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

Introduction: The aims of this study were to estimate state-level racial inequities in dental care use among children in the U.S., overall and by insurance type, and to examine relationships between inequities and state-level structural racism.

Methods: Pooled 2017-2019 data from the National Survey of Children's Health were used to estimate racial inequities in dental care use. Independent variables included state-level structural racism indicators and other factors.

Results: There was substantial variation in the degree and direction of inequities across states and by insurance type. Inequities were not associated with overall structural racism indices. However, one dimension of structural racism-the Black-White incarceration index-was significantly associated with the Black-White disparity (p=.040).

Conclusion: Racial inequities in dental utilization among children varied across states and by insurance status. More research is needed to explore more granular geographic levels of structural racism and relationships with additional dental care access indicators.

The United States grapples with over 30,000 new HIV infections annually, a challenge exacerbated by delayed diagnosis and treatment. HIV stigma hinders data collection and contributes to health disparities. High-quality data and a community-driven approach are critical to reducing these disparities. The collaborative effort of the Satcher Health Leadership Institute at Morehouse School of Medicine, and the Center for Minority Health and Health Disparities Research and Education at Xavier University of Louisiana, addresses systemic barriers perpetuating the HIV epidemic in Georgia and Louisiana. We influence policy, implement an HIV education curriculum, map resources, and display data via the Health Equity Tracker. Stigma surrounding HIV/AIDS impedes disclosure, creates data gaps, and affects care quality and access. Addressing these data gaps, influencing policy, and implementing education are crucial steps to improving outcomes for Black people living with HIV/AIDS. This framework aligns with the federal Ending the HIV Epidemic program's goals, advancing health equity for vulnerable populations.

The Georgetown University's Cancer Legal Assistance and Well-being Project launched in 2020 as a medical-legal partnership that works with health care providers at a Washington, D.C. safety-net hospital to treat the health-harming legal needs of historically and intentionally marginalized patients with cancer.

The prevalence of diabetes mellitus in the Haitian American population remains an important question. A recent study revealed an alarming prevalence of 39.9%. To corroborate these data, between November 2021 and September 2023 a representative sample was collected among 401 Haitian Americans in Florida, Maryland, New Jersey, and New York. Results revealed a crude prevalence rate of 36.6% (95% CI 31.85, 41.55%). The age-adjusted prevalence was 29.7% (CI 19.71%, 39.63%). This study's prevalence is nearly double the 16.8% (Z=10.48, p<.0001) rate in non-Hispanic African Americans and nearly two and a half times the 12.0% (Z=14.99, p<.0001) rate in all Americans. The crude prevalence for undiagnosed diabetes mellitus was 13.38% (CI 10.19%, 17.14%), with 17.11% age-adjusted prevalence (CI 7.53%, 26.70%). The scope of the diabetes burden, especially the high rate of undiagnosed cases, indicates a need for better strategies for the prevention, screening, treatment, and management of diabetes among Haitian Americans.

Demographic concordance between patients and clinicians has been associated with better outcomes. The current perinatal care workforce is not adequately diverse to allow for patient-clinician concordance. In this mixed-methods study, we aimed to understand family physicians' perception of the impact of patient-clinician concordance on perinatal care. The predominantly (91%) non-Hispanic White sample of 1,505 family physicians (FPs) perceived gender and language concordance to affect perinatal care more than racial or ethnic concordance. Religious concordance is not perceived to greatly affect perinatal care. Nearly half (721) of the respondents chose to leave a free-text comment on the impact of concordance on perinatal care. Four categories emerged (patients, physicians, the patient-physician relationship, and potential ways to mitigate the impact of discordance). Based on the perceptions of FPs experienced in perinatal care, intentionally supporting continuity of care between patients and clinicians may help to mitigate the negative impact of discordance on perinatal outcomes.

The Ryan White HIV/AIDS Program is a unique federal program to provide HIV care, treatment, and support services for people living with HIV in the United States. Through the distinctive structure of the program that allows for addressing both medical needs and some of the social determinants of health that can pose barriers to accessing care, the program has been instrumental in improving outcomes for people with HIV with documented improvement in HIV viral suppression and decreased disparities in that outcome over the past decade. To reach the goal of ending the HIV epidemic in the U.S., the program must expand services to people with HIV who are not regularly engaged in medical care.

This report reflects on two years of implementation of a youth-led, youth-run online food pantry serving youth ages 12-24 in Baltimore, Maryland. We describe the inception of the pantry and share descriptive statistics and qualitative quotations that demonstrate how the pantry helped overcome common barriers to youth food acquisition.

Objectives/background: To inform the development of a "food is medicine" (FIM) intervention, the present study aimed to describe how people living with HIV (PLWH) prioritize daily food choices in the context of food insecurity.

Methods: Interviews with PLWH experiencing various levels of food insecurity (n=24) were conducted using Q-Methodology. Participants ranked 57 food-choice value statements from "most like me" to "least like me" in a process called forced distribution. We then identified different viewpoints and shared perspectives through factor analysis.

Results: Although food cost was a salient value, distinct viewpoints prioritized: 1) creative expression and sensory appeal; 2) disease management within physical limitations; 3) safety, familiarity, household practicality; 4) mainstream convenience; and 5) disease prevention and socioemotional coping.

Discussion: Heterogeneous viewpoints on the relative importance of sensory appeal, functional capabilities, family food preferences, and other factors may affect whether and how future FIM participants use foods and related resources.

Objectives: To examine the association between caregiver-perceived cultural sensitivity of health care providers and child health status in the United States.

Methods: We analyzed National Survey of Children's Health data (n = 145,226) from 2016-2020. Using logistic regression, we determined odds of reporting a better health status by level of caregiver-perceived provider cultural sensitivity while controlling for potential confounders.

Results: Children with providers perceived as more culturally sensitive by their caregivers had 2.38 times the odds (95% confidence interval: 1.73, 3.28) of enjoying a better caregiver-assessed health status compared with children whose providers were perceived as less culturally sensitive. Caregivers of BIPOC children in our sample were 1.99 times more likely (95% CI: 1.89, 2.10) to report their provider as only sometimes or never culturally sensitive.

Conclusions: Cultural sensitivity of health care providers, as perceived by caregivers, was associated with caregiver-assessed child health status in our study. This association remained significant when controlling for various sociodemographic variables. Our findings highlight the need for more research around the potential positive impact that improving provider cultural sensitivity could have on the health of children who are Black, Indigenous, or other People of Color (BIPOC).