bluuebunny/crossref_metadata_2025 huggingface dataset:
Community-Partnered Research Conference Model: The Experience of Community Partners in Care Study
Authors: Khodyakov Dmitry , Pulido Esmeralda , Ramos Ana , Dixon Elizabeth
Published: May 2014

The Problem : Conducting community-partnered research conferences is a powerful yet underutilized approach to translating research into practice and improving result dissemination and intervention sustainability strategies. Nonetheless, detailed descriptions of conference features and ways to use them in empirical research are rare. Purpose : We describe how community-partnered conferences may be integrated into research projects by using an example of Community Partners in Care (CPIC), a large, cluster-randomized, controlled, trial (RCT) that uses community-partnered participatory research (CPPR) principles. Key Points : Our conceptual model illustrates the role community-partnered research conferences may play in three study phases and describes how different conference features may increase community engagement, build two-way capacity, and ensure equal project ownership. Conclusions : As the number of community-partnered studies grows, so too does the need for practical tools to support this work. Community-partnered research conferences may be effectively employed in translational research to increase two-way capacity building and promote long-term intervention success.
Capacity Needs in Community-Based Organizations for Enhancing Translational Research in Puerto Rico
Authors: Martínez Giovanni , Sardiñas Lili M. , Acosta-Perez Edna , Medina Lizbeth , Rivera Mirza , Pattatucci Angela
Published: May 2014

Background : In an effort to form and sustain community–academic partnerships (CAPs) to enhance clinical and translational research, an assessment of needs for selecting and implementing evidence-based programs (EBPs) was conducted among a group of community-based organizations (CBOs) throughout Puerto Rico. Methods : The survey was based on an instrument developed by the Cancer Prevention and Control Research Network. It assessed specific service information, program selection/implementation processes, knowledge and perception of EBPs, funding venues, evaluation processes, and capacity and training needs. Recruitment consisted of contacting 100 nonprofit organizations in Puerto Rico that work or address specific health areas, namely, cancer, neurological disorders, HIV, and cardiovascular health. Results : The survey revealed wide variability in understanding what constitutes an EBP. Training needs for building a productive translational research process also were identified. Prominent among these were securing funding for ongoing operations, utilizing data for decision making, developing collaborations, managing information, conducting community needs assessments, and program evaluation. Conclusions : These findings point to important implications for promoting community–campus partnerships for advancing clinical and translational research.
Brentwood Community Health Care Assessment
Authors: Goodman Melody S. , Gonzalez Maria , Gil Sandra , Si Xuemei , Pashoukos Judith L. , Stafford Jewel D. , Ford Elsa , Pashoukos Dennis A.
Published: May 2014

Background : The Community Alliance for Research Empowering Social Change (CARES) is an academic–community research partnership designed to train community members on research methods and develop the infrastructure for community-based participatory research (CBPR) to examine and address racial/ethnic health disparities. The Brentwood Community Health Assessment (BCHA) was developed through a CBPR pilot project grant from CARES. Objectives : The purpose of the BCHA is to assess health care utilization and identify existing barriers to health care access among a multi-ethnic community in the Hamlet of Brentwood, New York. Methods : Using CBPR approaches, the community–academic research partnership develop the study design and survey instrument. Trained Bilingual (English/Spanish) data collectors verbally administered surveys door-to-door to residents of Brentwood from October 2010 to May 2011. Inclusion criteria required participants to be at least 18 years of age and speak either English or Spanish. Results : Overall, 232 residents completed the BCHA; 49% were male, 66% Hispanic, 13% non-Hispanic White, 13% non-Hispanic Black, 29% had less than a high school education, and 33% were born in United States. The assessment results revealed that most residents are able to access health care when needed and the most significant barriers to health care access are insurance and cost. Conclusions : We describe the community–academic partnered process used to develop and implement the BCHA and report assessment findings; the community-partnered approach improved data collection and allowed access into one of Suffolk County’s most vulnerable communities.
The Spaces of the Schoolhouse and the City: Gender and Class in Boston Education, 1830–1832
Authors: Remmel Rachel
Published: May 2014

In 1830, Boston’s school committee reorganized its schools to match its spatial imagination: an idealized spatial model that reflected the lives and social experiences of its elite members. To unify individual schools and regulate student sexuality, the committee created single-sex schools with one male master. To unify the overall system, the committee redistributed students by sex and adopted a hierarchical teaching staff commanded by the committee. However, the committee’s spatial imagination conflicted with physical buildings and geography, with the different spatial imagination of middle-class parents, and with the irreconcilability of individualized buildings and a unified system. The committee backtracked in 1832.
Practical Patriotism: How the Canadian Junior Red Cross and its Child Members Met the Challenge of the Second World War
Authors: Glassford Sarah
Published: May 2014

The advent of the Second World War posed certain dilemmas for the previously internationalist and peace-promoting Canadian Junior Red Cross (JRC). This article draws upon institutional sources and secondary literature around coercion and agency in children’s wartime voluntary labor to examine both the adjustments made by the JRC and children’s responses to those changes. Through strategies of avoidance, adaptation and redirection, the Canadian JRC successfully negotiated the wartime challenge to its peacetime agenda. However, although these organizational changes were important, the program’s success ultimately relied upon young Canadians’ own productivity and desire to participate.
Dinny Gordon, Intellectual: Anne Emery’s Postwar Junior Fiction and Girls’ Intellectual Culture
Authors: Anderson Jill
Published: May 2014

In her Dinny Gordon series (1958–1965), junior novelist Anne Emery’s heroine manifests intellectual desire, a passionate engagement in the life of the mind along with the desire to connect with like-minded others. Within a genre which focused on socialization and dating, in Dinny, Emery normalizes a studious, inner-directed, yet feminine heroine, passionate about ancient history rather than football captains. Emery’s endorsement of the pleasure Dinny takes in intellectual work, and the friends and boyfriends Dinny collects, challenge stereotypes of intellectual girls as dateless isolates while suggesting an alternative model of girlhood operating within apparent conformism to postwar “good girl” standards.
The Experiences and Expectations of Canadian Female University Students at the “Dawn of the Age of Aquarius”
Authors: Grayson J. Paul
Published: May 2014

Using, among other sources, previously unanalyzed results of student surveys conducted in 1963 and 1967, in this article I examine the experiences and expectations of female students at Glendon College (York University, Toronto). Consistent with some Canadian feminist critiques of the period, students were likely exposed to an androcentric curriculum and had few female instructors. This said, female students were respected by male faculty and students; did well in their studies; were as likely as males to complete their academic programs; went to graduate school in large numbers; and were as satisfied as males with some important aspects of their education.
“Dare to Free Yourself”: The Red Tide, Feminism, and High School Activism in the Early 1970s
Authors: Ides Matthew
Published: May 2014

In 1971, a group of radical students at University High School in West Los Angeles began publishing the Red Tide newspaper. Using the Tide and oral histories of alumni, this article analyzes the relationship between feminism and youth culture in the early 1970s. It argues that the Tide ’s authors successfully tied together strains of women’s liberation, 1960s movement cultures, and the counterculture; through their activities they integrated this synthesis with the youth culture of their community. As explored in this article, a feminist youth culture charted alternatives to the norms of adult authorities, and provided students with peer-driven discussion of sex, sexual orientation, and gender roles.
Factors Associated with Perceived Patient-Provider Communication Quality among Puerto Ricans
Authors: Calo William A. , Ortiz Ana P. , Colon-Lopez Vivian , Krasny Sarah , Tortolero-Luna Guillemo
Published: May 2014

Patient-provider communication is an important factor influencing patients’ health outcomes. This study examined the relationship between patient-provider communication quality and sociodemographic, health care access, trusted information sources, and health status variables. Data were from a representative sample of 450 Puerto Rican adults who participated in the Health Information National Trends Survey. A composite score rating perceived patient-provider communication quality was created from five items (Cronbach’s alpha = 0.87). A multivariate linear regression analysis was conducted. Patient-provider communication ratings were lower among the unemployed ( p = 0.049), those who do not trust a lot in the information provided by their providers ( p = 0.003), and respondents with higher depressive symptoms scores ( p = 0.036). Perceived patient-provider communication quality, however, was higher among respondents who visited their providers five or more times in the last year ( p = 0.023). Understanding patient perceptions of provider communication may serve to develop system-level interventions aimed at eliminating communication disparities and improving patients’ health outcomes.
Knowledge and Perceptions of the Affordable Care Act by Uninsured Patients at a Free Clinic
Authors: Petrany Stephen M. , Christiansen Matthew
Published: May 2014

The Affordable Care Act (ACA) has as one of its main objectives to reduce the number of uninsured Americans. The understanding of the ACA reforms by uninsured patients will likely influence the degree of success in achieving this objective. This study assessed the basic knowledge and opinions regarding the ACA of patients at a free clinic and the impact of a brief educational intervention on respondents’ knowledge and opinions. One hundred uninsured adult patients completed a brief survey about the ACA before and after viewing a video outlining the major features of the act. The study cohort initially performed worse than national polls on all knowledge questions. Significant improvement was observed after the educational video. Our study suggests a need for educational efforts directed at those individuals most likely to benefit from the ACA. We demonstrated that a brief intervention during a routine office visit may improve knowledge of the ACA.
Prioritization of Inpatient Hospital Services to Prisoners: A Method for Justifying Care and Costs
Authors: Schneider Bryan C. , Harzke Amy Jo , Ivanitskaya Lana , Murray Owen J.
Published: May 2014

As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, we developed and applied a process framework for systematically prioritizing the provision of inpatient hospital services to prisoners. Specifically, all inpatient services provided from September 2009 through August 2011 at the University of Texas Medical Branch/Texas Department of Criminal Justice Hospital were sorted according to levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Nearly all inpatient services (94%) were deemed medically mandatory (Level 1) or medically necessary (Level 2). These services must be funded to ensure an adequate level of care, and capitated-funding mechanisms may not be sufficiently flexible to cover their costs. Correctional health care systems may adapt the framework used here to inform state policymakers regarding provision of inpatient services and funding requirements.
Suc Khoe La Quan Trong Hon Sac Dep! Health is Better than Beauty! A Community-based Participatory Research Intervention to Improve Cancer Screening among Vietnamese Women
Authors: Nguyen Anh B. , Belgrave Faye Z.
Published: May 2014

This paper examines community-based participatory research (CBPR) intervention approaches in promoting cancer-relevant outcomes for 102 Vietnamese women. Results indicated that the intervention was effective in promoting breast and cervical cancer knowledge, positive attitudes towards breast cancer screening, and breast cancer screening. Collectivism moderated the effect of the intervention on attitudes towards breast cancer screening. The intervention led to more favorable attitudes towards breast cancer screening for women with high levels of collectivism but not for women with low levels. Ethnic identity moderated the effect of the intervention on breast cancer screening: the intervention program led to higher probability of getting a clinical breast exam; however, this effect was more pronounced for women with low ethnic identity than for those with high ethnic identity. The study provides evidence for the effectiveness of culturally-tailored strategies in developing cancer screening interventions for the Vietnamese American population.
A Qualitative Study of Pregnancy Intention and the Use of Contraception among Homeless Women with Children
Authors: Kennedy Sara , Grewal Mandeep , Roberts Elizabeth M. , Steinauer Jody , Dehlendorf Christine
Published: May 2014

We undertook a qualitative analysis informed by grounded theory to explore pregnancy intention and the barriers to contraceptive use as perceived by homeless women with children. Semi-structured interviews (n = 22) were performed in English and in Spanish. The dominant theme emerging from the interviews was a strong desire to avoid pregnancy while homeless. However, few women in our sample used contraception or accessed reproductive health care consistently. There were multiple barriers to using contraception and to accessing reproductive health care services that homeless women reported: (1) inability to prioritize health due to competing demands, (2) shelter-related obstacles and restrictive provider practices that impede access to reproductive health care services and the use of contraception, and (3) change in the power dynamics of sexual relationships while homeless, making women more vulnerable to sexual exploitation. Findings suggest a multifactorial approach is needed to help homeless women use contraception and access reproductive health services.
Religious Beliefs and Cancer Screening Behaviors among Catholic Latinos: Implications for Faith-based Interventions
Authors: Allen Jennifer D. , Leyva Bryan , Torres María Idalí , Ospino Hosffman , Tom Laura , Rustan Sarah , Bartholomew Amanda
Published: May 2014

Although most U.S. Latinos identify as Catholic, few studies have focused on the influence of this religious tradition on health beliefs among this population. This study explores the role of Catholic religious teachings, practices, and ministry on cancer screening knowledge, attitudes, and behaviors among Latinos. Eight focus groups were conducted with 67 Catholic Latino parishioners in Massachusetts. Qualitative analysis provided evidence of strong reliance on faith, God, and parish leaders for health concerns. Parishes were described as vital sources of health and social support, playing a central role in the community’s health. Participants emphasized that their religious beliefs promote positive health behaviors and health care utilization, including the use of cancer screening services. In addition, they expressed willingness to participate in cancer education programs located at their parishes and provided practical recommendations for implementing health programs in parishes. Implications for culturally appropriate health communication and faith-based interventions are discussed.
Quality of Life among Urban Children with Obesity and Asthma
Authors: Rastogi Radhika , Rastogi Deepa , Silver Ellen J.
Published: May 2014

Objective . To investigate quality of life (QoL) among obese asthmatic children and elucidate its association with lung function. Methods . Preadolescent inner-city children with obesity, asthma, both, or neither completed the Pediatric Quality of Life 4.0 (PedsQL) and Asthma Quality of Life Questionnaires and spirometry testing. Spirometric indices, composite and individual QoL scores were compared between groups using analysis of variance while proportion of children reporting item-specific impairment were compared by chi-squaretest. Results . The composite QoL scores did not differ between obese asthmatics and the other study groups. FEV1/FVC was the lowest among obese asthmatics but did not correlate with QoL measures. Discussion . Overall QoL in obese asthmatic preadolescents is well preserved. Since QoL measures did not correlate with spirometric indices, asthma severity may not serve as a surrogate marker of QoL. QoL evaluation should be incorporated in asthma management and early identification of changes may prevent further deterioration.
The Effect of Involvement in a Student-run Free Clinic Project on Attitudes toward the Underserved and Interest in Primary Care
Authors: Smith Sunny D. , Yoon Ryan , Johnson Michelle L. , Natarajan Loki , Beck Ellen
Published: May 2014

Methods . The authors designed a survey instrument to examine the effect of involvement in a student-run free clinic project (SRFCP) on medical student self-reported attitudes toward the underserved and interest in primary care. From 2001–2010, first-and second-year medical students in an introductory service-learning elective course rated each of 15 statements on a seven-point Likert scale pre/post survey. Wilcoxon’s signed rank test was performed on all matched pairs and an intent-to-treat analysis included unmatched pairs. Results . The response rate was 97.9%, with 914 of 934 students enrolled participating. Significant increases were seen in each of the 15 items in matched pre/post survey pairs, N = 433 (47.4%), or with an intent-to-treat analysis, N = 914 (p ≤ .002 for all). Conclusions . This study found that medical student involvement in a SRFCP improved student knowledge, skills, attitudes and self-efficacy with the underserved, interest in work with the underserved after graduation, and interest in primary care.
Cervical Cancer and HPV: Knowledge, Attitudes, Beliefs, and Behaviors among Women Living in Guatemala
Authors: Petrocy Amy , Katz Mira L.
Published: May 2014

This study was conducted to explore knowledge, attitudes, and beliefs about cervical cancer, cervical cancer screening, human papillomavirus (HPV), and acceptance of the HPV vaccine. A purposive sample of 40 women was interviewed during August 2012. Fisher’s exact test was used to evaluate differences among rural and urban women, and open-ended questions were coded independently by two individuals (Cohen’s kappa coefficient of 0.816). Among the 22 rural and 18 urban women, there was limited knowledge about cervical cancer, screening, HPV, and the HPV vaccine. Cervical cancer was described in language related to gender, science, severity, or associated with having children, a uterus, or menstruation. All rural and most urban participants were interested in the HPV vaccine for themselves and their daughters. Limited awareness and knowledge about cervical cancer and HPV was common among Guatemalan women, highlighting the need for additional information prior to developing cancer prevention educational materials and programs.
Community Health Center Provider and Staff’s Spanish Language Ability and Cultural Awareness
Authors: Baig Arshiya A. , Benitez Amanda , Locklin Cara A. , Campbell Amanda , Schaefer Cynthia T. , Heuer Loretta J. , Lee Sang Mee , Solomon Marla C. , Quinn Michael T. , Burnet Deborah L. , Chin Marshall H.
Published: May 2014

Many community health center providers and staff care for Latinos with diabetes, but their Spanish language ability and awareness of Latino culture are unknown. We surveyed 512 Midwestern health center providers and staff who managed Latino patients with diabetes. Few respondents had high Spanish language (13%) or cultural awareness scores (22%). Of respondents who self-reported 76–100% of their patients were Latino, 48% had moderate/low Spanish language and 49% had moderate/low cultural competency scores. Among these respondents, 3% lacked access to interpreters and 27% had neither received cultural competency training nor had access to training. Among all respondents, Spanish skills and Latino cultural awareness were low. Respondents who saw a significant number of Latinos had good access to interpretation services but not cultural competency training. Improved Spanish-language skills and increased access to cultural competency training and Latino cultural knowledge are needed to provide linguistically and culturally tailored care to Latino patients.
Street Outreach and Other Forms of Engagement with Literally Homeless Veterans
Authors: Tsai Jack , Kasprow Wesley J. , Kane Vincent , Rosenheck Robert A.
Published: May 2014

Street outreach is one of the most direct methods of engaging homeless individuals, but the characteristics of those most likely to be engaged this way is not well-understood. Data from the Department of Veterans Affairs (VA) Homeless Operations Management and Evaluation System showed that of the 70,778 literally homeless veterans engaged in VA homeless services in 2011–2012, 12% were through street outreach while the majority was through provider referrals (41%) and self-referrals (28%). Veterans engaged through street outreach had more extensive histories of recent homelessness, were more likely to be chronically homeless, and were more likely to be referred and admitted to the VA’s supported housing program than other veterans. These findings suggest street outreach is an especially important approach to engaging chronic street homeless veterans in services and linking them to permanent supported housing.
AmeriCorps Members Increase Enrollment in Medicaid/CHIP and Preventive Care Utilization at a Community Health Center
Authors: Stipelman Carole , Dinkins Courtney Pariera , Pruhs Alan , Serr Randal , Young Paul
Published: May 2014

Background . Uninsured children have less access than others to primary care; Latino children are more likely than non-Latino children to be uninsured. Objectives . 1. Determine whether case management (CM) by AmeriCorps Members (ACM) increases enrollment of children in Medicaid/CHIP at a federally qualified community health center (FQHC); 2. Identify factors associated with non-enrollment; 3. Compare health care utilization by enrolled and non-enrolled children. Methods . Parents of uninsured children at two urban FQHCs serving primarily Latino families were offered CM assistance for enrollment in Medicaid/CHIP at one of the clinics. Application instructions alone were provided at the other clinic. Results . Of 107 children at the CM clinic, 74% were enrolled compared with 26% of the 96 from the non-CM clinic. Non-enrolled children completed fewer preventive care visits than enrolled children despite sliding fees at both FQHCs. Conclusion. Case management by ACM is a low-cost, effective approach to increasing access to care for Latino children.
Over-the-Counter But Out of Reach: A Pharmacy-Based Survey of OTC Syringe Sales in Tijuana, Mexico
Authors: Pollini Robin A. , Gallardo Manuel , Ruiz Serena , Case Patricia , Zaller Nickolas , Lozada Remedios
Published: May 2014

Sterile syringe access is critical to HIV prevention efforts targeting injection drug users (IDUs) but some pharmacies do not sell syringes over-the-counter (OTC) even where such sales are legal. We conducted a pharmacy survey in Tijuana, Mexico (where OTC sales are legal) to characterize attitudes toward syringe sales and to explore support for expanding pharmacy-based HIV prevention efforts. Of 203 respondents, 28% supported OTC syringe sales to IDUs and 74% said their pharmacy required a prescription for at least some syringe sales. Support for OTC syringe sales was independently associated with selling OTC syringes, understanding the role of sterile syringes in HIV prevention, and recognizing pharmacies as an important health resource for IDUs. Most respondents supported an expanded role for pharmacies in HIV prevention, exclusive of OTC syringe sales. Our study provides information for developing interventions to promote OTC syringe sales and expanding pharmacy-based distribution of HIV-related information and resources.
The Acceptability of Incorporating a Youth Smoking Prevention Intervention in the Pediatric Emergency Department
Authors: Mahabee-Gittens E. Melinda , Chen Chen , Huang Bin , Gordon Judith S.
Published: May 2014

The pediatric emergency department (PED) is under-utilized as a setting in which to provide tobacco prevention interventions for at-risk children. We sought to determine the acceptability and feasibility of incorporating a brief, parental tobacco prevention intervention to 520 parents during the PED visit. Mean age (SD) of parents and children was 38.6 (7.1) and 11.5 (1.1), respectively; 47% of children were female; 45% were African American; 36% of parents had an annual income less than $25,000; 28.8% of parents were current smokers. Over 90% of parents said the intervention provided “useful” and “easy to understand” information and 97% of practitioners said it did not “interfere with clinical care.” Given the high prevalence of parental smoking in the PED, there is a high likelihood that their children will initiate smoking in the future. Thus, the use of the PED as a venue to providing tobacco prevention interventions warrants further evaluation.
Perceived Social Stress, Pregnancy-Related Anxiety, Depression and Subjective Social Status among Pregnant Mexican and Mexican American Women in South Texas
Authors: Fleuriet K. Jill , Sunil T.S.
Published: May 2014

Purpose . The purpose of this study was to determine differences in subjective social status, perceived social stress, depressive symptoms, and pregnancy-related anxiety between pregnant Mexican American and Mexican immigrant women. Methods . Three hundred pregnant Mexican immigrant and Mexican American women in South Texas were surveyed for pregnancy-related anxiety, perceived social stress, depressive symptoms, and subjective social status. Results . Pregnant Mexican immigrant women had higher levels of pregnancy-related anxiety and lower levels of depression and perceived social stress than pregnant Mexican American women. Change in these variables among Mexican immigrant women was relatively linear as time of residence in the United States increased. Mexican immigrant and Mexican American women had significantly different correlations between subjective social status, self-esteem and perceived social stress. Conclusions . Results indicate that subjective social status is an important psychosocial variable among pregnant Hispanic women. Results contribute to ongoing efforts to provide culturally responsive prenatal psychosocial support services.
Quality of Hepatitis C Care at an Urban Tertiary Care Medical Center
Authors: Assoumou Sabrina A. , Huang Wei , Horsburgh C. Robert , Mus Mus , Linas Benjamin P.
Published: May 2014

Background . More effective treatment for hepatitis C virus (HCV) creates an opportunity to improve health outcomes. Objective . To use Centers for Medicare and Medicaid Services (CMS)-defined HCV quality indicators (QI) as a framework to assess the quality of care at an urban safety net hospital. Design . Retrospective cohort. Participants . Patients engaged in care (at least two outpatient visits, and minimum six-month follow-up time) between 2005 and 2011. Outcomes measures . 1) HCV ribonucleic acid (RNA); 2) genotyping; 3) treatment; and 4) Hepatitis A and B vaccination. Study time was divided into three periods: 1) 2005–2006, 2) 2007–2008, 3) 2009–2011. Key results . Number who met inclusion criteria: 3,018; 13% were human immunodeficiency virus co-infected. Only 1% completed the care recommended in the CMS quality indicators that were evaluated. Later time periods were independently associated with greater rates (aHR for HCV testing, 1.15; 95% CI, 1.04–1.28). Conclusions . Quality of care is improving, but it remains suboptimal. Initiatives are needed to increase QI completion.
Cultural Sensitivity and Health Education: Essential Components to the Success of the Early Detection Cancer Screening Program for Latinas at MedStar Georgetown University Hospital
Authors: Makariou-Pikis Chrissy , Peled Anne Warren , Newland Georgeen Melanson , Wessel Lois A. , Warren Robert D.
Published: May 2014

Over 13 years, the Celebremos la Vida (CLV) program has offered free breast examinations, mammograms, and cervical cancer screenings to uninsured Latinas residing in the Northern Virginia suburbs of Washington, D.C. The CLV program aims to educate participants on the importance of breast self-examination and regular cancer screening for the early detection of breast and cervical cancer.
Health Care Concerns of Rural Childhood Cancer Survivors
Authors: Warner Echo L. , Montenegro Roberto E. , Stroup Antoinette , Kinney Anita Y. , Kirchhoff Anne C.
Published: May 2014

Background . Geographic isolation may limit health care access due to burdens of time, cost and travel distance. We explored rural childhood cancer survivors’ experiences and concerns about accessing affordable, quality care. Methods . In-depth, semi-structured telephone interviews were conducted with 17 rural adult survivors recruited from the Utah Cancer Registry. Interviews were recorded, transcribed, and content analyzed with NVivo 9 by two coders (kappa = 0.93). Results . Two primary themes emerged: (1) concerns about health care quality and (2) geographic and insurance issues. Within these main themes, we identified salient sub-themes: quality of primary care, patient-provider trust, specialty care access, travel burdens, and financial and insurance concerns. Conclusions . Rural childhood cancer survivors have concerns about local health care services, but are willing to travel several hours to receive care. Partnerships between local primary care and cancer specialty providers via telemedicine that incorporate survivor care plans could improve risk-based care for rural survivors.
Reducing Barriers to Hepatitis C Treatment among Drug Users: An Integrated Hepatitis C Peer Education and Support Program
Authors: Roose Robert J. , Cockerham-Colas Lauren , Soloway Irene , Batchelder Abigail , Litwin Alain H.
Published: May 2014

This report describes an innovative HCV Peer Educator Program that facilitates education, support, and engagement in HCV treatment among patients in an opioid treatment program. Integrating peer educators in a collaborative manner with close supervision holds promise as a model to reduce barriers to HCV treatment among drug users.
Access to Primary and Specialty Care and Emergency Department Utilization of Medicaid Enrollees Needing Specialty Care
Authors: Mortensen Karoline
Published: May 2014

Objective . Medicaid enrollees are more likely to use the emergency department (ED) than the privately insured and uninsured, yet little is known about enrollees’ problems in accessing primary care and specialty care providers among those needing specialty care. Data sources . The study sample is from the 2003–2010 Medical Expenditure Panel Survey (MEPS) of 2,733 Medicaid enrollees reporting a need for specialty care. Methods . This paper estimates a two-part model to analyze the relationship between enrollees’ access to providers and ED visits. Principal findings . Perceived problems accessing a primary care physician are associated with ED use among Medicaid enrollees. Despite reporting need and facing barriers, access to specialty care is not significantly related to ED use. Conclusions . As states prepare for the impending expansion of Medicaid funded via the Affordable Care Act, they should address barriers to accessing primary care providers for Medicaid enrollees with high need.
Does a Wife’s Education Influence Spousal Agreement on Approval of Family Planning?: Random-effects Modeling Using Data from Two West African Countries
Authors: Hossain Mian , Ahmed Saifuddin , Rogers Laurencia
Published: May 2014

Spousal approval of family planning is critical for contraceptive use. Both contraceptive use rates and women’s education are low in many West-African countries and this study examines the role of wives’ education in spousal agreement on approval of family planning in two sub-Saharan West African countries. We used couples’ data from Demographic Health Surveys in Senegal and in Niger, conducted in 2005 and 2006, respectively. Multiple logistic regression results using multilevel modeling show that the odds of spousal agreement on approval of family planning were slightly over three times [OR: 3.16; 95% CI: 1.32 to 7.57] in Senegal and were about three times [OR: 3.07; 95% CI: 1.64 to 5.76] in Niger higher for women with more than primary education. Findings suggest that improvement in women’s education could lead to spousal agreement on approval of family planning, which may lead to use of family planning in sub-Saharan African countries.
Asthma and Adaptive Functioning among Homeless Kindergarten-Aged Children in Emergency Housing
Authors: Cutuli J. J. , Herbers Janette E. , Lafavor Theresa L. , Ahumada Sandra M. , Masten Ann S. , Oberg Charles N.
Published: May 2014

Background . Children who experience homelessness have elevated rates of asthma, a risk factor for other problems. Purpose . Examine rates of asthma and its relation to health care use and adaptive functioning among young children staying in family emergency shelters. Methods . Children and caregivers (N = 138) completed assessments in shelters, including measurement of child cognitive functioning, parent report of child health care service utilization and asthma diagnosis, and teacher report of child school functioning. Results . Asthma diagnosis was reported for 21% of 4-to-6-year-old children, about twice the national and state prevalences. Children with asthma used more health care services and had worse peer relationships. Asthma did not relate to cognitive test performance or subsequent academic performance, or to other behavior problems in school. Conclusions . High rates of asthma remain an important issue for children in emergency family housing, a context with high levels of child risk for toxic stress exposure and developmental problems.
Eliminating Health Disparities through Culturally and Linguistically Centered Integrated Health Care: Consensus Statements, Recommendations, and Key Strategies from the Field
Authors: Sanchez Katherine , Chapa Teresa , Ybarra Rick , Martinez Octavio N.
Published: May 2014

This report is the outcome of an expert consensus meeting sponsored by the United States Deparment of Health and Human Services Office of Minority Health, which was convened to formulate consensus statements, provide recommendations and identify key strategies from practice for implementing integrated health and behavioral health care intended to improve health status for underserved populations.
Relational Discord in Urban Primary Care: Prevalence Rates and Psychiatric Comorbidities
Authors: Woods Sarah B. , Priest Jacob B. , Fish Jessica N. , Rodriguez José E. , Denton Wayne H.
Published: May 2014

The current study primarily assesses uninsured, low-income patients (n = 125) in a primary care practice. Despite the knowledge that family relationships affect the management and outcomes of chronic illness, the rates of relational discord among primary care patients are unknown. Findings reveal that 54% of patients met criteria for problematic family functioning, while 40% of those in a romantic relationship reported relationship distress. In addition, 67% reported depression, 32% reported clinical levels of anxiety, and 33% at-risk alcohol use. Researchers used latent class analysis to explore characteristics of the sample, which revealed four classes. Comparisons with prior research with similar populations are made and implications for behavioral health providers working within primary care are discussed.
A Triple Play: Psychological Distress, Physical Comorbidities, and Access and Use of Health Services among U.S. Adults with Disabilities
Authors: Okoro Catherine A. , Dhingra Satvinder S. , Li Chaoyang
Published: May 2014

Purpose . Among adults with disabilities, we examined whether increasing levels of psychological distress were associated with higher estimated prevalences of chronic conditions, obesity, health care access, and use of preventive services. Methods . We analyzed data from the 2007 Behavioral Risk Factor Surveillance System. The Kessler-6 scale was used to assess psychological distress. Results . Increasing levels of psychological distress were associated with an increased prevalence of chronic diseases and conditions, and decreased access to health care and utilization of preventive services in keeping with what has been established for non-disabled populations. Among adults with disabilities, aged 18−64 years and 65 years or older, increasing levels of distress were also associated with increased receipt of mental health treatment. However, compared to adults aged 18−64 years, larger proportions of older adults reported non-receipt of mental health treatment (mild to moderate psychological distress: 58.0% versus 70.6%; serious psychological distress: 40.5% versus 54.5%). Conclusions . While adults with disabilities who had increased levels of psychological distress were more likely to receive mental health services, they also had higher estimated prevalences of chronic conditions, barriers to health care, and non-receipt of preventive cancer screenings.
Ethnic Variation in Access to Health Care of Asian Americans Who are Not U.S. Citizens: Chinese, Korean, and Vietnamese Ethnic Groups
Authors: Lee Sungkyu , Choi Sam , Jung Min-Jung
Published: May 2014

Using the 2009 California Health Interview Survey, this study examined ethnic variation in the predictors of having a usual source of health care among Asian Americans who are non-U.S. citizens. Chinese residents reported the highest probability of having a usual source of health care (78.0%), followed by Vietnamese (59.8%) and Korean residents (45.2%), and the differences were statistically significant (χ 2 = 11.65, p < .01). Poverty status was the only significant predictor for Korean residents and insurance status was the only significant predictor for Vietnamese residents. By contrast, both poverty and insurance status predicted which Chinese residents had a usual source of care. To enhance health care access for vulnerable subgroups of non-U.S. citizens, health care professionals must be aware that there are cultural differences in the predictors of having a usual source of health care based on whether one is an immigrant from China, Korea, or Vietnam.
Prevalence of Intimate Partner Violence and Its Impact on Health: Female and Male Patients Using a Free Clinic
Authors: Kamimura Akiko , Christensen Nancy , Tabler Jennifer , Ashby Jeanie , Olson Lenora M.
Published: May 2014

Purpose . Examine the prevalence of intimate partner violence (IPV) with physical and mental health indicators among free clinic patients. Methods . A cross-sectional study conducted via self-administered surveys. English and Spanish-speaking women and men aged 18 to 64 years responded to standardized questionnaires regarding IPV, physical and mental health, depression, and emotional support. Results . The overall prevalence of IPV was 41%. U.S.-born participants reported a higher prevalence of IPV (women 61%, men 69%) compared with the national average (women 36%, men 29%) and the non-U.S.-born or immigrant participants (women 39%, men 7%). Women with IPV reported poorer mental health but the same level of physical health functioning compared with women without IPV. The impact of IPV on health was somewhat different for men. Conclusions . Intimate partner violence is associated with poor health outcomes, especially for U.S.-born participants. Further research is warranted to understand causal mechanisms and to aid patients.
Low Socioeconomic Status is Associated with Increased Risk for Hypoglycemia in Diabetes Patients: The Diabetes Study of Northern California (DISTANCE)
Authors: Berkowitz Seth A. , Karter Andrew J. , Lyles Courtney R. , Liu Jennifer Y. , Schillinger Dean , Adler Nancy E. , Moffet Howard H. , Sarkar Urmimala
Published: May 2014

Background . Social risk factors for hypoglycemia are not well understood. Methods . Cross-sectional analysis from the DISTANCE study, a multi-language, ethnically-stratified random sample of adults in the Kaiser Permanente Northern California diabetes registry, conducted in 2005–2006 (response rate 62%). Exposures were income and educational attainment; outcome was patient report of severe hypoglycemia. To test the association, we used multivariable logistic regression to adjust for demographic and clinical factors. Results . 14,357 patients were included. Reports of severe hypoglycemia were common (11%), and higher in low-income vs . high-income (16% vs . 8.8) and low-education vs . high-education (11.9% vs . 8.9%) groups. In multivariable analysis, incomes of less than $15,000 (OR 1.51 95%CI 1.19–1.91), $15,000–$24,999 (OR 1.57 95%CI 1.27–1.94), and high school or less education (OR 1.42, 95% CI 1.24–1.63) were associated with increased hypoglycemia, similar to insulin use (OR 1.44 95%CI 1.19–1.74). Conclusions . Low income and educational attainment are important risk factors for hypoglycemia.
Mission, Margin, and the Role of Consumer Governance in Decision-Making at Community Health Centers
Authors: Wright Brad , Martin Graham P.
Published: May 2014

Objective . We explore the role of consumer trustees in decision-making as community health centers (CHCs) work to navigate the tension between pursuing their mission to provide primary care to all regardless of ability to pay and maintaining their limited finances. Methods . We interviewed 30 trustees from 16 CHCs in 14 different states, asking extensively about decision-making processes at their CHC related to services and finances, as well as perceived advantages and disadvantages of consumer governance. Results . Respondents described mission-dominant, margin-dominant, and balanced decision-making philosophies, and different decision-making pathways for service provision and finances. Consumer trustees were lauded for their role in informing the board of service quality and community needs, but criticized for being professionally unskilled and exhibiting a lack of objective decision-making. Conclusions . While CHC boards do play a role in navigating the tension between mission and margin, executive directors and staff appear to be more influential.
Successful Management of Latent Tuberculosis Infection in an Underserved Community by a Student-run Free Clinic
Authors: Peluso Michael J. , Hung Adelina , Lukasiewicz Adam , Chang Harry , Ramallo Jorge , Bartlett Mary , Friedland Gerald , Ellis Peter
Published: May 2014

The management of latent tuberculosis infection (LTBI) most commonly consists of a nine-month course of isoniazid (INH) therapy and is complicated by low adherence and completion rates. The Latent Tuberculosis Initiative at the HAVEN Free Clinic was developed to provide LTBI treatment to an underserved, high-risk, foreign-born population. We conducted a retrospective chart review to evaluate the program. Of 39 patients enrolled, 26 (67%) successfully completed nine months of INH, eight (21%) discontinued, and five (12%) were lost to follow-up. Patients had a median of nine encounters during the course of treatment and mean self-reported medication adherence was 29/30 pills/month (96%). Median days-of-treatment was 273, 95, and 63 among completion, discontinuation, and lost to follow-up groups, respectively (p < .0001). There was one death in the program, related to a complication of a diagnostic procedure in a patient who had developed INH toxicity. These results are comparable to the most successful published programs (50–65% six-month completion rates), suggesting that student-run clinics serving high-risk populations may contribute to LTBI management and TB control efforts.
Response to a Patient Activation Intervention among Spanish-speaking Patients at a Community Health Center in New York City
Authors: Maranda Michael J. , Deen Darwin , Elshafey Suzanne , Herrera Milton , Gold Marthe R.
Published: May 2014

Patient activation describes an individual’s readiness to participate in their health care. Lower levels of activation that may contribute to poor health outcomes have been documented in Latino patients. We administered a brief activating intervention directed at Spanish-speakers that sought to improve and encourage question-asking during a medical visit. We used quantitative measures of patient attitudes supplemented with open-ended questions to evaluate the effectiveness of the intervention at a community health center. Post-intervention changes in the Patient Activation Measure (PAM) and Decision Self-Efficacy (DSE) were measured. Both control and intervention group PAM scores changed significantly, but for those at lower levels of activation, only the intervention group showed significant gains. For the DSE the intervention group showed significant changes in scores. These findings, which are supported by the qualitative data, suggest that the intervention helped patients who may have difficulty asking questions during medical visits.
Perspectives of Older Adults of Low Socioeconomic Status on the Post-hospital Transition
Authors: Kangovi Shreya , Levy Kathryn , Barg Frances K. , Carter Tamala , Long Judith A. , Grande David
Published: May 2014

Background . Older adults of low socioeconomic status are at high risk for poor post-hospital outcomes. Design . A qualitative researcher, who was also an outreach worker from the West Philadelphia community, conducted in-depth interviews with 25 participants within 30 days of their hospital discharge. Participants . Eligible participants were: 1) residents of high-poverty ZIP codes; 2) dually eligible for Medicare and Medicaid; 3) had capacity or a caregiver who could be interviewed as a proxy; 4) general medicine or cardiology patients. Results . Participants were unable to access the care and accommodations needed to cope with post-hospital frailty. As a result, medical disability was amplified by socioeconomic disability. Participants were ashamed of the resulting loss of control and had difficulty asking for help, particularly from potential supports who were perceived as emotionally controlling or judgmental. Conclusion . Strategies that address socioeconomic stressors of hospitalization and provide empathic support may improve the post-hospital transition for these high-risk individuals.
Articulatory Play among American Cuers
Authors: Mirus Gene
Published: May 2014

Cuers are a socially significant category in terms of language play—they are interesting from a linguistic anthropological perspective in that respect because their performance, expressed using manual English at the phonemic level rather than the traditional spoken model, has had very limited documentation. For this reason, a study of language play in cueing addresses various questions about modality in general. In this article I am interested in seeing how cuers take advantage of the linguistic resources offered by both modalities.

After a brief definition and background on Cued Speech, this article discusses spoken and signed language play and follows with a description and an analysis of various types of cued English play.