Journal of Health Care for the Poor and Underserved

Journal of Health Care for the Poor and Underserved
Volume 17, Number 2, May 2006


    Cora-Bramble, Denice.
  • Minority Faculty Recruitment, Retention and Advancement: Applications of a Resilience-based Theoretical Framework
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    Subject Headings:
    • Minority college teachers -- United States -- Social conditions.
    • Discrimination in higher education -- United States.

Brief Communications

    Reinschmidt, Kerstin M.
    Hunter, Jennifer B.
    Fernández, M. Lourdes.
    Lacy-Martínez, Charles R.
    Guernsey de Zapien, Jill.
    Meister, Joel.
  • Understanding the Success of Promotoras in Increasing Chronic Diseases Screening
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    Subject Headings:
    • Medical screening -- Mexican-American Border Region.
    • Chronic diseases -- Mexican-American Border Region -- Prevention.
    • Hispanic Americans -- Health and hygiene -- Mexican-American Border Region.
    • Community health services -- Mexican-American Border Region.
      The purpose of this qualitative study was to elicit information on why a promotora (or, community health worker (CHW)) increased adherence to chronic disease screening among women along the U.S.-Mexico border. After completion of the intervention, women and clinic staff who participated in the promotora phase of a randomized, controlled study answered structured, open-ended questionnaires. Clinicians from two non-participating clinics were also interviewed. Content analysis found that the promotora's roles included health education and the facilitation of routine and follow-up care. Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves. Most clinicians recommended working with a CHW to increase adherence to chronic disease prevention practices. A CHW can play a crucial role on a health care team and interventions should tap into this resource.
      Community health worker, promotora, Hispanic, U.S.-Mexico border, community-based intervention, women's chronic disease screening, adherence, self-reliance, self-efficacy.
    Kang, Sung Yeon.
    Goldstein, Marjorie F.
    Deren, Sherry.
  • Health Care Utilization and Risk Behaviors among HIV Positive Minority Drug Users
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    Subject Headings:
    • HIV infections -- New York (State) -- New York -- Prevention.
    • African Americans -- Drug use -- Social aspects -- New York (State) -- New York.
    • Hispanic Americans -- Drug use -- Social aspects -- New York (State) -- New York.
    • Medical care -- Utilization -- New York (State) -- New York.
      This study compared health care utilization and HIV-related risk behaviors between HIV-infected African American (n=123) and Hispanic (n=97) drug users recruited in New York City. African Americans were more likely to use crack, while Hispanics were more likely to use heroin and speedball. African Americans were more likely than Hispanics to report having traded sex for drugs or money. The two groups did not significantly differ in HIV care utilization (e.g., taking HIV medications). In multiple logistic regression analyses, for African Americans, taking HIV medications was significantly related to enrollment in HIV clinics and non-use of crack, while for Hispanics, being married and attending HIV support groups were significant factors. Drug treatment enrollment was significantly related to non-use of crack and injection drug use among African Americans, and a trend (p=.07) was found between injection drug use and drug treatment enrollment among Hispanics. The findings indicate the continuing need for harm reduction programs for HIV positive drug using populations. Programs for these populations should also take into account the different risk behaviors among different racial/ethnic groups, in order to tailor culturally sensitive programs for HIV care and intervention.
      Health care utilization, HIV/AIDS, risk behaviors, minority groups, drug use.
    Schrop, Susan Labuda.
    Pendleton, Brian F.
    McCord, Gary.
    Gil, Karen M.
    Stockton, LuAnne.
    McNatt, Joshua.
    Gilchrist, Valerie J.
  • The Medically Underserved: Who Is Likely to Exercise and Why?
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    Subject Headings:
    • Exercise -- Social aspects -- United States.
    • Medically uninsured persons -- Health and hygiene -- United States.
    • Health promotion -- United States.
      Adults who exercise regularly have better health, but only 15% of U.S. adults engage in regular exercise, with some social groups, such as people with lower incomes and women, having even lower rates. This study investigates the rate at which medically underserved patients receive exercise counseling from health care providers, characteristics of those who exercise, and barriers and motivations to exercise. The convenience sample was predominantly female and White and exclusively low-income and uninsured or underinsured. On average, participants were obese, by Federal Obesity Guidelines; 43% smoked.

      Although 60% of 126 patients reported that providers discussed exercise with them, the discussions had no relationship with patients' engagement in exercise. Women and those with lung problems, diabetes, or children in the home were less likely than others surveyed to exercise. The highest rated motivations included body image and health issues. The most important barriers were time, cost, and access to exercise facilities and equipment.

      In order for exercise counseling to be more effective, health care providers' interventions must consider patients' personal characteristics, health status, readiness to engage in an exercise program, and motivations and barriers to exercise.

      Medically underserved, exercise, preventive health, stages of change, health promotion.
    Fridman, Vladimir.
    Vandalovsky, Ella.
    Bergmann, Steven R.
  • Cardiac Risk Factors, Medicine Usage, and Hospital Course in Immigrants from the Former Soviet Union
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    Subject Headings:
    • Russian Americans -- Medical care -- New York (State) -- New York.
    • Heart -- Diseases -- Alternative treatment -- New York (State) -- New York.

Original Papers

    Leslie, Laurel K.
    Stallone, Kimberly A.
    Weckerly, Jill.
    McDaniel, Amy L.
    Monn, Amy.
  • Implementing ADHD Guidelines in Primary Care: Does One Size Fit All?
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    Subject Headings:
    • Attention-deficit hyperactivity disorder -- Diagnosis -- California -- San Diego County.
    • Primary care (Medicine) -- California -- San Diego County.
    • Poor children -- Mental health services -- California -- San Diego County.
      To determine if the American Academy of Pediatrics Attention-Deficit/Hyperactivity Disorder (ADHD) guidelines require tailoring for different settings, the researchers used a mixed-method research design to review an ADHD quality improvement effort in community clinics and private offices in San Diego County. Clinically, no differences were noted in rates of ADHD in the two settings. Children in community clinics (58.3%) were more likely to report public insurance (p<.001), diverse ethnic backgrounds (p=.003), low household incomes (p<.001), single parent households (p=.009), and to screen positive for Oppositional Defiant Disorder/Conduct Disorder (p=.027). They were also more likely to have experienced socio-environmental stressors (p<.001) including foster care, homelessness, parental drug use, and domestic violence. No differences were noted by treatment received at 12 months post-evaluation by office type. Open-ended interviews with clinicians confirmed these findings and revealed a need for tailoring of implementation strategies to more closely fit the needs of children and families cared for in public sector settings.
      Attention Deficit Hyperactivity Disorder, pediatrics, Medicaid, guidelines, poverty, community clinics.
    Jee, Sandra H.
    Barth, Richard P., 1952-
    Szilagyi, Moira A.
    Szilagyi, Peter G.
    Aida, Masahiko.
    Davis, Matthew M.
  • Factors Associated with Chronic Conditions Among Children in Foster Care
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    Subject Headings:
    • Foster children -- Health and hygiene -- United States.
    • Foster children -- United States -- Social conditions.
    • Foster children -- United States -- Economic conditions.
    • Child welfare -- United States.
      The population of children in foster care is rapidly growing. Previous local and state-level analyses have measured the prevalence of chronic conditions among such children to be from 44%–82%. The study objective was to identify factors associated with chronic conditions among a nationally representative sample of children in foster care for one year. The authors analyzed data from The National Survey of Child and Adolescent Well-Being (NSCAW), Wave 1, the first national dataset of children in the child welfare system. In regression analysis, factors significantly associated with having a chronic condition included: child age under 2 years, caregiver race/ethnicity other than Hispanic, and relatively few household members. Discussion includes consideration of chronic conditions in this high-risk population.
      Foster care, chronic conditions, children, well being.
    Tarshis, Thomas P.
    Jutte, Douglas P.
    Huffman, Lynne C.
  • Provider Recognition of Psychosocial Problems in Low-Income Latino Children
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    Subject Headings:
    • Hispanic American children -- Mental health services.
    • Poor children -- Mental health -- United States.
      The purpose of this study was to determine the frequency of identification of psychosocial problems in Latino children by primary care providers (PCPs). This was a cross-sectional study of 269 low-socioeconomic status (SES), Latino children, ages 2–16 years, seen at a community clinic for well-child care. Primary care providers completed a World Health Organization checklist, which organized provider assessment of child psychosocial problems. Clinicians identified one or more psychosocial problems in 39.8% of children. Clinicians recognized only 20% of children with clinically significant aggression symptoms, 18% of children with clinically significant attention/hyperactivity symptoms, and none (0%) of the children with clinically significant anxiety/depression symptoms with clinical data from parent-completed child-behavior checklists used as the benchmark. Despite high rates of identification of psychosocial problems in a low-SES, Latino population, PCPs still miss symptoms of mental health difficulties, especially anxiety and depression. Since symptoms of anxiety and depression are likely to be more pronounced in Latino populations, there is a continued need for improvement in detection of mental health concerns among these children.
      Child mental disorders, Latinos, primary care, psychosocial factors.
    Ebel, Beth E.
    Coronado, Gloria D.
    Thompson, Beti.
    Martinez, Teri.
    Fitzgerald, Katharine.
    Vaca, Frederico.
    Rivara, Frederick P.
  • Child Passenger Safety Behaviors in Latino Communities
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    Subject Headings:
    • Automobiles -- Washington (State) -- Seat belts.
    • Traffic safety and children -- Washington (State)
    • Hispanic American children -- Washington (State)
    • Safety education -- Washington (State)
      Booster seats protect child occupants between 4 and 8 years of age. The objective of this study was to determine barriers and facilitators for booster seat use among Latino families. We conducted one-to-one elicitation interviews with 56 mothers and 35 fathers of booster-eligible Latino children in an urban county and a rural county in Washington State. Half of the parents did not consistently use booster seats. Interviews were recorded, transcribed, translated, and coded. Statements expressed by at least one-third of respondents were entered into explanatory models. Motivators for booster use were child safety and concern about getting a ticket. Facilitators for booster use included affordability, ease of use, and children liking the seat. Barriers were the belief that the child was too big/old, perceived child resistance, and cost. Rural parents preferred radio to television messages. Campaign messages highlighting the risks to child safety and the risk of a citation are likely to motivate booster seat use among Latino families.
      Booster seat, seat belt, child passenger safety, motor vehicle injury, community health, social marketing, Latino families, Hispanic, qualitative research, elicitation interview.
    Ross, Sara J.
    Pagán, José A., 1969-
    Polsky, Daniel.
  • Access to Health Care for Migrants Returning to Mexico
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    Subject Headings:
    • Health services accessibility -- Mexico.
    • Older Hispanic Americans -- Medical care -- Mexico.
      Continued migration from Mexico over the past several decades has created a large population of elderly Mexicans in the U.S. There is no system in Mexico for those Mexicans who would like to retire there to obtain health insurance during their retirement years. Using a nationally representative dataset of Mexican elders, we explore the current state of health insurance status for Mexican elders with a history of migration to the U.S. We find a robust negative association between years spent in the U.S. and the probability of being insured. Coordination between the U.S. and Mexico on policy options to insure Mexicans migrants may prove beneficial to the social security systems in both countries as well as to migrants themselves.
      Health insurance, Mexico, migrants, retirement.
    Sable, Marjorie R.
    Campbell, James D. (James Davis), 1946-
    Schwarz, Lisa R.
    Brandt, Julie.
    Dannerbeck, Anne, 1956-
  • Male Hispanic Immigrants Talk about Family Planning
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    Subject Headings:
    • Hispanic American men -- Attitudes.
    • Birth control -- United States.
    • Hispanic American men -- Family relationships.
      In order to improve delivery of family planning services by better understanding the views of people affected, researchers conducted four focus groups among Hispanic men who recently migrated to a Midwestern community. Participants expressed opinions about, attitudes towards, and knowledge of such matters as family planning, birth control information and access, the influence of religion on family planning and birth control decisions, general familial relations, the prevalence of infidelity, use of and access to the health care system, and cultural differences between the U.S. and their countries of origin. The men voiced opinions and attitudes supportive of family planning and appeared knowledgeable about various methods of birth control. Understanding the attitudes held by immigrant men is important for health care providers in designing successful service interventions for this rapidly growing segment of the population.
      Hispanics, family planning, birth control, sterilization, condoms, Hispanic gender relations.
    Asanbe, Comfort B.
    Lockert, Edna.
  • Cognitive Abilities of African American Children with Prenatal Cocaine/Polydrug Exposure
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    Subject Headings:
    • Fetus -- Effect of drugs on -- United States -- Psychological aspects.
    • Cognition in children -- United States.
    • African American children -- Mental health.
      The aim of this study was to investigate the effects of prenatal cocaine/polydrug exposure on cognitive abilities of school-aged children. The study examined differences in the performance of low income prenatal cocaine/polydrug-exposed and non-exposed African American children (n=49) between 6 and 8 years of age, on the Wechsler Intelligence Scale for Children-Third Edition. Twenty-five children had a history of prenatal cocaine/polydrug exposure and 24 had no known history. The groups were matched for age, sex, and socioeconomic status. Test scores determined if drug exposure predicted global intelligence score and if there were significant differences between the two groups in specific areas of cognitive ability assessed. Drug exposure predicted IQ scores, as drug-exposed children performed significantly lower than their non-exposed counterparts on global intelligence and verbal comprehension, but comparably on the freedom from distractibility tasks. On individual cognitive tasks, the performances of cocaine/polydrug-exposed and non-exposed children were comparable on 8 of the 11 tasks assessed. The findings call into question earlier predictions about cocaine-exposed children.
      Prenatal cocaine/polydrug-exposure, African American, school-aged children, low income, global intelligence, verbal comprehension, attention regulation, distractibility.
    Fernander, Anita F.
    Patten, Christi A.
    Schroeder, Darrell R.
    Stevens, Susanna R.
    Croghan, Ivana T.
    Offord, Kenneth P.
    Hurt, Richard D.
  • Characteristics of Six-Month Tobacco Use Outcomes of Black Patients Seeking Smoking Cessation Intervention
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    Subject Headings:
    • Smoking cessation -- United States.
    • African Americans -- Tobacco use -- Prevention.
      Although Blacks experience disproportionately greater morbidity and mortality attributable to smoking than other racially-classified social groups, few studies have examined the impact of clinical interventions for nicotine dependence within this population. The main objective of this study was to examine 6-month outcomes among 146 self-identified adult Black patients who received an individually-tailored nicotine dependence intervention in an academic medical setting. Measures included a baseline demographic questionnaire and telephone follow-up to obtain self-reported 6-month tobacco use status. Univariate analysis was performed to assess the association of baseline patient characteristics with tobacco abstinence at 6 months following the clinic intervention. Of the 146 patients, 83% were seen in an outpatient clinic setting, while 17% were seen as inpatients in the hospital. At baseline, 53% reported smoking an average of 20 or more cigarettes per day, 32% were highly nicotine dependent, and 53% were in the preparation or action stage of change. Six months following the intervention, the 7-day point-prevalence tobacco abstinence rate was 43/146 (29%; 95% C.I. 22% to 37%). An individualized nicotine dependence intervention conducted in an academic medical setting yielded encouraging abstinence rates for Black smokers.
      Black smokers, tobacco abstinence, clinical intervention, nicotine dependence.
    Greenberg, Greg A.
    Hoblyn, Jennifer.
    Seibyl, Catherine.
    Rosenheck, Robert A.
  • Housing Outcomes for Hospitalized Homeless Veterans
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    Subject Headings:
    • Homeless veterans -- Housing -- United States.
    • Homeless veterans -- Services for -- United States.
    • Hospital patients -- Housing -- United States.
      This study examines housing status at the time of hospital discharge in a national sample of 3,502 veterans who were homeless at admission to a Veterans Health Administration (VHA) medical center. A supplemental survey on homelessness was added to the annual VHA inpatient census over a 4-year period (1995 through 1998). Data from this survey were used to identify homeless veterans hospitalized on the final day of the fiscal year and to document their housing status at discharge. A signal detection technique, Receiver Operating Characteristic analysis, was used to identify predictors of housing status at discharge. At discharge, only 13% of the veterans in our analytic sample were literally homeless, 40% were doubled up, and 33% were transferred to another an institution; only 13% were living independently. Housing status at admission (specifically, staying with friends or family temporarily rather than literally homeless), treatment in a psychiatric or substance abuse program rather than a medical program, and a greater income level or access to VHA benefits were found to be associated with better housing outcomes. As one might expect, homelessness was infrequently resolved during an acute inpatient hospitalization, but few veterans returned to literal homelessness at the time of discharge.
      Homelessness, health services, hospitalization, housing, veterans.
    Ciaranello, Andrea L.
    Molitor, Fred.
    Leamon, Martin.
    Kuenneth, Christina.
    Tancredi, Daniel.
    Diamant, Allison L.
    Kravitz, Richard.
  • Providing Health Care Services to the Formerly Homeless: A Quasi-Experimental Evaluation
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    Subject Headings:
    • Homeless persons -- Services for -- United States.
    • Medical care -- United States -- Evaluation.

Books Received

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