A Note from the Editor

The Association of Clinicians for the Underserved (ACU) Column by Virna Little that opens this issue casts a spotlight on the opportunities for improved behavioral health care offered by the transdisciplinary care teams increasingly seen in community health care settings. The ACU column is an excellent lead-in to the opening part of the issue, Hospital and Clinical Care, highlights of which will be discussed below. That section is succeeded by Part 2—Risk Factors and Part 3—Perceptions, Priorities, Preferences.

Part 1—Hospital and Clinical Care. Opening with a Commentary by Bazazi and colleagues on the debate about the legalization of take-home Naxolone medication to prevent deaths from overdose, this part of the issue delves into clinical care from many angles. Two papers concern sickle cell disease (SCD), a small study by Lattimer and colleagues on problematic care experiences of SCD patients, and another by Shawn Bediako on predictors of employment among African Americans with SCD. Bediako reports that women and patients who scored higher on measures of assertiveness and positive outlooks on their condition were significantly more likely to be employed than their counterparts.

Another important paper in this section, by Leiyu Shi and colleagues, compares patients and services at community health centers (CHCs) and physicians' offices (POs). They report that a greater proportion of CHC patients than PO patients had diagnoses of diabetes, obesity, and depression, which offers direction to policy and program planning in this growing sector of the health care system. Additionally, the researchers report that CHCs tend to be located in low-income, low-education, urban communities, and that CHC patients tend to be younger than PO patients and more likely to be uninsured or covered by Medicaid, and members of minority groups. Patients at POs, conversely, were more likely to be privately insured or on Medicare and White. Patient-physician visits tended to be longer at POs and to result in more referrals to specialists in comparison with visits at CHCs.

This section also includes papers on surveillance after colorectal cancer diagnosis (Boehmer et al.) and a study of problematic care experiences among Latinos with diabetes (Rodriguez et al.)

Part 2—Risk Factors. The papers in this part of the issue all identify correlates of health disorders, providing pointers to prevention and detection. One interesting Brief Communication, by Peoples and colleagues, reports on qualitative research with emancipated migrant youth (ages 13-22 years) in California. Interviewed in small groups, this predominantly male sample of 29 young people draw back the curtain to let us see what motivated their move to the U.S. and what their lives are like here. Work and money predominate as stressors in the lives of these young people, who talk about leaving home in order to make money to send back to their families, whom they identify as their greatest source of strength. The participants worry about becoming sick or injured because it would disable them from working, but tend not to seek out health care except in emergencies and to underestimate the health threats posed by heat stroke and pesticide exposure. Few knew about local clinics or payment options, and most reported frequent injuries and widespread alcohol and drug use among themselves.

Two papers in this section address homelessness. Greenberg and colleagues investigated correlates of past homelessness in a national dataset. They found that substance abuse disorders, exposure to personal violence, Black race, and having been incarcerated for 27 days or longer at least once were all correlated with episodes of past homelessness. Echoing Greenberg et als finding regarding violence, Husdon and colleagues report that homeless women in their sample of 202 who had been sexually abused as children were nearly four times as likely as others in the sample to suffer assault as adults. Women characterized by substance use, involvement in sex trades, and incarceration were also found to be at increased risk of abuse.

This section also includes work on diet and cardiovascular risk among women at historically Black colleges and universities (Brown et al.), incarceration as a risk factor for HIV and HCV (Burton et al.), physical activity...