Journal of Health Care for the Poor and Underserved

Migration, detention, and deportation are often rife with violence. This study sought to examine associations between pre-migration experiences, detention conditions, and mental health among Mexicans deported from the U.S. to Mexico between 2020 and 2021. Data from the Migrante Project (N=306, weighted N=14,841) were analyzed using descriptive statistics and unadjusted and adjusted multivariate regression models. The prevalence of a lifetime mental health diagnosis was 18.5%. Exposure to adverse conditions in detention (adjusted odds ratio [AOR]=17...

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Patients in historically underserved communities are most vulnerable to uncontrolled chronic conditions and report a lack of health knowledge to manage them. This report aims to describe the development of SMART MEDS, a pharmacy-led program implemented to address health literacy disparities among medically and socially vulnerable patients.

In September 2017, Hurricane Irma struck several Caribbean islands, which suffered catastrophic damage. Anguilla, the most northerly of the Caribbean's Leeward Islands, a developing nation, experienced devastating damage to its social, physical, political, and economic infrastructures. Anguilla's longstanding Dental Unit, a public sector health care facility, was among the services that suffered irreparable destruction. Hurricane Irma's debilitating impact on a developing nation and its citizens' livelihoods exacerbated existing challenges in dental care, and created barriers to access...

Hepatitis C virus (HCV) infection causes liver-related morbidity/mortality and disproportionately affects people who are incarcerated and non-Hispanic Black populations, largely due to social and policy issues that contribute to poor health. With the advent of highly efficacious treatment, HCV is now curable. However, most states' departments of corrections do not offer universal HCV testing or treatment. Two southern states-Tennessee and Louisiana-provide examples of divergent approaches to addressing HCV infection...

Racism named as a public health issue largely focuses on those at the care-receiving end of health care. Home health care workers (HHCWs) are predominantly Black, immigrant, and women; in New York state it is illegal for HHCWs to work 24 consecutive hours, but homecare agencies assign HHCWs to 24-hour shifts and only pay for 13 hours of work. The demanding work of HHCWs increases their risk for and experiences of injury, depression, cardiovascular disease, and cerebrovascular events. This manifestation of exploitation illustrates that racism affects health care workers as well as the public...

Medical-legal partnerships (MLPs) integrate lawyers into medical teams to address patients' unmet legal needs that create barriers to good health and well-being (i.e., health-harming legal needs). This systematic review of the peer-reviewed literature focused on measuring 1) cancer patients' legal needs and 2) outcomes for cancer patients after receiving MLP services. Literature was searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for the period 2006-2022...

People of African descent and those identifying as Black and/or Latino experience a disproportionate burden of sickle cell disease (SCD), a chronic, serious blood condition. Caregivers of children with chronic medical conditions report worse mental health than others. Disease-associated stressors can affect caregivers of children with SCD. We conducted a systematic review to summarize the prevalence of mental health symptoms in caregivers of children with SCD and to see if symptoms were associated with the child's SCD...

Appalachian women face significant health disparities and have limited access to health care. Mental health conditions and treatment-seeking are stigmatized in Appalachian communities. Appalachian women may benefit from web-based interventions targeting less stigmatized health complaints (e.g., insomnia), while simultaneously yielding benefit in associated mental health conditions including symptoms of post-traumatic stress disorder (PTSD). In this study, 37 trauma-exposed adult women aged 45 and older from rural Appalachian Kentucky completed a six-session online self-administered cognitive behavioral therapy for insomnia (CBT-I) intervention and completed measures of PTSD symptoms, insomnia, and depression at pre- and post-treatment...

The coronavirus disease 2019 (COVID-19) pandemic dramatically changed how people socialized. However, little is known about the extent to which the pandemic changed the social connections of people with tenuous interpersonal relationships at baseline, including homeless-experienced people and people with psychotic disorders. We sought to understand how these populations experienced changes in their social connectivity and to identify coping strategies employed. We conducted 43 semi-structured interviews with 27 vulnerable participants (11 homeless-experienced people and 16 people with psychotic disorders) and 16 comparison group participants, all of whom used services at the Department of Veterans Affairs (VA)...

INTRODUCTION: Women in Ohio Appalachia experience greater maternal health disparities relative to the general U.S. population, resulting in poorer health outcomes. This paper describes the Ohio Better Starts for All (BSFA) program that provides mobile maternal health services in rural Ohio. METHODS: This three-year intervention was delivered through a community-clinical partnership in Ohio Appalachia. The program's preliminary evaluation and opportunities were informed by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework...

Older adults experiencing homelessness are a growing population with high rates of medical, psychiatric, and substance use-related health conditions. This mixed-methods study sampled older adults experiencing homelessness admitted to an academic safety-net hospital. We analyzed chart review data on the cohorts' medical and psychiatric conditions and their health care utilization. Qualitative interviews examined the impact of the congregate shelter environment on health. The sixteen participants with experiences living in a shelter had high rates of depression (56%), alcohol use disorder (52%) and hypertension (39%)...

BACKGROUND: Human trafficking involves coerced labor or sex. THRIVE, a multidisciplinary University of Miami clinic for trafficked persons, transitioned to a hybrid telehealth model during the COVID-19 pandemic. Th is paper presents appointment data across THRIVE clinic services during this transition. METHODS: A review of appointments for THRIVE patients (n=156) was conducted to compare pre-pandemic (February 2019 to February 2020) and pandemic (March 2020 to December 2021) appointment trends...

This study aimed to measure the proportion of adverse birth outcomes among all births and maternal factors associated with low birth weight among Indigenous (Orang Asli) infants in Kelantan, Malaysia. Proportionate stratified random sampling was done to select 327 samples from five antenatal centres involved with Orang Asli in Kelantan. Multiple logistic regression analysis was used to determine maternal factors associated with low birth weight among Orang Asli infants. The proportion of low birth weight was measured at 16...

The Affordable Care Act has significantly reduced the number of uninsured individuals in the U.S., yet millions of insured Americans lack adequate coverage or face substantial health-related financial risks. In this study, we conduct an analysis of a nationally representative sample to generate up-to-date evidence on the association between insurance types and demographic factors and the probability of cost-related underinsurance among continuously insured, lower-income adults in the U.S. We extend the previously established definition of underinsurance by including a measure of subjective financial burden...

We conducted a cross-sectional study of low-income San Franciscans to assess the impact of COVID-19 on their life and well-being during the period of the COVID-19 pandemic when the focus was on higher socioeconomic populations. Stratified analyses compared people who used drugs with those who did not and open-ended response data were sorted into themes. Of the 145 participants, most (70%) changed their behavior by practicing social distancing and reducing the number of their contacts. Of people who used drugs (98, 68%), 40% reported increased difficulty accessing/using drugs, 33% reduced access to drug treatment, and 41% increased concern about drug overdose for themselves or others...

Housing insecurity can take multiple forms, such as unaffordability, crowding, forced moves, multiple moves, and homelessness. Existing research has linked homelessness to increased emergency department (ED) use, but gaps remain in understanding the relationship between different types of housing insecurity and ED use. In this study, we examined the association between different types of housing insecurity, including detailed measures of homelessness, and future ED use among a cohort of patients initially seen in an urban safety-net hospital ED in the United States between November 2016 and January 2018...

Their initial years in the U.S. can be stressful for recent Latino/a immigrants (RLIs). This study examines the association between perceived stress and depressive symptoms and the moderating effect of emotion regulation and dispositional mindfulness. Cross-sectional data from an ongoing longitudinal study of RLIs was used. Hierarchical multiple regression analyses were performed to examine simple main effects of the predictor variables on depressive symptoms. The study also tested the moderating effects of emotion regulation and dispositional mindfulness on the association between perceived stress and depressive symptoms...

PURPOSE: To qualitatively examine barriers to patient portal use among low-income patients receiving health care services at a federally qualified health center (FQHC). METHODS: In-depth interviews were conducted with a volunteer sample of patients recruited from an FQHC. The interviews took 30-45 minutes. As participants arrived for each scheduled interview, written informed consent was obtained and participants completed a brief (5-10 minutes) self-administered survey...

OBJECTIVES: To describe health care utilization and occupational exposures during trafficking among foreign-born people labor-trafficked in the U.S. METHODS: Retrospective analysis of immigration files for health data among 114 labor-trafficked individuals. RESULTS: Mean age was 30. Files of 38% mentioned accessing medical services at least once, mostly via hospitals (73%-81%). Forty-three percent (43%) had U.S. citizen children-indicating their children and spouses interacted with social and medical systems during exploitation...