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

This study explores the association between health system changes over the last decade and women's preventive care utilization in Illinois. A cross-sectional analysis using Illinois Behavioral Risk Factor Surveillance System (BRFSS) data from 2012-2020 among women aged 21-75 (n=21,258) examined well-woman visit (WWV) receipt and breast and cervical cancer screening overall and over several time periods. There was an increase in the prevalence of receiving a WWV for Illinois women overall from 2012-2020. However, the overall adjusted prevalence difference was only significant for the 2020 versus 2015-2019 comparison and not for 2015-2019 versus 2012-2014. The COVID-19 pandemic was not associated with a decrease in the prevalence of mammogram use but was manifest for cervical cancer screening, particularly for Black women. Finally, those reporting having a WWV in the past year had a significantly higher prevalence of being up to date with screening compared with those not reporting a WWV.

Inpatient food insecurity (FI), or caregiver inability to obtain adequate food for themselves during child hospitalization, negatively affects caregiver participation in care. Using mixed methods, we assessed inpatient FI prevalence, factors associated with inpatient FI, and perspectives on an inpatient FI intervention among immigrant caregivers (ICs) at a children's hospital from 2021-2022. We performed a sub-analysis of data from a larger FI intervention study, which provided meal trays and food bank public benefit navigator referrals for caregivers screening positive for household or inpatient FI. Logistic regression assessed factors associated with inpatient FI among ICs. We interviewed ICs enrolled in the intervention and identified themes. Of 369 ICs, 56% reported inpatient FI. Low income, poor caregiver health, and household FI were associated with inpatient FI in regression analysis. Nine qualitative interviews revealed positive reception to the intervention. Immigrant caregivers noted that it facilitated participation in care and alleviated financial burden.

Vietnamese Americans experience significant health disparities compared with other groups, but their health care utilization is suboptimal. Boat People SOS (BPSOS), a nationwide Vietnamese-serving community-based organization, implemented a community health worker and community-clinical linkage electronic referral system to improve health care utilization. Three sites (in Alabama, California, and Virginia) received the intervention; Mississippi was the comparison site. The intervention included bridging between communities and health systems, culturally appropriate health education, informal counseling and social support, advocating for individual and community needs, direct services, and building individual and community capacity through partnerships with service providers. Compared with the comparison site, clients at the intervention sites reported better overall perceived health after the intervention. Past-year medical checkups declined in both groups during the COVID-19 pandemic but declined less in the treatment group. The intervention did not reduce emergency room visits. Findings suggest that this intervention can improve health care utilization and health status among Vietnamese Americans.

Home Together (HT) is a multi-level multi-component health promotion program, co-led by academic and non-profit partners in Arkansas that sought (1) to improve access to and family acceptance of social services and health care among women experiencing homelessness who have a diagnosed mental health condition and a child younger than six years and (2) to increase service provider capacity to engage with this population. A socioecological perspective was used to detail program components and lessons learned. Home Together enrolled 345 women representing unduplicated families. Of these, 214 completed six-month reassessments and 111 completed discharge assessments. Representative of the area and population served, most self-identified as belonging to racial minorities (87.0%), being younger than 35 years (80.1%), experiencing violence (76%), and being heterosexual (82%). Pre-post testing indicated positive changes for HT families, including improvements in mental health, health care access, and housing. Yet, even the most coordinated comprehensive programs are no substitute for policy-level changes that help families reach stability.

In 2014, the Affordable Care Act (ACA) expanded the role of Medicaid by encouraging states to increase eligibility for lower-income adults. As of 2024, 10 states had not adopted the expanded eligibility provisions of the ACA, possibly due to concerns about the state's share of spending. Using the Medical Expenditure Panel Survey (MEPS), we documented how health care utilization, expenditures, and the overall health status of newly eligible enrollees compare with enrollees who would have been eligible under their states' rules before the ACA. Our estimates suggest that, during 2014-16, newly eligible Medicaid enrollees had worse health and greater utilization and expenditures than previously eligible enrollees. However, during 2017-19, newly and previously eligible enrollees had comparable per capita health expenditures across six types of health spending. We find some evidence that changes in Medicaid enrollment composition muted observed differences between eligibility groups.

Objectives: To characterize the proportion of Medicaid-eligible infants experiencing gaps in Medicaid coverage during early infancy and to determine whether infants without Medicaid coverage were covered by other plans or not at all.

Study design: Infants with Medicaid-financed births from three states participating in the 2016-2020 Pregnancy Risk Assessment Monitoring System (PRAMS) were included (N=3,658). Infant insurance coverage (Medicaid, non-Medicaid, none) was assessed at the time of the PRAMS survey, typically around four months of age.

Results: Fifteen percent of infants had non-Medicaid insurance coverage, two percent were uninsured, and 83% had Medicaid coverage after Medicaid-financed birth. The strongest predictor of infant uninsurance was maternal uninsurance or non-Medicaid coverage before pregnancy.

Conclusion: Some presumably eligible infants are not enrolled in Medicaid or experience lapses in Medicaid coverage. Informing families about infants' coverage eligibility and supporting families during the enrollment process would especially benefit families with no pre-pregnancy experience with Medicaid.

Abortion clients who experience economic hardship face barriers paying for abortion care. Between September 2020 and June 2021, we conducted a facility-based survey with 211 abortion clients who obtained care in Mississippi, and 25 respondents completed in-depth interviews. We computed the frequency with which survey respondents used social network-based, agency-based, and individual strategies to pay for care and we employed thematic analysis to explore in-depth interviewees' decision-making and experiences with these strategies. Overall, 93% used at least one strategy to pay for their abortion: 62% sought help from social networks; 61% received assistance from abortion funds (non-profit organizations that help people pay for abortion care); and 47% relied on individual strategies, such as postponing routine expenses. Interviewees often noted it was difficult to use these strategies and doing so adversely affected their economic stability. These findings support the need for insurance coverage and expanded financial assistance for abortion seekers, particularly those now forced to travel following abortion bans.

Mass incarceration is a significant structural determinant of health, affecting incarcerated individuals, their families, and communities, with profound racial disparities. Health care professionals have an opportunity to reduce these inequities through abolition medicine. Abolition in health care means rewriting how doctors relate to patients labeled as criminal and is not a new checklist that can be imposed on the existing curriculum. Beyond changing individual clinical practice, abolition medicine also provides a critical framework for dismantling unjust policies. However, published medical education curricula lack an in-depth component on how to identify and disrupt medical practices designed to perpetuate inequities, and few report development alongside individuals with lived experience. In this article we explore the current state of medical education curricula as they pertain to health, incarceration, and abolition. We propose best practices for reducing health inequities for criminalized individuals grounded in our work alongside individuals with lived experience of incarceration.

Socio-demographic inequities in health treatment and outcomes are not new. However, the COVID-19 pandemic presented new opportunities to examine and address biases. This article describes a scoping review of 170 papers published prior to the onset of global vaccinations and treatment (December 2021). We report differentiated COVID-19-related patient outcomes for people with various socio-demographic characteristics, including the need for intubation and ventilation, intensive care unit admission, discharge to hospice care, and mortality. Using the PROGRESS-Plus framework, we determined that the most researched socio-demographic factor was race/ethnicity/culture/language. Members of minoritized racial and ethnic groups tended to have worse COVID-19-related patient outcomes; more research is needed about other categories of social disadvantage, given the scarcity of literature on these factors at the time of the review. It is only by researching and addressing the causes of social disadvantage that we can avoid such injustice in future public health crises.

Self-rated health (SRH), an indicator of overall health status, has been associated with morbidity and mortality. Yet links between SRH and nutrition are lacking, especially in conjunction with other characteristics affecting SRH. Therefore, the study objective was to identify significant sociodemographic/socioeconomic, chronic disease, dietary habits, and food environment explanatory variables for perceptions of self-rated health (SRH). Data were collected in 2021 and consisted of households at risk of or experiencing food insecurity. Multivariable logistic regression was used to identify significant explanatory variables for SRH. Of the 54% of participants with low SRH, 43% had nutrition insecurity and 66% had one or more chronic disease. For participants with high SRH, 25% had nutrition insecurity and 32% had one or more chronic disease. Household income, fruit and vegetable intake, and scratch-cooked meals consumption were protective against low SRH (5%-16% decrease in odds). Participants with low SRH were 1.8 and 4.3 times as likely to have nutrition insecurity and one or more chronic disease, respectively than participants with high SRH. Perceptions of one's health are positively associated with healthful dietary habits and negatively associated with nutrition insecurity and presence of chronic disease.