Note from the Editor

Welcome to the May 2018 issue of JHCPU, which ranges widely in locale, populations, and conditions studied, yet strongly affirms several unifying ideas.

First, we continue to hear the drumbeat that signals the importance of the work conducted by JHCPU authors: health inequities persist or are newly recognized. Among them:

• • Disparities among social groups associated with HIV have reached catastrophic proportions, with particularly ill effects for people of African descent. Kerr and colleagues examine the role of HIV-related stigma among African Diasporic youth in a mid-sized city in Ontario.

• • The local environment affects health in numerous ways, and for people who are homeless, the street itself carries (animal and insect) disease vectors often unimagined by people with housing. Leibler et al. investigated with Boston residents who are homeless the extent and nature of this fundamental public health problem.

• • Pregnant refugees in Toronto face increased barriers to adequate prenatal care due to refusal of care. Such refusals emerged as a result of changing health policies, time-consuming administrative requirements, and slow reimbursement (Stewart et al).

• • American Indians face disproportionately high rates of colorectal cancer. Frerichs and colleagues conducted six focus groups in rural Eastern U.S. to understand more fully the factors that affect American Indians' cancer screening decisions.

• • Residents of rural areas, especially Appalachia, are under-represented in biomedical research. Llanos surveyed nearly 500 Appalachian adults about biobanking research (collection and banking of blood, saliva, and buccal specimens) and found widespread willingness to participate.

• • Peripheral artery disease—associated with being elderly, having a history of diabetes or smoking, being obese, and having high blood pressure—can lead to amputation. Strikingly, American Indians undergo PAD-related amputation much more commonly than others. Rizzo et al. demonstrate that this disparity is far greater in the West than elsewhere in the U.S. and conjecture this is due to reliance of AIs in the West on the chronically under-funded Indian Health Service.

Second, a series of papers describe promising interventions successfully combatting inequities:

• • Integrating an oral health team into a Harvard student-faculty collaborative clinic serving a low- income Latino population (Simon et al.).

• • UPenn 4^th year medical students serving as apprentices to community health workers to enhance their community engagement skills and foster cultural humility (Kangovi et al.).

• • Integrating oral health and primary care in a Boston Health Care for the Homeless program (Dolce et al.).

• • Opening communication between researchers and community partners to address obesity in South Los Angeles (Yee et al.).

• • Using rapid assessment to study underground cigarette market in Oakland Chinatown (California) (Wang-Schweig et al.).

• • Offering free group sessions for Latino migrants moderated by bilingual therapists to help participants cope with the stressors of migration (Jalisi et al.).

• • Enhancing primary care services for high-risk Latino populations with diabetes to reduce disparities in glycemic control (Marquez et al.).

• • Reducing hospitalization by referral to Vanderbilt University's Shade Tree Clinic for indigent patients (Trumbo et al.).

Third, health policy bears heavily on the well-being of vulnerable populations. This issue includes these policy-related papers:

• • A rule change at the Centers for Medicare and Medicaid Services requires states to monitor access to care. Perry et al.'s paper presents findings from the first national survey to see how different states were complying with the rule.

• • Medical respite care for people who are homeless is a cost-saving (and likely a life-saving) measure, report Shetler and Shepard, who compared a Medicaid-expansion state (Connecticut) with a non-expansion state (Florida) in this connection. Both states would save money, but Florida would save more since it currently experiences greater losses due to uncompensated care.

• • There are differences in the distribution of primary care physicians and general internists, Xierali (of the Association of American Medical Colleges) reports, with more primary care physicians working in rural areas and health professional shortage areas, and in areas whose residents are members of racial/ethnic minority groups, live in poverty, and are uninsured.

• • Being employed and stably housed are both inversely related to frequency of health care encounters for people with sickle cell disease, Williams et al. report, a...