages due to underfunding and underdevelopment of clinical training programs. Unlike other direct federal health care systems that have implemented clinical training paradigms as central parts of their success, the IHS has no formalized process for developing such programs internally or in partnership with academic institutions. While the Indian Health Care Improvement Act (IHCIA) authorizes mechanisms by which the IHS can support overall workforce development, a critical portion of the act (U.S. Code 1616p) intended for developing clinical training programs within the agency remains unfunded. Here, we review the funding challenges of the IHCIA, as well as its authorized and funded workforce development programs that have only partially addressed workforce shortages. We propose that through additional funding to 1616p, the IHS could implement clinical training programs needed to prepare a larger workforce more capable of meeting the needs of American Indian/Alaska Native communities.