Current depression among women in California according to residence in the California-Mexico border region.

PubMed

Ryan-Ibarra, Suzanne; Epstein, Joan Faith; Induni, Marta; Wright, Michael A

2012-05-01

To estimate the prevalence of current depression; examine the relationship between current depression and immigration, health status, health care access, and health behaviors; and assess differences by California-Mexico border region (Imperial and San Diego Counties) among women in California. Using a cross-sectional, representative sample of adult women from the California Women's Health Survey (n = 13 454), a statewide telephone survey, prevalence of current depression and predictors of depression were examined in California and according to border region residence. Depression was assessed with the eight-item Patient Health Questionnaire. The prevalence of current depression for women in California was 12.0%. It was similar in the border (13.0%) and the nonborder (11.9%) regions. Odds of current depression in women were lower among recent immigrants (< 5 years or 5 to < 10 years in the United States) than in women born in the United States and in immigrants who had been living in the United States for 10 to < 15 years or longer (P < 0.05). Odds ratios for current depression and health status, health care access, and binge drinking were larger in the border region than outside the border region. Similar prevalences of current depression were observed among those who live in the border region of California and in those who do not, but the relationship between depression and health status, health care access, and binge drinking varied by border region residence. Ideally, future surveillance of depression and its predictors along the Mexico-California border will be conducted binationally to inform interventions and tracking such as the Healthy Border Program's objectives.

Si, Se Puede! Preparing Teachers to Build Leadership among Underserved Students

ERIC Educational Resources Information Center

Duffy, Helen M.

2005-01-01

The High School Puente Project, one of several outreach efforts of the University of California, is an innovative program that is designed to assist traditionally underserved students. Puente builds on community and the idea of "familia" and features a strong component of professional developments for teachers as well as structural…

Cancer screening promotion among medically underserved Asian American women: integration of research and practice.

PubMed

Yu, Mei-yu; Seetoo, Amy D; Hong, Oi Saeng; Song, Lixin; Raizade, Rekha; Weller, Adelwisa L Agas

2002-01-01

Mammography and Pap smear tests are known to be effective early detection measures for breast and cervical cancers, respectively, but Asian Americans are reluctant to make visits for routine preventive care. Quantitative and qualitative research conducted by the Healthy Asian Americans Project (HAAP) between 1996 and 1999 indicated that Asian residents in southeastern Michigan, like the general Asian population in the US, underutilized early cancer screening programs due to cultural, psychosocial, linguistic, and economic barriers. This article reports how the HAAP's research findings guided the Michigan Breast and Cervical Cancer Control Program (BCCCP) promotion (conducted from 2000 to 2001 among medically underserved Asian women residing in southeastern Michigan), and how evaluation of the HAAP's BCCCP promotion will direct future research and health promotion programs. The article presents strategies used to improve access to cancer screening programs for diverse Asian sub-groups as well as outcomes of the 2-year HAAP's BCCCP promotion among the target population. Discussion regarding lessons and experiences gained from integration of research and practice has implications on design and implementation of the cancer screening promotion for the rapidly increasing Asian American population as well as other medically underserved minority populations in the US.

Providing oral health care to underserved population of pregnant women: retrospective review of 320 patients treated in private practice setting.

PubMed

Kerpen, Steven J; Burakoff, Ronald

2013-01-01

This article aims to quantify the impact of a novel partnership between a fee-for-service private practice and a teaching hospital dental service intended to provide oral care to an underserved population of pregnant women. Further, it seeks to ascertain the oral needs of this high-risk and diverse population. Data is presented that suggests the dire need for oral care among this pregnant population and the efficacy of treating these women in a private practice setting.

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2010 CFR

2010-01-01

...—Housing in Underserved Areas I. Objective A. To improve the quality of affordable housing by targeting... Arizona, California, New Mexico or Texas; 2. Is in the area of the United States within 150 miles of the border between the United States and Mexico, except that the term does not include any standard...

Decreased Anemia Prevalence Among Women and Children in Rural Baja California, Mexico: A 6-Year Comparative Study.

PubMed

Moor, Molly A; Fraga, Miguel A; Garfein, Richard S; Harbertson, Judith; Rodriguez-Lainz, Alfonso; Rashidi, Hooman H; Elder, John P; Brodine, Stephanie K

2016-08-01

Anemia is a public health problem in Mexico. This study sought to determine the prevalence and correlates of anemia among women and children residing in a rural farming region of Baja California, Mexico. An existing partnership between universities, non-governmental organizations, and an underserved Mexican community was utilized to perform cross-sectional data collection in 2004-2005 (Wave 1) and in 2011-2012 (Wave 2) among women (15-49 years) and their children (6-59 months). All participants completed a survey and underwent anemia testing. Blood smears were obtained to identify etiology. Nutrition education interventions and clinical health evaluations were offered between waves. Participants included 201 women and 99 children in Wave 1, and 146 women and 77 children in Wave 2. Prevalence of anemia significantly decreased from 42.3 to 23.3 % between Waves 1 and 2 in women (p < 0.001), from 46.5 to 30.2 % in children 24-59 months (p = 0.066), and from 71.4 to 45.8 % in children 6-23 months (p = 0.061). Among women in Wave 1, consumption of iron absorption enhancing foods (green vegetables and fruits high in vitamin C) was protective against anemia (p = 0.043). Women in Wave 2 who ate ≥4 servings of green, leafy vegetables per week were less likely to be anemic (p = 0.034). Microscopic examination of blood smears revealed microcytic, hypochromic red blood cells in 90 % of anemic children and 68.8 % of anemic women, consistent with iron deficiency anemia.

Women and Equality: A California Review of Women's Equity Issues in Civil Rights, Education and the Workplace.

ERIC Educational Resources Information Center

Sproul, Kate

More women were elected to the California Legislature in November 1998 than ever before. Twenty-five percent of the 40 state senators who began the two-year legislative session on December 7, 1998 were women. In the 80-seat Assembly, the figure also was 25 percent. Historically, the number of women serving in the California Legislature was…

Exploring the financial impact of breast cancer for African American medically underserved women: a qualitative study.

PubMed

Darby, Kathleen; Davis, Cindy; Likes, Wendy; Bell, John

2009-08-01

In addition to the physical suffering experienced by cancer survivors, there are considerable financial hardships and access barriers to quality health care. The current study explored the financial burden of breast cancer on African American medically underserved women. Four focus groups were conducted in three major cities across Tennessee. Research participants (N=36) were recruited by the staff of cancer support and treatment programs in the area. Findings revealed that participants' lack of insurance or inadequate insurance resulted in missed, delayed, or fewer treatment opportunities. The financial burden of cancer was not limited to the acute treatment phase. The women in the current study reported extreme economic hardship resulting from this disease into long-term survivorship. This exploratory study confirms the importance of providing care across the continuum to address the complex needs of low-income cancer survivors.

Who is food-insecure in California? Findings from the California Women's Health Survey, 2004.

PubMed

Kaiser, Lucia; Baumrind, Nikki; Dumbauld, Sheila

2007-06-01

To identify factors associated with food insecurity in California women. The California Women's Health Survey is an ongoing annual telephone survey that collects data about health-related attitudes and behaviours from a randomly selected sample of women. Food insecurity of the women was measured by a 6-item subset of the Food Security Module. Statistical procedures included chi-square tests, t-tests, logistic regression analysis and analysis of covariance. California, USA. Four thousand and thirty-seven women (18 years or older). Prevalence of food insecurity was 25.7%. After controlling for income, factors associated with greater food insecurity were Hispanic or Black race/ethnicity; less than a 12th grade education; being unmarried; less than 55 years old; being Spanish-speaking; having spent less than half of one's life in the USA; sadness/depression; feeling overwhelmed; poor physical/mental health interfering with activities; and fair to poor general health. Among Food Stamp Program (FSP) participants, 71% were food-insecure. Among FSP-eligible women who had not applied for the programme, the prevalence of food insecurity was lower among women responding that they did not need food stamps than in women giving other reasons for not applying (23.9% vs. 66.9%, P < 0.001). Factors associated with food insecurity in FSP recipients included being unable to make food stamps last for 30 days, feeling overwhelmed, and having a birthplace in Mexico or Central America. Along with several socio-economic variables, poor physical and mental health is associated with food insecurity. Whether food insecurity is a cause or effect of poor health remains in question.

Text4baby program: an opportunity to reach underserved pregnant and postpartum women?

PubMed

Gazmararian, Julie A; Elon, Lisa; Yang, Baiyu; Graham, Megan; Parker, Ruth

2014-01-01

Text4baby was launched in 2010 to promote healthy pregnancies and babies by the use of text messaging. The primary objective of this study was to assess factors related to the enrollment process and reception of text4baby. A prospective cohort study was conducted in two Women, Infant and Children clinics in Atlanta (April 2010-July 2011). Randomly selected pregnant and postpartum women (n = 468) were queried on cell phone use and instructed on text4baby enrollment. Self-enrollment issues were assessed at one-week follow-up (n = 351, 75.0 %), and message reception and reading patterns at two-month follow-up (n = 209, 44.7 %). Forty-two percent of the women had some college education and 82 % had household income <=$20,000. About half attempted text4baby self-enrollment (162/351), with enrollment success more likely among women with more education (80 % with some college vs. 62 % with less education), with household income above $10,000 (61 % < $10,000 vs. 83 % $10,001-$20,000 and 76 % > $20,000), and among women living in smaller households (77 % 1-3 members vs. 58 % > 3 members) (all p < 0.001). Among the 209 participants in the final follow-up contact, >90 % reported uninterrupted reception and regular reading of messages, and 88 % planned to continue using text4baby. Results also suggested that respondents who were younger (<26 year), less educated and had lower health literacy skills were more likely to have interrupted messages. Despite substantial interest in the text4baby program in an underserved population, innovative ways to help women with significant disadvantages enroll and receive uninterrupted messages are needed.

Recruiting and Retaining Primary Care Physicians in Urban Underserved Communities: The Importance of Having a Mission to Serve

PubMed Central

Ryan, Gery; Ramey, Robin; Nunez, Felix L.; Beltran, Robert; Splawn, Robert G.; Brown, Arleen F.

2010-01-01

Objectives. We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. Methods. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Results. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Conclusions. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work–life balance. PMID:20935263

Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve.

PubMed

Odom Walker, Kara; Ryan, Gery; Ramey, Robin; Nunez, Felix L; Beltran, Robert; Splawn, Robert G; Brown, Arleen F

2010-11-01

We examined factors influencing physician practice decisions that may increase primary care supply in underserved areas. We conducted in-depth interviews with 42 primary care physicians from Los Angeles County, California, stratified by race/ethnicity (African American, Latino, and non-Latino White) and practice location (underserved vs nonunderserved area). We reviewed transcriptions and coded them into themes by using standard qualitative methods. Three major themes emerged in relation to selecting geographic- and population-based practice decisions: (1) personal motivators, (2) career motivators, and (3) clinic support. We found that subthemes describing personal motivators (e.g., personal mission and self-identity) for choosing a practice were more common in responses among physicians who worked in underserved areas than among those who did not. By contrast, physicians in nonunderserved areas were more likely to cite work hours and lifestyle as reasons for selecting their current practice location or for leaving an underserved area. Medical schools and shortage-area clinical practices may enhance strategies for recruiting primary care physicians to underserved areas by identifying key personal motivators and may promote long-term retention through work-life balance.

Mobile colposcopy in urban and underserved suburban areas in Baja California

NASA Astrophysics Data System (ADS)

Madiedo, Marta; Contreras, Sonia; Villalobos, Octavio; Kahn, Bruce S.; Safir, Amit; Levitz, David

2016-03-01

Cervical cancer is the leading cause of cancer death for women in low resource settings, often affecting the most economically disenfranchised segment of the population. The key challenge with cervical cancer is the lack of an effective screening program for many of the at-risk, difficult-to-reach women. Outreach programs that utilize mobile clinics to increase access to screening and care in Baja California have been developed. However, many barriers such as quality assurance, efficient referral remained a challenge in this region. Visualization-based co-tests together with cytology (Pap smears) as a primary screen have been proposed. Here, the mobile colposcope of the enhanced visual assessment (EVA) is used to capture an image immediately following a Pap smear. EVA images were reviewed by expert colposcopists. Initial or preliminary data from pilot services showed that Pap false positives and Pap false negatives maybe reduced by expert review of EVA images. This suggests that reviewing of EVA images may be instrumental in catching inaccurate Pap results, thereby improving care. Thus, there is a need to further explore the benefits of using EVA as additional information when conducting Pap smear screenings.

Obesity, Gynecological Factors, and Abnormal Mammography Follow-Up in Minority and Medically Underserved Women

PubMed Central

Wujcik, Debra; Lin, Jin-Mann S.; Grau, Ana; Wilson, Veronica; Champion, Victoria; Zheng, Wei; Egan, Kathleen M.

2009-01-01

Abstract Background The relationship between obesity and screening mammography adherence has been examined previously, yet few studies have investigated obesity as a potential mediator of timely follow-up of abnormal (Breast Imaging Reporting and Data System [BIRADS-0]) mammography results in minority and medically underserved patients. Methods We conducted a retrospective cohort study of 35 women who did not return for follow-up >6 months from index abnormal mammography and 41 who returned for follow-up ≤6 months in Nashville, Tennessee. Patients with a BIRADS-0 mammography event in 2003–2004 were identified by chart review. Breast cancer risk factors were collected by telephone interview. Multivariate logistic regression was performed on selected factors with return for diagnostic follow-up. Results Obesity and gynecological history were significant predictors of abnormal mammography resolution. A significantly higher frequency of obese women delayed return for mammography resolution compared with nonobese women (64.7% vs. 35.3%). A greater number of hysterectomized women returned for diagnostic follow-up compared with their counterparts without a hysterectomy (77.8% vs. 22.2%). Obese patients were more likely to delay follow-up >6 months (adjusted OR 4.09, p = 0.02). Conversely, hysterectomized women were significantly more likely to return for timely mammography follow-up ≤6 months (adjusted OR 7.95, p = 0.007). Conclusions Study results suggest that weight status and gynecological history influence patients' decisions to participate in mammography follow-up studies. Strategies are necessary to reduce weight-related barriers to mammography follow-up in the healthcare system including provider training related to mammography screening of obese women. PMID:19558307

Disparity in rates of HPV infection and cervical cancer in underserved US populations

PubMed Central

Karuri, Asok Ranjan; Kashyap, Vivek Kumar; Yallapu, Murali Mohan; Zafar, Nadeem; Kedia, Satish K.; Jaggi, Meena; Chauhan, Subhash C.

2018-01-01

There is a higher rate of HPV infection and cervical cancer incidence and mortality in underserved US population who reside in Appalachian mountain region compared to Northern Plains. Social and behavioral factors such as smoking and alcohol consumption are for such a high incidence. However, by and large, the reasons for these discrepancies lie in the reluctance of the underserved population to adopt preventive measures such as prophylactic Human papilloma virus (HPV) vaccines and Pap smear screening that have significantly reduced the incidence and mortality rate of cervical cancer in Caucasian women. Thus, it is clear that drastic change in social behavior and implementation of preventive measures is required to effectively reduce the incidence and mortality from cervical cancer in this underserved population. PMID:28410118

Food insecurity and intimate partner violence against women: results from the California Women's Health Survey.

PubMed

Ricks, Joni L; Cochran, Susan D; Arah, Onyebuchi A; Williams, John K; Seeman, Teresa E

2016-04-01

To investigate the association between food insecurity and intimate partner violence in a population-based sample of heterosexual women. Logistic regression was used to evaluate the association between three levels of food insecurity and intimate partner violence. Data from 6 years of the California Women's Health Survey. Randomly selected women (n 16 562) aged 18 years and older from the State of California, USA. We found: (i) that African-American women had a higher prevalence of food insecurity and were more likely to report severe intimate partner violence; (ii) a strong positive association between food insecurity and intimate partner violence; (iii) evidence of effect modification of the association between food insecurity and intimate partner violence by marital status; and (iv) higher odds of intimate partner violence among those reporting more severe food insecurity. Food insecurity is an important risk indicator for intimate partner violence among women. Understanding the factors that put women, especially minority women, at greatest risk facilitates intervention development.

Finding the Underserved

ERIC Educational Resources Information Center

Futterman, Marc

2008-01-01

The heart of the public library mission is to provide service to the entire community and serve the underserved. But how does a library identify the people it is not reaching, where they live, and what they need? And what does it mean for a library's services if in its community the underserved are not also underprivileged? Contrary to popular…

Campesinas: Women Farmworkers in the California Agricultural Labor Force. Report of a Study Project by The California Commission on the Status of Women.

ERIC Educational Resources Information Center

Barton, Amy E.

A one year descriptive study of demographic characteristics, employment situations, and supportive services needs of women farmworkers in the California labor force was conducted in 1977-78. Data were collected in interviews with both employers and 400 women and 200 men engaged in farmwork in Fresno and Imperial Counties. Most of the women were of…

The relationship between child abuse and adult obesity among california women.

PubMed

Alvarez, Jennifer; Pavao, Joanne; Baumrind, Nikki; Kimerling, Rachel

2007-07-01

Despite clinical studies suggesting that child abuse is associated with adult obesity, very few studies have been conducted with large community or state-based samples. This study examines the relationship between child abuse and adult obesity, relative to other risk factors such as demographics, food insecurity, inadequate fruit and vegetable consumption, and physical inactivity, in a representative sample of California women. Data are from the California Women's Health Survey, a state-based, random-digit-dial annual probability survey of California women. Participants included 11,115 nonpregnant women aged 18 or older, who provided complete data for all study variables. The telephone interview included assessment of child abuse (abstracted from the Traumatic Stress Schedule), food insecurity, perceived stress, physical activity, fruit and vegetable consumption, height, and weight. Data were collected in 2002, 2003, and 2004, and analyzed in 2006. Obese (body mass index [BMI] of 30 or higher) women were significantly more likely to report exposure to child abuse (odds ratio [OR]=1.32, 95% confidence interval [CI]=1.23-1.42). In a multivariate model adjusted for age, race/ethnicity, education, food insecurity, inadequate fruit and vegetable consumption, physical inactivity, and perceived stress, women exposed to child abuse remained significantly more likely to be obese than unexposed women (adjusted OR=1.27, 95% CI=1.13-1.40). The population-attributable fraction of obesity associated with any type of abuse was 4.5% (95% CI=2.28-6.55). Exposure to child abuse is associated with adult obesity among California women, even accounting for other relevant variables. This supports the notion that child abuse and its sequelae may be important targets for public health intervention, particularly in subpopulations where the prevalence of child abuse is known to be high.

Rural-Urban Differences in Awareness and Use of Family Planning Services Among Adolescent Women in California.

PubMed

Yarger, Jennifer; Decker, Martha J; Campa, Mary I; Brindis, Claire D

2017-04-01

The purpose of this study was to compare awareness and use of family planning services by rural and urban program site among a sample of adolescent women before participation in the federal Personal Responsibility Education Program in California. We conducted a secondary analysis of survey data collected from youth before participation in California's Personal Responsibility Education Program. Bivariate and multivariate analyses were conducted for a sample of 4,614 females ages 14-18 years to compare awareness and use of family planning services between participants at rural and urban program sites, controlling for the program setting and participant demographic, sexual, and reproductive characteristics. Overall, 61% of participants had heard of a family planning provider in their community, and 24% had visited a family planning provider. Awareness and use of family planning services were lower among rural participants than urban participants. After adjusting for the program setting and participant characteristics, rural participants were less likely to know about a family planning provider in their community (odds ratio, .64; 95% confidence interval, .50-.81) or receive family planning services (odds ratio, .76; 95% confidence interval, .58-.99) than urban participants. Findings suggest that adolescents in rural areas face greater barriers to accessing family planning services than adolescents in urban areas. Targeted efforts to increase awareness and use of family planning services among adolescents in rural areas and among other underserved populations are needed. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The association between women's self-rated health and satisfaction with environmental services in an underserved community in Lebanon.

PubMed

Habib, Rima R; Elzein, Kareem; Hojeij, Safa

2013-01-01

This research evaluated the association between women's self-rated health and a number of socioeconomic and environmental health indicators relating to drinking water services in an underserved Lebanese community. A population-based, cross-sectional survey using interviews was adopted to obtain information from female homemakers of 2,223 households in the town of Bebnine, Lebanon. The questionnaire included indicators on self-rated health, satisfaction with water quality, source of drinking water, occurrence of diarrhea, and socioeconomic variables, such as education, occupation, and perceived economic status. Self-rated health was categorized as poor, fair, and good. Odds ratios for poor and fair compared to good self-rated health values were calculated using multinomial logistic regression. A total of 712 women (32%) reported poor self-rated health. Women who perceived their household income to be worse than others in town were four times as likely to report poor health. Compared to women who were satisfied with drinking water quality, dissatisfied women were 42% more likely to report poor health. Women living in households reporting recent episodes of diarrheal illness had poorer health ratings than those without. The findings suggest a positive relationship between individual perceptions of water quality and self-rated health. Community concerns over their surrounding environment serve as a primary guide for infrastructural development and government policy.

Underage and underserved: reaching young women who sell sex in Zimbabwe.

PubMed

Busza, Joanna; Mtetwa, Sibongile; Mapfumo, Rumbidzo; Hanisch, Dagmar; Wong-Gruenwald, Ramona; Cowan, Frances

2016-03-01

Young women who sell sex (YWSS) in Southern Africa are highly vulnerable to HIV, as the risks of being young and female in a high prevalence setting coalesce with those of commercial sex. YWSS are less able to negotiate safe sex, more likely to have higher risk partners, and less likely to use available health services compared to older sex workers. In Zimbabwe's national HIV programme for sex workers, fewer than 1% of clients were 15-29. We developed monthly interactive workshops for YWSS based on an Activity Pack consisting of 21 sessions organised into six modules. The aim was to encourage YWSS' interaction with each other, build their trust, confidence and skills, and encourage uptake of clinical services. We conducted a process evaluation to assess programme strengths, identify challenges, and recommend changes. This paper presents findings synthesising programme records with qualitative data and discusses feasibility, acceptability, and outputs during the pilot phase. In total, 143 YWSS attended meetings and most were from the target 15-19-year-old age group. Participants enjoyed the sessions and reported improved cooperation, willingness to negotiate with clients, and self-reflection about their futures. Staff found facilitating sessions easy and activities clear and appropriate. Challenges included identifying appropriate referrals, initial recruitment of women in some sites, and managing participants' requests for financial compensation. The number of clients aged 15-19 increased at sex worker clinics in all sites. This programme is the first to target YWSS in Zimbabwe to address their disproportionately low service use. It proved feasible to staff and acceptable to participants over a one-year period. Given enhanced vulnerability of YWSS, this programme provides one workable model for reaching this underserved group.

34 CFR 303.128 - Traditionally underserved groups.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 34 Education 2 2011-07-01 2010-07-01 true Traditionally underserved groups. 303.128 Section 303... underserved groups. The statement must include an assurance satisfactory to the Secretary that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low...

34 CFR 303.128 - Traditionally underserved groups.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 2 2010-07-01 2010-07-01 false Traditionally underserved groups. 303.128 Section 303... underserved groups. The statement must include an assurance satisfactory to the Secretary that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low...

Equal Opportunity: Women in Administration in the California Community Colleges.

ERIC Educational Resources Information Center

Kistler, Kathleen M.

This paper examines the extent to which women have attained administrative positions in California community colleges, highlights barriers to women's advancement and methods of overcoming them, and profiles the female college administrator. After citing the low incidence of female community college administrators and the increasing visibility of…

Individual Breast Cancer risk assessment in Underserved Populations: Integrating empirical Bioethics and Health Disparities Research

PubMed Central

Anderson, Emily E.; Hoskins, Kent

2013-01-01

Research suggests that individual breast cancer risk assessment may improve adherence to recommended screening and prevention guidelines, thereby decreasing morbidity and mortality. Further research on the use of risk assessment models in underserved minority populations is critical to informing national public health efforts to eliminate breast cancer disparities. However, implementing individual breast cancer risk assessment in underserved patient populations raises particular ethical issues that require further examination. After reviewing these issues, we will discuss how empirical bioethics research can be integrated with health disparities research to inform the translation of research findings. Our in-progress National Cancer Institute (NCI) funded study, How Do Underserved Minority Women Think About Breast Cancer?, conducted in the context of a larger study on individual breast cancer risk assessment, is presented as a model. PMID:23124498

The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women.

PubMed

Koroukian, Siran M; Bakaki, Paul M; Htoo, Phyo Than; Han, Xiaozhen; Schluchter, Mark; Owusu, Cynthia; Cooper, Gregory S; Rose, Johnie; Flocke, Susan A

2017-08-15

As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society

Access to specialty mental health services among women in California.

PubMed

Kimerling, Rachel; Baumrind, Nikki

2005-06-01

The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities. The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables. Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services. Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.

What Promotes Cervical Cancer Screening among Chamorro Women in California?

PubMed Central

Tanjasiri, Sora P.; Mouttapa, Michele; Sablan-Santos, Lola; Quitugua, Lourdes F.

2012-01-01

Objectives Pacific Islander women represent a significant at-risk population for cervical cancer, yet little is known about the modifiable factors associated with routine Pap testing. Therefore, the aims of this paper are to report and discuss the known and unknown factors associated with cervical cancer screening among Chamorro women in California. Design This cross-sectional study explored the factors associated with receipt of regular Pap testing among Chamorro women age 18 years and older in California. A self-administered survey was designed and distributed to women in order to understand their knowledge, beliefs and behaviors regarding routine receipt of Pap tests. Results Only about two-thirds of women had received a Pap test within the past two years, which is below the U.S. average of 72%. Significant predictors included age, health insurance coverage, knowledge of screening frequency, and beliefs regarding risk groups. These factors, however, accounted for less than 16% of the variance in Pap testing behavior. Conclusion We discuss the poor predictive value of existing demographic and theoretical variables, and discuss potentially new areas of research that can aid in the development of future intervention studies. Study limitations and implications are also discussed. PMID:22806217

76 FR 63846 - Substantially Underserved Trust Areas (SUTA)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-14

... CFR Part 1700 RIN 0572-AC23 Substantially Underserved Trust Areas (SUTA) AGENCY: Rural Utilities... of infrastructure projects in Substantially Underserved Trust Areas (SUTA). The intent is to..., Washington, DC 20250-1522. Title: Substantially Underserved Trust Areas. Type of Request: Approval of a new...

Acculturation, physical activity and television viewing in Hispanic women: findings from the 2005 California Women's Health Survey.

PubMed

Banna, Jinan C; Kaiser, Lucia L; Drake, Christiana; Townsend, Marilyn S

2012-02-01

To assess the relationship of acculturation with physical activity and sedentary behaviours among Hispanic women in California. Data from the 2005 California Women's Health Survey (CWHS) - a cross-sectional telephonic survey of health indicators and health-related behaviours and attitudes - were used. Using a random-digit dialling process, data were collected monthly from January to December 2005. A total of 1298 women aged ≥18 years in California who self-identified as Hispanic. Of the participants included in the analysis, 49 % were adherent to physical activity recommendations (with 150 min of weekly activity signifying adherence). There was no significant association between language acculturation and moderate or vigorous physical activity after controlling for potential confounders such as smoking, age and employment status. There was also no association between duration of residence in the USA and moderate or vigorous physical activity. Language acculturation was positively associated with television (TV) viewing, with highly acculturated women reporting more hours of TV viewing compared with women with an intermediate acculturation score (P = 0·0001), and those with an intermediate score reporting more hours of TV viewing compared with those with a low score (P = 0·003). This relationship persisted after inclusion of smoking, employment status, age and education in the model. Higher levels of language acculturation may be associated with increased sedentary behaviours because of the influence of US culture on those women who have assimilated to the culture. Acculturation is an important factor to be taken into account when designing health education interventions for the Hispanic female population.

Knowledgeable Neighbors: a mobile clinic model for disease prevention and screening in underserved communities.

PubMed

Hill, Caterina; Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L; Quarles, Aaron; Oriol, Nancy

2012-03-01

The Family Van mobile health clinic uses a "Knowledgeable Neighbor" model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities.

Caring for the Underserved: Exemplars in Teaching

PubMed Central

Shane-McWhorter, Laura; Scott, Doneka R.; Chen, Judy T.; Seaba, Hazel H.

2009-01-01

The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received. The 3 best exemplars for teaching pharmacy students the awareness, attitudes, knowledge, and skills needed to care for the underserved were selected and are described in this manuscript. Included are 1 didactic, 1 experiential, and 1 international experience. These exemplars in educating students on working with the underserved provide schools with models which could be adapted to fit individual programmatic curricular needs. PMID:19513156

Risks for abuse against pregnant Hispanic women: Morelos, Mexico and Los Angeles County, California.

PubMed

Castro, Roberto; Peek-Asa, Corinne; García, Lorena; Ruiz, Agustín; Kraus, Jess F

2003-11-01

Although violence against women is gaining international attention as a prevention priority, little is known about how risks differ across countries. A comparative study of violence against pregnant Mexican women in Morelos, Mexico, and Latina women in Los Angeles County, California, United States. In 1998 and 1999, women in prenatal clinics were interviewed about psychological abuse and sexual and physical violence by their partner, during and the 1 year prior to the index pregnancy. The overall response rate for Morelos was 99%, with a sample size of 914; Los Angeles County had a response rate of 96.9%, with a sample size of 219. Women in Morelos reported a higher prevalence of violence compared to women in the California (14.8% v 11.9%, respectively). A partner aged <20 years was associated with increased violence in both countries, but the association of violence with other socioeconomic factors differed by country. For example, employed women had higher odds of violence in California but lower odds in Morelos. Women who experienced violence during both the year prior to pregnancy and as a child were more than 25 times more likely to be abused during pregnancy than women not reporting this type of abuse. The identification of factors associated with violence against women, especially as they differ by culture and ethnicity, will help clinicians to better identify victims and to design and implement culturally appropriate prevention programs.

Teachers' Preferences to Teach Underserved Students

ERIC Educational Resources Information Center

Ronfeldt, Matthew; Kwok, Andrew; Reininger, Michelle

2016-01-01

To increase the supply of teachers into underserved schools, teacher educators and policymakers commonly use two approaches: (a) recruit individuals who already report strong preferences to work in underserved schools or (b) design pre-service preparation to increase preferences. Using survey and administrative data on more than 1,000 teachers in…

Knowledgeable Neighbors:A Mobile Clinic Model for Disease Prevention and Screening in Underserved Communities

PubMed Central

Zurakowski, David; Bennet, Jennifer; Walker-White, Rainelle; Osman, Jamie L.; Quarles, Aaron; Oriol, Nancy

2012-01-01

The Family Van mobile health clinic uses a “Knowledgeable Neighbor” model to deliver cost-effective screening and prevention activities in underserved neighborhoods in Boston, MA. We have described the Knowledgeable Neighbor model and used operational data collected from 2006 to 2009 to evaluate the service. The Family Van successfully reached mainly minority low-income men and women. Of the clients screened, 60% had previously undetected elevated blood pressure, 14% had previously undetected elevated blood glucose, and 38% had previously undetected elevated total cholesterol. This represents an important model for reaching underserved communities to deliver proven cost-effective prevention activities, both to help control health care costs and to reduce health disparities. PMID:22390503

Microbicide preference among young women in California.

PubMed

Holt, Bethany Young; Morwitz, Vicki G; Ngo, Long; Harrison, Polly F; Whaley, Kevin J; Pettifor, Audrey; Nguyen, Anh-Hoa

2006-04-01

Microbicides for HIV/sexually transmitted infection (STI) prevention are still in development. Microbicide acceptability studies have thus focused on soliciting input from individuals about hypothetical products using traditional epidemiological and behavioral research methodologies. Here, we integrate a well-established market research method, conjoint analysis, with more traditional epidemiological and behavioral research to examine potential users' preferences for different microbicide formulations. Focus group discussions (n = 67) were held with a diverse population of young men and women (aged 18-32 years) from Northern California. Then, young women participated in structured surveys (n = 321) that included a conjoint study, a methodology not yet used in microbicide acceptability. The main outcome measures were intentions for different microbicide formulations, inferred preferences for microbicide characteristics, and self-reported risk factors for HIV, other STIs, and pregnancy. Risk of STIs and unwanted pregnancies is a concern within this population. Participants' responses suggest that the ideal microbicide would (1) offer protection from pregnancy, HIV, STIs, and vaginal infections, (2) offer as much protection as condoms, (3) allow insertion up to 8 hours prior to sexual activity, (4) be available over the counter (OTC), (5) be inserted with an applicator, and (6) have only slight leakage not requiring a panty liner. The average predicted purchase probability for this ideal microbicide was 69%. Our findings help illustrate microbicide product preferences and demand among young women in California, and the methodological approach should lend itself to other populations as well as during clinical trials when understanding product use and nonuse is critical.

Strangers in Paradise: The Life and Literature of Foreign-Born Women in California.

ERIC Educational Resources Information Center

Friedman, Adele C.

This paper presents student research from a class project on the Life and Literature of Foreign-Born Women in California. It examines the role of these women in agriculture, the arts, and political and economic life. Specific accounts of women from Russia, Poland, France, and Mexico are given. Others mentioned include those women born in America…

Improving cardiovascular health of underserved populations in the community with Life's Simple 7.

PubMed

Murphy, Marcia Pencak; Coke, Lola; Staffileno, Beth A; Robinson, Janis D; Tillotson, Robin

2015-11-01

The purpose of this nurse practitioner (NP) led initiative was to improve the cardiovascular health of two underserved populations in the community using the American Heart Association (AHA) Life's Simple 7 and My Life Check (MLC) tools. Two inner city community sites were targeted: (a) a senior center servicing African American (AA) older adults, and (b) a residential facility servicing homeless women. Preprogram health data (blood pressure, cholesterol, blood glucose levels, body mass index, and health behaviors) were collected to calculate MLC scores. Postprogram health data were obtained on participants with the lowest MLC scores who completed the program. Eight older adults completed the program with a 37.1% increase in average MLC score (6.2 vs. 8.5). Ten women completed the program with a 9.3% decrease in average MLC score (4.3 vs. 3.9). Favorable benefits were observed in the AA older adults. In contrast, similar benefits were not observed in the women, which may be because of a constellation of social, environmental, biological, and mental health factors. NPs are prepared to target community-based settings to address the health of underserved populations. Engaging key stakeholders in the planning and implementation is essential for success. ©2015 American Association of Nurse Practitioners.

A Statewide Approach to Health Care Personnel Maldistribution—The California Area Health Education Center System

PubMed Central

Crowder, John E.; Schnepper, James E.; Gessert, Charles

1984-01-01

An Area Health Education Center (AHEC) system has been established in California to address the maldistribution of physicians and other health care professionals. The AHEC program uses educational incentives to recruit and retain health care personnel in underserved areas by linking the academic resources of university health science centers with local educational and clinical facilities. The medical schools, working in partnership with urban or rural AHECs throughout the state, are implementing educational programs to attract trainees and licensed professionals to work in underserved communities. The California AHEC project entered its fifth year in October of 1983 with the participation of all eight medical schools and the Charles Drew Postgraduate School of Medicine, 35 other health professions schools, 17 independent AHECs and more than 400 clinical training sites. Educational programs are reaching more than 22,000 students and practicing health professionals throughout California. We review the current status of the California AHEC system and use the AHEC programs at Loma Linda University to illustrate the effect this intervention is having. PMID:6730500

Utilization of pay-in antenatal leave among working women in Southern California.

PubMed

Guendelman, Sylvia; Pearl, Michelle; Graham, Steve; Angulo, Veronica; Kharrazi, Martin

2006-01-01

Examine antenatal leave arrangements among pregnant workers in California, and the occupational, demographic and well-being characteristics associated with leave taking. Unlike most states, California provides paid pregnancy leave up to 4 weeks antenatally and 6-8 weeks postnatally. Weighted data from postpartum telephone interviews conducted between July 2002 and November 2003 were analyzed for 1214 women participating in a case-control study of birth outcomes in Southern California. Eligible women worked at least 20 h/week during the first two trimesters of pregnancy or through the date of prenatal screening. The overall response rate was 73%. Fifty-two percent of women took no leave, 32% took antenatal leave expecting to return to their job or employer sometime after giving birth, and 9% quit their jobs during pregnancy. For leave-takers with paid leave (69%), the state was the main source of pay (74%). Medical problems (52%) rather than maternity leave benefits (25%) were the most common stated reasons for taking leave. The strongest predictors of leave taking versus working through pregnancy were feeling stressed and tired (adjusted OR = 4.3, 95% CI [2.2-8.2]) and having young children (adjusted OR = 2.1, 95% CI [1.2-3.7]), followed by occupational factors (night shift, unfulfilling and inflexible work, short work tenure). Lack of employer-offered maternity leave benefits was associated with increased quitting relative to both leave taking and working through pregnancy. Maternity benefits influence quitting, but alone do not determine antenatal leave taking. Working pregnant women in California utilize leave cautiously and predominantly to cope with health problems, work dissatisfaction and fatigue.

Evaluation of a Community Health Worker Intervention to Reduce HIV/AIDS Stigma and Increase HIV Testing Among Underserved Latinos in the Southwestern U.S.

PubMed Central

Becker, Davida; Espinoza, Lilia; Nguyen-Rodriguez, Selena; Diaz, Gaby; Carricchi, Ana; Galvez, Gino; Garcia, Melawhy

2015-01-01

Objectives Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. Methods An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). Results From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). Conclusion Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities. PMID:26327724

Sustaining Family Physicians in Urban Underserved Settings.

PubMed

Getzin, Anne; Bobot, Bonnie L; Simpson, Deborah

2016-11-01

Our objective was to identify factors that sustain family physicians practicing in Milwaukee's underserved urban areas. Family physicians with clinical careers in Milwaukee's urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB. Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urban underserved settings was seen as rewarding in and of itself and aligned with these physicians' values and skills. Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underserved settings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities.

Precommitting to Serve the Underserved

PubMed Central

Eyal, Nir; Bärnighausen, Till

2014-01-01

In many countries worldwide, especially in Sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas. PMID:22548519

Precommitting to serve the underserved.

PubMed

Eyal, Nir; Bärnighausen, Till

2012-01-01

In many countries worldwide, especially in sub-Saharan Africa, a shortage of physicians limits the provision of lifesaving interventions. One existing strategy to increase the number of physicians in areas of critical shortage is conditioning medical school scholarships on a precommitment to work in medically underserved areas later. Current practice is usually to demand only one year of service for each year of funded studies. We show the effectiveness of scholarships conditional on such precommitment for increasing physician supplies in underserved areas. Then we defend these scholarships against ethical worries that they constitute slavery contracts; rely on involuntary, biased, or unauthorized early consent by a young signatory; put excessive strains on signed commitments; give rise to domination; and raise suspicion of slavery contracts. Importantly, we find that scholarships involving far longer commitment than current practice allows would also withstand these worries. Policymakers should consider introducing conditional scholarships, including long-term versions, as a means to increasing the supply of physicians to medically underserved areas.

Evaluation of the Program in Medical Education for the Urban Underserved (PRIME-US) at the UC Berkeley-UCSF Joint Medical Program (JMP): The First 4 Years.

PubMed

Sokal-Gutierrez, Karen; Ivey, Susan L; Garcia, Roxanna M; Azzam, Amin

2015-01-01

Medical educators, clinicians, and health policy experts widely acknowledge the need to increase the diversity of our healthcare workforce and build our capacity to care for medically underserved populations and reduce health disparities. The Program in Medical Education for the Urban Underserved (PRIME-US) is part of a family of programs across the University of California (UC) medical schools aiming to recruit and train physicians to care for underserved populations, expand the healthcare workforce to serve diverse populations, and promote health equity. PRIME-US selects medical students from diverse backgrounds who are committed to caring for underserved populations and provides a 5-year curriculum including a summer orientation, a longitudinal seminar series with community engagement and leadership-development activities, preclerkship clinical immersion in an underserved setting, a master's degree, and a capstone rotation in the final year of medical school. This is a mixed-methods evaluation of the first 4 years of the PRIME-US at the UC Berkeley-UC San Francisco Joint Medical Program (JMP). From 2006 to 2010, focus groups were conducted each year with classes of JMP PRIME-US students, for a total of 11 focus groups; major themes were identified using content analysis. In addition, 4 yearly anonymous, online surveys of all JMP students, faculty and staff were conducted and analyzed. Most PRIME-US students came from socioeconomically disadvantaged backgrounds and ethnic backgrounds underrepresented in medicine, and all were committed to caring for underserved populations. The PRIME-US students experienced many program benefits including peer support, professional role models and mentorship, and curricular enrichment activities that developed their knowledge, skills, and sustained commitment to care for underserved populations. Non-PRIME students, faculty, and staff also benefited from participating in PRIME-sponsored seminars and community-based activities

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 34 Education 2 2012-07-01 2012-07-01 false Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 34 Education 2 2013-07-01 2013-07-01 false Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

34 CFR 303.227 - Traditionally underserved groups.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 2 2014-07-01 2013-07-01 true Traditionally underserved groups. 303.227 Section 303... groups. The State must ensure that policies and practices have been adopted to ensure— (a) That traditionally underserved groups, including minority, low-income, homeless, and rural families and children with...

Perceptions of cardiovascular health in underserved communities.

PubMed

Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

2010-03-01

Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Advanced dental education programs: status and implications for access to care in California.

PubMed

Glassman, Paul

2012-01-01

Primary care residencies in dentistry include general practice residency and advanced education in general dentistry--collectively known as postdoctoral general--dentistry and pediatric dentistry. These primary care programs are the most likely to serve underserved populations during the training experience. An expansion of primary care dental residency positions in California has the potential to positively impact access to care in California. However, there are significant political and financial barriers to realizing this potential.

Breast Cancer--Screening Behavior among Rural California American Indian Women

ERIC Educational Resources Information Center

Hodge, Felicia Schanche

2009-01-01

A community-based Wellness Circles Program was designed and implemented at 13 sites in California to evaluate a culturally appropriate community-based health care model for American Indian families. Data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) that was administered to a subset of women demonstrate that American Indian…

Women lose suit over involuntary sterilizations (California).

PubMed

1978-10-01

Federal Judge Jesse W. Curtis dismissed a suit brought by 10 Mexican-American women, who charged that between 1971-1974 they were sterilized without their voluntary and informed consent by physicians at the USC-Los Angeles County General Medical Center. Judge Curtis considered the case a communications breakdown between doctor and patient based on the patients' limited ability to speak English. Many women testified that they were pressured by hospital staff to consent to sterilization while they were in labor. Subsequent regulations passed by the California health department prohibit obtaining sterilization consent from a woman in labor or 24 hours postpartum. It further requires the consent form be written in the patient's preferred language. 8 of the plaintiffs had signed consent forms; 2 of the plaintiffs' husbands had signed. In the future, doctors must fully explain the procedure and its effects.

Factors Associated With Medical School Graduates' Intention to Work With Underserved Populations: Policy Implications for Advancing Workforce Diversity.

PubMed

Garcia, Andrea N; Kuo, Tony; Arangua, Lisa; Pérez-Stable, Eliseo J

2018-01-01

Given projected U.S. physician shortages across all specialties that will likely impact underserved areas disproportionately, the authors sought to explore factors most correlated with medical school graduates' intention to work with underserved populations (IWUP). Data from the 2010-2012 Association of American Medical Colleges Medical School Graduation Questionnaire (n = 40,846) were analyzed. Variables (demographics, career preference, debt burden, intention to enter loan forgiveness programs) were examined using chi-square tests and logistic regression models. Respondents included 49.5% (20,228/40,846) women, 16.6% (6,771/40,837) underrepresented minorities (URMs), and 32.4% (13,034/37,342) with primary care intent. The median educational debt was $160,000. Respondents who were women (adjusted odds ratio [aOR] 1.59, 95% confidence interval [CI] 1.49, 1.70), URMs (aOR 2.50, 95% CI 2.30, 2.72), intended to enter loan forgiveness programs (aOR 2.44, 95% CI 2.26, 2.63), intended to practice primary care (aOR 1.65, 95% CI 1.54, 1.76), and intended to emphasize nonclinical careers (aOR 1.23, 95% CI 1.11, 1.37) had greater odds of reporting IWUP. Among those who chose specialties and careers with a nonclinical emphasis, and among those with greater burdens of educational and consumer debt, URMs were nearly twice as likely as other minorities and whites to report IWUP. Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.

Dentist shortage: an analysis of dentists, practices, and populations in the underserved areas.

PubMed

Voinea-Griffin, Andreea; Solomon, Eric S

2016-09-01

The objectives of this study are to identify and describe the characteristics of dental underserved geographic areas. Understanding these characteristics is an important step in addressing access to dental care barriers. Dental underserved areas were identified from the Health Resources and Services Administration (HRSA) database and converted to census tracts for analysis. Characteristics of dental underserved geographic areas were compared with areas not designated as underserved. Dental practices included in the Dun & Bradstreet Business information database were geocoded and analyzed according to the underserved designation of their location and census demographic data. Thus, the relationships between dental underserved status, practice, and population characteristics were evaluated. Dental underserved areas are more likely to comprise individuals with lower socio-economic status (income and education levels), higher levels of underrepresented population groups, and have lower population densities than non-underserved areas. The populations living in dental underserved areas are more likely to experience geographic, financial, and educational barriers to dental care. The study identifies the geographic and financial barriers to dental care access. These findings suggest that the likelihood of a market-driven solution to dental underserved geographic areas is low and support public sector interventions to improve the status quo. © 2016 American Association of Public Health Dentistry.

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

5 CFR 894.801 - Will benefits be available in underserved areas?

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE REGULATIONS (CONTINUED) FEDERAL EMPLOYEES DENTAL AND VISION INSURANCE PROGRAM Benefits in Underserved Areas § 894.801 Will benefits be available in underserved areas? (a) Dental and vision plans under... underserved areas. (b) In any area where a FEDVIP dental or vision plan does not meet OPM access standards...

Diet self-management and readiness to change in underserved adults with type 2 diabetes.

PubMed

Knight, Holly; Stetson, Barbara; Krishnasamy, Sathya; Mokshagundam, Sri Prakash

2015-06-01

Dietary assessment in diabetes may be enhanced by considering patient-centered perspectives and barriers to change within IDF guidelines. Consideration of readiness to change (RTC) diet in underserved samples may guide future interventions in high risk populations. This study assesses the utility of a rapid assessment of RTC diet in a medically underserved sample. Participants were 253 Black (43.7%) and White (55.1%) American adults with type 2 diabetes [M age=57.93 (11.52); 60.5% female; 19% below the US poverty threshold]. Participants were recruited at medical clinics and completed validated self-report measures assessing diabetes knowledge, self-efficacy and dietary behaviors and barriers by RTC. Stage-based comparisons identified significant differences in diabetes and dietary domains: participants in the Action stage endorsed fewer behavioral dietary barriers (p<.001), more frequent dietary problem-solving (p<.001), and greater diabetes self-efficacy (p<.001) than participants in the Contemplation and Preparation stages. Women were more likely to be in the Preparation stage and beyond (p<.05). Findings highlight the clinical utility of a brief measure of RTC in understanding patient perspectives toward dietary behaviors in a medically underserved sample. The impact of gender on RTC diet warrants further exploration. Copyright © 2014 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Navigating the digital divide: A systematic review of eHealth literacy in underserved populations in the United States.

PubMed

Chesser, Amy; Burke, Anne; Reyes, Jared; Rohrberg, Tessa

2016-01-01

eHealth provides an important mechanism to connect medically underserved populations with health information, but little is known about gaps in eHealth literacy research in underserved adult populations within the U.S. Between June and July 2013, three systematic literature reviews of five databases were conducted and a subsequent hand search was completed. Identified literature was screened and studies meeting exclusion and inclusion criteria were synthesized and analyzed for common themes. Of the 221 articles critically appraised, 15 met these criteria. Thirty-five of these studies were excluded due to international origin. Of the articles meeting the inclusion criteria, underserved populations assessed included immigrant women, the elderly, low-income, the un- and underemployed, and African-American and Hispanic populations. eHealth literacy assessments utilized included one or two item screeners, the eHEALS scale, health information competence and cognitive task analysis. Factors examined in relation to eHealth literacy included age, experience, overall health literacy, education, income and culture. The majority did not assess the impact of locality and those that did were predominately urban. These data suggest that there is a gap in the literature regarding eHealth literacy knowledge for underserved populations, and specifically those in rural locations, within the U.S.

Physical activity in Arab women in Southern California.

PubMed

Qahoush, Rafat; Stotts, Nancy; Alawneh, Manal S; Froelicher, Erika Sivarajan

2010-12-01

The limited research of Arab women suggests that most are sedentary. Given the known health benefits of physical activity suggests that the study of physical activity of women in Southern California where the climate favors year round outdoor activities is warranted. To describe Arab women's cardiovascular risk factors (CVD): physical activity levels, self-efficacy, and determinants of physical inactivity and their preferences for physical activity programs. This cross-sectional design used the International Physical Activity Questionnaire (IPAQ), Exercise Self-Efficacy Scale, Choose to Move Questionnaire, and "How America Measures Up" Questionnaire. The mean age of the 180 women was 37.6 (±12.9). Most (91.1%) had ≥high school education, 68.9% were married, and 24.4% were below poverty level. CVD risk factors were: hypertension 20.6%; hyperlipidemia 21.1%; diabetes 10%; and excess weight in 60%. Their self-efficacy scores were 39.2 (±18.2); and 46.2% were sedentary. A logistic regressions analysis found statistically significant determinant(s) for physical inactivity performance were low self-efficacy score and "not being born in the U.S." These young Arab women are considerably physically inactive and overweight. The findings from our study can guide culturally relevant health promotion programs in Arab women who have unique needs and preferences. Copyright © 2010 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Traditionally Untraditional: The Career Trajectory Navigation of California Community College Women of Color Administrators

ERIC Educational Resources Information Center

Fong-Batkin, LeAnn Gayle

2011-01-01

This qualitative study examines deeply the career trajectories of 13 women of color administrators at the dean, vice president, and president levels in the California community college (CCC) system. The study focuses particular attention on the specific opportunities and challenges that some of these women have encountered on their leadership…

Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?

PubMed

Laraque-Arena, Danielle; Frintner, Mary Pat; Cull, William L

2016-01-01

To examine whether resident characteristics and experiences are related to practice in underserved areas. Cross-sectional survey of a national random sample of pediatric residents (n = 1000) and additional sample of minority residents (n = 223) who were graduating in 2009 was conducted. Using weighted logistic regression, we examined relationships between resident characteristics (background, values, residency experiences, and practice goals) and reported 1) expectation to practice in underserved area and 2) postresidency position in underserved area. Response rate was 57%. Forty-one percent of the residents reported that they had an expectation of practicing in an underserved area. Of those who had already accepted postresidency positions, 38% reported positions in underserved areas. Service obligation in exchange for loans/scholarships and primary care/academic pediatrics practice goals were the strongest predictors of expectation of practicing in underserved areas (respectively, adjusted odds ratio 4.74, 95% confidence interval 1.87-12.01; adjusted odds ratio 3.48, 95% confidence interval 1.99-6.10). Other significant predictors include hospitalist practice goals, primary care practice goals, importance of racial/ethnic diversity of patient population in residency selection, early plan (before medical school) to care for underserved families, mother with a graduate or medical degree, and higher score on the Universalism value scale. Service obligation and primary care/academic pediatrics practice goal were also the strongest predictors for taking a postresidency job in underserved area. Trainee characteristics such as service obligations, values of humanism, and desire to serve underserved populations offer the hope that policies and public funding can be directed to support physicians with these characteristics to redress the maldistribution of physicians caring for children. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All

Serving the Underserved

ERIC Educational Resources Information Center

Scott, Michael

2006-01-01

Efforts to expand diversity in the health professions has received a boost from a prominent member of Congress. U.S. Senator Bill Frist, R-Tennessee, recently introduced a bill to amend the Public Health Service Act as part of a comprehensive initiative to improve the health of minority and other underserved populations. This bill, which is being…

Re-Presenting Slavery: Underserved Questions in Museum Collections

ERIC Educational Resources Information Center

Levenson, Cyra

2014-01-01

This article looks at the notion of what, not who, is underserved in museum education. The importance of looking through, in, and from objects in order to uncover underserved questions and themes is vital. A willingness to consider new ways to approach collections and display is necessary to have a dialogue with our audiences about how museums can…

Osteoporosis and milk intake among Korean women in California: relationship with acculturation to U.S. lifestyle.

PubMed

Irvin, Veronica L; Nichols, Jeanne F; Hofstetter, C Richard; Ojeda, Victoria D; Song, Yoon Ju; Kang, Sunny; Hovell, Melbourne F

2013-12-01

The Korean population in the US increased by a third between 2000 and 2010. Korean women in the US report low calcium intake and relatively high rate of fractures. However, little is known about the prevalence of osteoporosis among Korean American women. This paper examined the relationship between prevalence of osteoporosis and milk consumption, and their relationship with acculturation among a representative sample of immigrant California women of Korean descent. Bilingual telephone surveys were conducted from a probability sample (N = 590) in 2007. Lower acculturation significantly related to lower milk consumption for women during the age periods of 12-18 and 19-34 years. Acculturation was related to higher prevalence of osteoporosis among post-menopausal, but not pre-menopausal Korean women in California. Future research should include larger cohorts, objective measures of osteoporosis, other sources of calcium specific to Korean cuisine, and assessment of bone-loading physical activity.

Mobile health care operations and return on investment in predominantly underserved children with asthma: the breathmobile program.

PubMed

Morphew, Tricia; Scott, Lyne; Li, Marilyn; Galant, Stanley P; Wong, Webster; Garcia Lloret, Maria I; Jones, Felita; Bollinger, Mary Elizabeth; Jones, Craig A

2013-08-01

Underserved populations have limited access to care. Improved access to effective asthma care potentially improves quality of life and reduces costs associated with emergency department (ED) visits. The purpose of this study is to examine return on investment (ROI) for the Breathmobile Program in terms of improved patient quality-adjusted life years saved and reduced costs attributed to preventable ED visits for 2010, with extrapolation to previous years of operation. It also examines cost-benefit related to reduced morbidity (ED visits, hospitalizations, and school absenteeism) for new patients to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits). This is a retrospective analysis of data for 15,986 pediatric patients, covering 88,865 visits, participating in 4 Southern California Breathmobile Programs (November 16, 1995-December 31, 2010). The ROI calculation expressed the cost-benefit ratio as the net benefits (ED costs avoided+relative value of quality-adjusted life years saved) over the per annum program costs (∼$500,000 per mobile). The ROI across the 4 California programs in 2010 was $6.73 per dollar invested. Annual estimated emergency costs avoided in the 4 regions were $2,541,639. The relative value of quality-adjusted life years saved was $24,381,000. For patients new to the Breathmobile Program during 2008-2009 who engaged in care (≥3 visits), total annual morbidity costs avoided per patient were $1395. This study suggests that mobile health care is a cost-effective strategy to deliver medical care to underserved populations, consistent with the Triple Aims of Therapy.

Guidelines for research recruitment of underserved populations (EERC).

PubMed

Matsuda, Yui; Brooks, Jada L; Beeber, Linda S

2016-11-01

Despite concerted efforts to establish health equity, significant disparities persist. One roadblock to eliminating health disparities is the inadequate recruitment of underserved populations, which prevents researchers from creating culturally-tailored interventions. To further develop the science of recruitment, we argue that a systematic approach should be applied to research participant recruitment. Given the lack of practical and comprehensive recruitment conceptual frameworks or guidelines in the literature, the authors propose newly synthesized guidelines for research recruitment of underserved populations: EERC (evaluate, engage, reflect, and carefully match). The EERC guidelines are delineated, and the application of these guidelines is illustrated through a study recently conducted by the authors. The guidelines consist of the following four components: 1. Evaluate the composition of the research team; 2. Engage fully with the community by working with key informants and cultural insiders; 3. Reflect the unique cultural characteristics of the community in the research conduct; and 4. Carefully use a matching technique. The application component of the article demonstrates concrete examples of how the guidelines can enhance research recruitment for an underserved population. The authors intend these guidelines to be broadly applicable for research teams regardless of research design or characteristics of the underserved population. Application of these guidelines in nursing and health science will contribute to increasing research recruitment of underserved populations, with the goal of reducing health disparities and achieving health equity for all persons. Copyright © 2016 Elsevier Inc. All rights reserved.

Diabetes Self-management Quality Improvement Initiative for Medically Underserved Patients.

PubMed

Seol, Haesun; Thompson, Mark; Kreider, Kathryn Evans; Vorderstrasse, Allison

The burden of diabetes is greater for minorities and medically underserved populations in the United States. An evidence-based provider-delivered diabetes self-management education intervention was implemented in a federally qualified health center for medically underserved adult patients with type 2 diabetes. The findings provide support for the efficacy of the intervention on improvement in self-management behaviors and glycemic control among underserved patients with diabetes, while not substantially changing provider visit time or workload.

Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program

PubMed Central

Markossian, Talar W.; Darnell, Julie S.; Calhoun, Elizabeth A.

2012-01-01

Background We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Methods Women with an abnormal breast (n=352) or cervical (n=545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Results Compared to controls, the breast navigation group had shorter time to diagnostic resolution (aHR=1.65, CI=1.20–2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR= 2.31, CI=1.75–3.06), with no difference before 30 days (aHR= 1.42, CI=0.83–2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Conclusions Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Impact Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women. PMID:23045544

Follow-up and timeliness after an abnormal cancer screening among underserved, urban women in a patient navigation program.

PubMed

Markossian, Talar W; Darnell, Julie S; Calhoun, Elizabeth A

2012-10-01

We evaluated the efficacy of a Chicago-based cancer patient navigation program developed to increase the proportion of patients reaching diagnostic resolution and reduce the time from abnormal screening test to definitive diagnostic resolution. Women with an abnormal breast (n = 352) or cervical (n = 545) cancer screening test were recruited for the quasi-experimental study. Navigation subjects originated from five federally qualified health center sites and one safety net hospital. Records-based concurrent control subjects were selected from 20 sites. Control sites had similar characteristics to the navigated sites in terms of patient volume, racial/ethnic composition, and payor mix. Mixed-effects logistic regression and Cox proportional hazard regression analyses were conducted to compare navigation and control patients reaching diagnostic resolution by 60 days and time to resolution, adjusting for demographic covariates and site. Compared with controls, the breast navigation group had shorter time to diagnostic resolution (aHR = 1.65, CI = 1.20-2.28) and the cervical navigation group had shorter time to diagnostic resolution for those who resolved after 30 days (aHR = 2.31, CI = 1.75-3.06), with no difference before 30 days (aHR = 1.42, CI = 0.83-2.43). Variables significantly associated with longer time to resolution for breast cancer screening abnormalities were being older, never partnered, abnormal mammogram and BI-RADS 3, and being younger and Black for cervical abnormalities. Patient navigation reduces time from abnormal cancer finding to definitive diagnosis in underserved women. Results support efforts to use patient navigation as a strategy to reduce cancer disparities among socioeconomically disadvantaged women. 2012 AACR

Development and pilot evaluation of novel genetic educational materials designed for an underserved patient population.

PubMed

Lubitz, Rebecca Jean; Komaromy, Miriam; Crawford, Beth; Beattie, Mary; Lee, Robin; Luce, Judith; Ziegler, John

2007-01-01

Genetic counseling for BRCA1 and BRCA2 mutations involves teaching about hereditary cancer, genetics and risk, subjects that are difficult to grasp and are routinely misunderstood. Supported by a grant from the Avon Foundation, the UCSF Cancer Risk Program started the first genetic testing and counseling service for a population of traditionally underserved women of varied ethnic and social backgrounds at the San Francisco General Hospital (SFGH). Informed by educational theory and clinical experience, we devised and piloted two simplified explanations of heredity and genetic risk, with the aim of uncovering how to best communicate genetics and risk to this underserved population. A "conventional" version comprised pictures of genes, pedigrees, and quantitative representations of risk. A "colloquial" pictorial version used an analogy of the "information book" of genes, family stories and vignettes, and visual representations of risk, without using scientific words such as genes or chromosomes. A verbal narrative accompanied each picture. We presented these modules to four focus groups of five to eight women recruited from the SFGH Family Practice Clinic. Overall, women preferred a picture-based approach and commented that additional text would have been distracting. The majority of women preferred the colloquial version because it was easier to understand and better conveyed a sense of comfort and hope. We conclude that simplicity, analogies, and familiarity support comprehension while vignettes, family stories, and photos of real people provide comfort and hope. These elements may promote understanding of complex scientific topics in healthcare, particularly when communicating with patients who come from disadvantaged backgrounds.

Enrolling Underserved Women in mHealth Programs: Results From Text4baby Outreach Campaigns.

PubMed

Bushar, Jessica A; Fishman, Jodie; Garfinkel, Danielle; Pirretti, Amy

2018-03-01

Public health practitioners have increasingly leveraged technology-based communication to get health information into the hands of hard-to-reach populations; however, best practices for outreach and enrollment into mobile health (mHealth) programs are lacking. This article describes enrollment results from campaigns focused on enrolling underserved pregnant women and mothers in Text4baby-a free, mHealth service-to inform outreach strategies for mHealth programs. Text4baby participants receive health and safety information, interactive surveys, alerts, and appointment reminders through at least three weekly texts and a free app-timed to users' due date or babies' birth date. Text4baby worked with partners to implement national, state, and community-based enrollment campaigns. Descriptive statistics were used to compare baseline enrollment prior to a campaign with enrollment during a campaign to generate enrollment estimates. Enrollment rates were calculated for campaigns for which the number targeted/reached was available. National television campaigns resulted in more than 10,000 estimated enrollments. Campaigns that were integrated with an existing program and text-based recruitment had the highest enrollment rates, ranging from 7% to 24%. Facebook advertisements and traditional media targeting providers and consumers were least effective. mHealth programs should consider text-based recruitment and outreach via existing programs; additional research is needed on return on investment for different outreach strategies and on the effectiveness of different outreach strategies at reaching and enrolling specific target populations.

Dental students' attitudes toward underserved populations across four years of dental school.

PubMed

Habibian, Mina; Seirawan, Hazem; Mulligan, Roseann

2011-08-01

The objective of this study was to assess dental students' attitudes toward underserved populations across their four years of dental school. Students at the Herman Ostrow School of Dentistry of the University of Southern California were invited to take part in the study. Participating students completed a questionnaire on their attitudes toward the underserved at three time points: 1) during orientation week; 2) at the end of their second year after taking part in some community dental programs; and 3) at the end of their fourth year after they had completed all their mandatory and volunteer rotations in community dental programs. Students' attitudes were measured in four categories: societal expectations, dentist/student responsibility, personal efficacy, and access to care. First-year students scored 85 out of a maximum of 115 on the questionnaire. Female students scored higher than male students (P=0.006). Age, debt, and past history of volunteer work were not related to first-year students' total attitude scores; however, students with a history of volunteer experience scored higher on the dentist/student responsibility category (P=0.04). Students' attitude scores declined across the four years of dental school (P=0.001). The same patterns were evident for all categories except societal expectations. The decline was not related to age, gender, debt, or volunteer work experience. Follow-up studies are needed to help explain the factors that may be related to this decline.

77 FR 43127 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2013

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-23

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved Areas for 2013 AGENCY: U.S. Office of Personnel Management. ACTION: Notice of Medically Underserved... determination of the States that qualify as Medically Underserved Areas under the Federal Employees Health...

A Comparison of Perinatal HIV Prevention Opportunities for Hispanic and Non-Hispanic Women in California

ERIC Educational Resources Information Center

Kropp, Rhonda Y.; Sarnquist, Clea C.; Montgomery, Elizabeth T.; Ruiz, Juan D.; Maldonado, Yvonne A.

2006-01-01

Using a semi-structured survey and convenience sample of pregnant/recently delivered Hispanic (n = 453) and non-Hispanic (n = 904) women in four California counties, this study compared rates of timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test acceptance in PNC between Hispanic and non-Hispanic women. Hispanic…

A National Longitudinal Survey of Medical Students' Intentions to Practice Among the Underserved.

PubMed

O'Connell, Thomas F; Ham, Sandra A; Hart, Theodore G; Curlin, Farr A; Yoon, John D

2018-01-01

To explore students' intentions to practice in medically underserved areas. In January 2011, 960 third-year medical students from 24 MD-granting U.S. medical schools were invited to participate in a survey on their intention to practice in a medically underserved area. A follow-up survey was sent to participants in September 2011. Covariates included student demographics, medical school characteristics, environmental exposures, work experiences, sense of calling, and religious characteristics. Adjusted response rates were 564/919 (61.4%, first survey) and 474/564 (84.0%, follow-up survey). Among fourth-year medical students, an estimated 34.3% had an intention to practice among the underserved. In multivariate logistic regression modeling, predictors for intentions to practice among the underserved included growing up in an underserved setting (odds ratio [OR] range: 2.96-4.81), very strong sense of calling (OR range: 1.86-3.89), and high medical school social mission score (in fourth year: OR = 2.34 [95% confidence interval (CI), 1.31-4.21]). International experience was associated with favorable change of mind in the fourth year (OR = 2.86 [95% CI, 1.13-7.24]). High intrinsic religiosity was associated with intentions to practice primary care in underserved settings (in fourth year: OR = 2.29 [95% CI = 1.13-4.64]). Growing up in medically underserved settings, work experience in religiously affiliated organizations, very strong sense of calling, and high medical school social mission score were associated with intentions to practice in underserved areas. Lack of formative educational experiences may dissuade students from considering underserved practice.

Asian American Women in California: A Pooled Analysis of Predictors for Breast and Cervical Cancer Screening

PubMed Central

Breen, Nancy; Liu, Benmei; Lee, Richard; Kagawa-Singer, Marjorie

2015-01-01

Objectives. We examined patterns of cervical and breast cancer screening among Asian American women in California and assessed their screening trends over time. Methods. We pooled weighted data from 5 cycles of the California Health Interview Survey (2001, 2003, 2005, 2007, 2009) to examine breast and cervical cancer screening trends and predictors among 6 Asian nationalities. We calculated descriptive statistics, bivariate associations, multivariate logistic regressions, predictive margins, and 95% confidence intervals. Results. Multivariate analyses indicated that Papanicolaou test rates did not significantly change over time (77.9% in 2001 vs 81.2% in 2007), but mammography receipt increased among Asian American women overall (75.6% in 2001 vs 81.8% in 2009). Length of time in the United States was associated with increased breast and cervical cancer screening among all nationalities. Sociodemographic and health care access factors had varied effects, with education and insurance coverage significantly predicting screening for certain groups. Overall, we observed striking variation by nationality. Conclusions. Our results underscore the need for intervention and policy efforts that are targeted to specific Asian nationalities, recent immigrants, and individuals without health care access to increase screening rates among Asian women in California. PMID:25521898

Promoting Health and Behavioral Health Equity in California.

PubMed

Mishra, Meenoo; Lupi, Monica Valdes; Miller, Wm Jahmal; Nolfo, Tamu

2016-01-01

Behavioral health disparities are not usually considered part of the same system of health disparities. However, the California Department of Public Health focused its health equity strategies on reducing behavioral health disparities through its California Statewide Plan to Promote Health and Mental Health Equity. This statewide plan was developed through a community-wide stakeholder engagement and outreach process. In addition, the California Reducing Disparities Project is a prevention and early intervention effort to reduce mental health disparities in underserved populations. This strategic plan represents the voice of several racial/ethnic communities, such as African American, Asian and Pacific Islander, Latino, Native American, as well as lesbian, gay, bisexual, transgender, and queer and questioning communities in California, through 5 strategic planning workgroups. The workgroups were composed of a broad range of stakeholders, including community leaders, mental health care providers, consumer and family members, individuals with lived experience, and academia. This case example highlights the various efforts of California's Office of Health Equity in eliminating behavioral health disparities and promoting mental health equity, as well as discusses the unique statutory and regulatory role of the Office of Health Equity's deputy director.

Lifetime interpersonal violence and self-reported chlamydia trachomatis diagnosis among California women.

PubMed

Alvarez, Jennifer; Pavao, Joanne; Mack, Katelyn P; Chow, Joan M; Baumrind, Nikki; Kimerling, Rachel

2009-01-01

To examine the relationship between cumulative exposure to various types of interpersonal violence throughout the life span and self-reported history of Chlamydia trachomatis (CT) diagnosis in a population-based sample of California women. This was a cross-sectional analysis of a population-based survey of California women aged 18-44 years (n = 3521). Participants reported their experience of multiple types of interpersonal violence: physical or sexual abuse in childhood or adulthood and intimate partner violence (IPV) in the past 12 months. Current posttraumatic stress disorder (PTSD) and depressive symptoms were also reported. Separate logistic regression models assessed the association between experiencing each type of interpersonal violence, as well as women's cumulative exposure to violence, and past CT diagnosis, adjusting for age, race/ethnicity, and poverty, as well as mental health problems. Six percent of women reported a past diagnosis of CT, and 40.8% reported experiencing at least one type of interpersonal violence in their lifetime. All types of violence were significantly associated with higher odds of having a past CT diagnosis even after controlling for sociodemographics. Women who reported experiencing four or more types of violence experiences had over five times the odds of reporting a lifetime CT diagnosis compared with women who never experienced interpersonal violence (adjusted odds ratio = 5.71, 95% CI 3.27-9.58). Current PTSD and depressive symptoms did not significantly affect the relationship between a woman's cumulative experience of violence and her risk of past CT diagnosis. There is a robust association between experiencing multiple forms of violence and having been diagnosed with CT. Women who seek treatment for sexually transmitted diseases (STDs), such as CT, should be assessed for their lifetime history of violence, especially violence in their current intimate relationships. Sexual risk reduction counseling may also be important

Building a workforce of physicians to care for underserved patients.

PubMed

Anthony, David; El Rayess, Fadya; Esquibel, Angela Y; George, Paul; Taylor, Julie

2014-09-02

There is a shortage of physicians to care for underserved populations. Medical educators at The Warren Alpert Medical School of Brown University have used five years of Health Resources and Services Administration funding to train medical students to provide outstanding primary care for underserved populations. The grant has two major goals: 1) to increase the number of graduating medical students who practice primary care in underserved communities ("Professional Development"); and 2) to prepare all medical school graduates to care for underserved patients, regardless of specialty choice ("Curriculum Development"). Professional Development, including a new scholarly concentration and an eight-year primary care pipeline, has been achieved in partnership with the Program in Liberal Medical Education, the medical school's Admissions Committee, and an Area Health Education Center. Curriculum Development has involved systematic recruitment of clinical training sites and disease-specific curricula including tools for providing care to vulnerable populations. A comprehensive, longitudinal evaluation is ongoing.

75 FR 54349 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-07

... Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional Shortage... on Designation of Medically Underserved Populations and Health Professional Shortage Areas. Date and... Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional...

Patient navigation for underserved patients diagnosed with breast cancer.

PubMed

Raj, Aparna; Ko, Naomi; Battaglia, Tracy A; Chabner, Bruce A; Moy, Beverly

2012-01-01

The elimination of cancer disparities is critically important for lessening the burden of breast cancer (BC). Patient navigator programs (PNPs) have been shown to improve rates of BC screening in underserved communities, but there is a dearth of evidence regarding their benefits after the actual diagnosis of BC. We retrospectively examined sociodemographic characteristics, disease characteristics, and concordance to quality measures (QMs) of BC care among women participating in a PNP that services disadvantaged minority communities in the greater Boston area. Of the 186 PNP patients diagnosed with BC in 2001-2011 in three neighborhood community health centers, treatment data was available for 158 (85%) and race and disease stage information was available for 149 (80%). Regarding stage, 25% were diagnosed with in situ cancer, 32% had stage 1, 25% had stage 2, 13% had stage 3, and 5% had stage 4 BC. Guideline-indicated care was received by 70 of 74 patients (95%) for the hormonal therapy QM, 15 of 17 (88%) patients for the chemotherapy QM, and 65 of 71 (92%) patients for the radiation QM, all similar to published concordance rates at elite National Comprehensive Cancer Network institutions. These findings suggest that PNPs may facilitate evidence-based quality care for vulnerable populations. Future research should prospectively analyze quality metrics to assess measures to improve the process and outcomes of patient navigation in diverse underserved settings, compared with control non-navigated populations.

76 FR 39062 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-05

... Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting... Designation of Medically Underserved Populations and Health Professional Shortage Areas. DATES: Meetings will... Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional...

Nevada Underserved Science Education Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nicole Rourke; Jason Marcks

2004-07-06

Nevada Underserved Science Education Program (NUSEP) is a project to examine the effect of implementing new and innovative Earth and space science education curriculum in Nevada schools. The project provided professional development opportunities and educational materials for teachers participating in the program.

76 FR 50442 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-15

... Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting... Designation of Medically Underserved Populations and Health Professional Shortage Areas. DATES: Meetings will... Medically Underserved Populations and Health Professional Shortage Areas is to establish a criteria and a...

Report of the Task Force on the Status of Women at the University of California, Davis.

ERIC Educational Resources Information Center

Fisher, Kathleen M.

The charge given to the Task Force on the Status of Women at the University of California, Davis, was to determine the employment opportunities for women on the Davis campus. The Task Force addressed itself primarily to 4 major employment categories: non-academic staff, academic staff, faculty, and administration, with lesser consideration given…

Struggling to be seen and heard: the underserved and unserved populations.

PubMed

Cheng, Li-Rong Lilly

2014-01-01

The purpose of this paper is to provide some current information on the topic of the underserved and unserved populations including modern-day slaves, stateless/displaced persons, refugees/migrants and indigenous populations. Speech-language pathology education and services for the underserved as well as unserved populations are discussed. Three case studies which demonstrate knowledge transfer and exchange as potential models for future development are presented. These case studies lead to more inquiries, studies, innovations and involvement from individuals and groups who are concerned about the underserved and unserved populations. © 2015 S. Karger AG, Basel.

Feasibility of a psychosocial and patient navigation intervention to improve access to treatment among underserved breast cancer patients.

PubMed

Madore, Shannon; Kilbourn, Kristin; Valverde, Patricia; Borrayo, Evelinn; Raich, Peter

2014-08-01

Medically underserved women with recently diagnosed breast cancer face a number of significant obstacles that impact the timeliness and quality of their care. The Breast CARES (Cancer Advocacy, Resources Education and Support) intervention combined patient navigation with telephone counseling to guide newly diagnosed breast cancer patients in overcoming treatment barriers. The study aimed to learn more about the types of barriers encountered by the participants. The study also sought to understand the relationship between patient-reported barriers and patient-reported psychosocial distress in underserved women recently diagnosed with breast cancer. Data were analyzed using a mixed-methods approach. Participants were assessed pre- and post-intervention. Psychosocial measures included cancer-related distress, depression, anxiety, social support, and quality of life. Case notes and responses to process evaluation questions were used to determine whether the CARES intervention adequately addressed the needs of the participants. The mean age of participants (N = 20) was 54 years (SD = 12.5), 40% were Hispanic, 70% were unemployed, 50% were uninsured, and 20% were mono-lingual in Spanish. Qualitative analysis revealed four categories of barriers: psychosocial, medical, logistical, and communication. Similarities and differences existed between the PN and TC regarding how barriers were addressed. Post-intervention psychosocial scores indicate a decrease in depression and cancer-related distress and an increase in social support. The participants reported that participation in the Breast CARES program helped them overcome financial barriers (73%), transportation problems (60%), and communication barriers with medical staff (73%). This study demonstrates the unique and complementary roles for PNs and TCs in overcoming barriers to treatment adherence faced by underserved breast cancer patients.

Sleep duration of underserved minority children in a cross-sectional study

USDA-ARS?s Scientific Manuscript database

Short sleep duration has been shown to associate with increased risk of obesity. Childhood obesity is more prevalent among underserved minority children. The study measured the sleep duration of underserved minority children living in a large US urban environment using accelerometry and its relation...

Women and the Superintendency: Characteristics of and Barriers Encountered by Female Superintendents in California

ERIC Educational Resources Information Center

MacArthur, Tracy

2010-01-01

Though women constitute the majority of the teacher workforce, historically, they have been underrepresented in the school superintendency. And although California boasts higher percentages of female superintendents than the national average, a discrepancy clearly continues to exist. This study investigated female school superintendents' common…

Contraceptive use and risk of unintended pregnancy in California.

PubMed

Foster, Diana G; Bley, Julia; Mikanda, John; Induni, Marta; Arons, Abigail; Baumrind, Nikki; Darney, Philip D; Stewart, Felicia

2004-07-01

California is home to more than one out of eight American women of reproductive age. Because California has a large, diverse and growing population, national statistics do not necessarily describe the reproductive health of California women. This article presents risk for pregnancy and sexually transmitted infections among women in California based on the California Women's Health Survey. Over 8900 women of reproductive age who participated in this survey between 1998 and 2001 provide estimates of access to care and use of family-planning methods in the state. We find that 49% of the female population aged 18-44 in California is at risk of unintended pregnancy. Nine percent (9%) of women at risk of an unintended pregnancy are not using any method of contraception, primarily for method-related reasons, such as a concern about side effects or a dislike of available contraceptive methods. Among women at risk for unintended pregnancy, we find disparities by race/ethnicity and education in use of contraceptive methods.

Where Do We Start? Using Family Navigation to Help Underserved Families

ERIC Educational Resources Information Center

Blenner, Stephanie; Fernández, Ivys; Giron, Adriana; Grossman, Xena; Augustyn, Marilyn

2014-01-01

The period of time after a child is identified with a developmental or mental health condition can be highly challenging. This is particularly true for diverse, underserved families who may face competing concerns related to poverty, culture, language, immigration, and family issues. Likewise, clinicians working with underserved families may…

Facilitators of Survivorship Care Among Underserved Breast Cancer Survivors: a Qualitative Study.

PubMed

Ustjanauskas, Amy E; Quinn, Gwendolyn P; Pan, Tonya M; Rivera, Maria; Vázquez-Otero, Coralia; Ung, Danielle; Roetzheim, Richard G; Laronga, Christine; Johnson, Kenneth; Norton, Marilyn; Carrizosa, Claudia; Muñoz, Dariana; Goldenstein, Marissa; Nuhaily, Sumayah; Wells, Kristen J

2017-12-01

Research investigating facilitators of survivorship care among underserved breast cancer survivors (BCS) is sparse. This study aimed to explore facilitators of survivorship care among underserved BCS within the first 5 years following chemotherapy, radiation, or surgery for breast cancer. In-depth interviews were conducted, using a semi-structured interview guide, with underserved BCS exploring survivorship care experiences. Content analysis of the verbatim transcripts was applied, and results were summarized according to themes related to facilitators of breast cancer survivorship care. Interviews were conducted with 25 BCS. Eight main themes were identified: coordination of care; positive perceptions of health care providers; communication between patient and health care providers; financial and insurance facilitators; information, classes, and programs provided; assistance provided by organizations and health care professionals; transportation facilitators; and job flexibility. This study provides a comprehensive look at facilitators of survivorship care among underserved BCS. BCS endorsed several facilitators of their survivorship care, mainly at the interpersonal, organizational, and societal level. This study adds to the research literature on catalysts of care among underserved BCS. Results from this study are currently being used to inform a patient navigation intervention to facilitate care among this population.

Evaluation of the Effectiveness of a Problem-Solving Intervention Addressing Barriers to Cardiovascular Disease Prevention Behaviors in 3 Underserved Populations: Colorado, North Carolina, West Virginia, 2009

PubMed Central

Bryant, Lucinda L.; Leary, Janie M.; Vu, Maihan B.; Hill-Briggs, Felicia; Samuel-Hodge, Carmen D.; McMilin, Colleen R.; Keyserling, Thomas C.

2014-01-01

Introduction In low-income and underserved populations, financial hardship and multiple competing roles and responsibilities lead to difficulties in lifestyle change for cardiovascular disease (CVD) prevention. To improve CVD prevention behaviors, we adapted, pilot-tested, and evaluated a problem-solving intervention designed to address barriers to lifestyle change. Methods The sample consisted of 81 participants from 3 underserved populations, including 28 Hispanic or non-Hispanic white women in a western community (site 1), 31 African-American women in a semirural southern community (site 2), and 22 adults in an Appalachian community (site 3). Incorporating focus group findings, we assessed a standardized intervention involving 6-to-8 week group sessions devoted to problem-solving in the fall of 2009. Results Most sessions were attended by 76.5% of participants, demonstrating participant adoption and engagement. The intervention resulted in significant improvement in problem-solving skills (P < .001) and perceived stress (P < .05). Diet, physical activity, and weight remained stable, although 72% of individuals reported maintenance or increase in daily fruit and vegetable intake, and 67% reported maintenance or increase in daily physical activity. Conclusion Study results suggest the intervention was acceptable to rural, underserved populations and effective in training them in problem-solving skills and stress management for CVD risk reduction. PMID:24602586

Self-efficacy of Osteopathic Medical Students in a Rural-Urban Underserved Pathway Program.

PubMed

Casapulla, Sharon L

2017-09-01

Self-efficacy has been shown to play a role in medical students' choice of practice location. More physicians are needed in rural and urban underserved communities. Ohio University Heritage College of Osteopathic Medicine has a co-curricular training program in rural and urban underserved practice to address this shortage. To assess whether participation in the co-curricular program in rural and urban underserved practice affects self-efficacy related to rural and underserved urban practice. This cross-sectional study explored self-efficacy using Bandura's 5 sources of self-efficacy (vicarious learning, verbal persuasion, positive emotional arousal, negative emotional arousal, and performance accomplishments). A validated scale on self-efficacy for rural practice was expanded to include self-efficacy for urban underserved practice and e-mailed to all 707 medical students across 4 years of medical school. Composite rural and urban underserved self-efficacy scores were calculated. Scores from participants in the rural and urban underserved training program were compared with those who were not in the program. Data were obtained from 277 students. In the overall sample, students who indicated that they grew up in a rural community reported significantly higher rural self-efficacy scores than those who did not grow up in a rural community (F1,250=27.56, P<.001). Conversely, students who indicated that they grew up in a nonrural community reported significantly higher urban underserved self-efficacy scores than those who grew up in a rural community (F1,237=7.50, P=.007). The participants who stated primary care as their career interest (n=122) had higher rural self-efficacy scores than the participants who reported a preference for generalist specialties (general surgery, general psychiatry, and general obstetrics and gynecology) or other specialties (n=155) (F2,249=7.16, P=.001). Students who participated in the rural and urban underserved training program (n=49

GRID Alternatives: Solar Programs in Underserved Communities

EPA Pesticide Factsheets

Introduces GRID Alternatives: Solar Programs in Underserved Communities, a program that partners with a variety of organizations to help low-income communities access the benefits of solar technology.

Clinic-based nutrition and lifestyle counseling for Hispanic women delivered by community health workers: design of the California WISEWOMAN study.

PubMed

Farrell, Maureen A; Hayashi, Toshi; Loo, Ryan K; Rocha, David A; Sanders, Charlene; Hernandez, Marianne; Will, Julie C

2009-05-01

The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program in California, named Heart of the Family, implements and evaluates the effectiveness of lifestyle interventions to improve nutrition and physical activity while reducing cardiovascular disease (CVD) risk factors among low-income, uninsured or underinsured Hispanic women aged 40-64 who participate in the Cancer Detection Programs: Every Woman Counts (CDP:EWP). This paper reports the study design and baseline findings of the California WISEWOMAN program. Heart of the Family, a within-site randomized controlled study at four community health centers in Los Angeles and San Diego, featured a unique set of strategies meeting the state population in implementing a California WISEWOMAN program. The program exclusively targeted Hispanic women who are at risk of developing CVD, provided lifestyle intervention using a validated intervention material in Spanish and English to motivate behavioral changes, and used bilingual (English and Spanish) community health workers (CHWs) to provide individually based face-to-face counseling. Women meeting enrollment criteria were randomly assigned either to an enhanced intervention group (EIG), who received lifestyle intervention, or usual care group (UCG), who received the usual care for elevated blood pressure or cholesterol. A total of 1093 women enrolled between January 2006 and August 2006. Demographic and baseline CVD risk profiles are similar in both groups. Some notable characteristics of the California participants are lower smoking rate (5%), higher average body mass index (BMI) (31.9), and a significantly higher percentage with less than high school education (70%). With its unique study design and large number of enrolls, Heart of the Family will enable future public health efforts to better meet the health needs of Hispanic women by addressing education levels, economic considerations, and cultural and linguistic needs.

Health and Wellness Technology Use by Historically Underserved Health Consumers: Systematic Review

PubMed Central

Perchonok, Jennifer

2012-01-01

Background The implementation of health technology is a national priority in the United States and widely discussed in the literature. However, literature about the use of this technology by historically underserved populations is limited. Information on culturally informed health and wellness technology and the use of these technologies to reduce health disparities facing historically underserved populations in the United States is sparse in the literature. Objective To examine ways in which technology is being used by historically underserved populations to decrease health disparities through facilitating or improving health care access and health and wellness outcomes. Methods We conducted a systematic review in four library databases (PubMed, PsycINFO, Web of Science, and Engineering Village) to investigate the use of technology by historically underserved populations. Search strings consisted of three topics (eg, technology, historically underserved populations, and health). Results A total of 424 search phrases applied in the four databases returned 16,108 papers. After review, 125 papers met the selection criteria. Within the selected papers, 30 types of technology, 19 historically underserved groups, and 23 health issues were discussed. Further, almost half of the papers (62 papers) examined the use of technology to create effective and culturally informed interventions or educational tools. Finally, 12 evaluation techniques were used to assess the technology. Conclusions While the reviewed studies show how technology can be used to positively affect the health of historically underserved populations, the technology must be tailored toward the intended population, as personally relevant and contextually situated health technology is more likely than broader technology to create behavior changes. Social media, cell phones, and videotapes are types of technology that should be used more often in the future. Further, culturally informed health information

Health coaching for the underserved.

PubMed

Jordan, Meg

2013-05-01

Twelve individuals (four homeless, two formerly homeless, and six low-income) received 12 weeks of free health coaching, an intervention normally undertaken by clients who pay $40 to $200 out of pocket for coaching services. The health coaching relationships were conducted with protocols developed for managing executive health at a Fortune 100 firm. This experimental model was constructed to explore what happens when coaching conversations for change and possibility are delivered to marginalized and underserved communities that typically undergo vastly different interactions with authorities in law, healthcare, and social services. Phase 1 of the project recruited the homeless individuals from street sites throughout San Francisco, California, and a temporary shelter. Phase 2 of the project worked with low-income and formerly homeless individuals who occupied a subsidized housing complex. Of the coaching recipients, three were black, five were Hispanic, three were of mixed race, and one declined to disclose his ethnicity. Half were Spanish speaking; immigrant status was recent for five of the 12. None had ever talked with a health coach before; only three knew how to utilize low-cost public health clinics. This case report illustrates how the motivational power of coaching conversations was a modestly useful methodology in breaking through the social isolation and loneliness of street-dwelling adults with chronic health problems. It also was a useful methodology for developing capacity for accomplishing short-term goals that were self-identified. Additionally, health coaching presented an opportunity for transitioning poverty-level individuals from passive recipients using public health sector services to more empowered actors with first-stage awareness who initiated preventive health actions.

Mobilizing women for minority health and social justice in california.

PubMed

Littlefield, Diane; Robison, Connie Chan; Engelbrecht, Luz; González, Belma; Hutcheson, Heather

2002-04-01

Women's Health Leadership is building the leadership capacity of diverse community leaders in California committed to promoting health and social justice in their communities. This program provides opportunities for cross-cultural exchanges of ideas, resources, and expertise. Graduates continue to receive technical support and to engage in peer learning via an alumnae network. The network is dedicated to advancing social justice issues and to addressing health disparities. It is also a way to mobilize trained grassroots leaders to provide expertise to influence policy decisions, to provide technical support and resources to local communities, and to foster new partnerships across the state.

Financial incentives for return of service in underserved areas: a systematic review

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

Background In many geographic regions, both in developing and in developed countries, the number of health workers is insufficient to achieve population health goals. Financial incentives for return of service are intended to alleviate health worker shortages: A (future) health worker enters into a contract to work for a number of years in an underserved area in exchange for a financial pay-off. Methods We carried out systematic literature searches of PubMed, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, and the National Health Services Economic Evaluation Database for studies evaluating outcomes of financial-incentive programs published up to February 2009. To identify articles for review, we combined three search themes (health workers or students, underserved areas, and financial incentives). In the initial search, we identified 10,495 unique articles, 10,302 of which were excluded based on their titles or abstracts. We conducted full-text reviews of the remaining 193 articles and of 26 additional articles identified in reference lists or by colleagues. Forty-three articles were included in the final review. We extracted from these articles information on the financial-incentive programs (name, location, period of operation, objectives, target groups, definition of underserved area, financial incentives and obligation) and information on the individual studies (authors, publication dates, types of study outcomes, study design, sample criteria and sample size, data sources, outcome measures and study findings, conclusions, and methodological limitations). We reviewed program results (descriptions of recruitment, retention, and participant satisfaction), program effects (effectiveness in influencing health workers to provide care, to remain, and to be satisfied with work and personal life in underserved areas), and program impacts (effectiveness in influencing health systems and health outcomes). Results Of the 43

75 FR 32972 - Federal Employees Health Benefits Program; Medically Underserved Areas for 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-10

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program; Medically Underserved Areas for 2011 AGENCY: Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2011. This is...

The impact of a lifestyle change program on the mental health of obese under-served African American women.

PubMed

Groh, Carla J; Urbancic, Joan C

2015-04-01

Obesity is a critical social and health issue, adversely impacting life expectancy, quality of life, and mental health. Minorities are disproportionately impacted by obesity with African Americans experiencing the highest prevalence among minority groups. The aim of this study was to determine if a lifestyle program that integrated chair exercises, nutrition and educational counseling, and scripture readings would help under-served obese African American women make lifestyle changes that would positively impact their quality of life, especially mental health. A repeated measures intervention study was conducted (24-weeks). Weeks 1-12 involved meeting twice a week for a total of 4h with participants engaged in chair exercises, educational counseling, and scripture readings. During weeks 13-24, the participants were "on their own" but were encouraged to exercise and eat healthy. Focus groups were held at 12 and 24-weeks. Participants were recruited from a nurse managed center and a primary care clinic for the uninsured. Mental health data were collected at baseline, 12, and 24-weeks. The Medical Outcomes Study Short Form Version 2 (SF-36v2) was used to measure changes in mental health. Higher scores indicate better perceived health status. Group scores less than 47 indicate impaired functioning. 55 women had complete data for all three data collection points, with a mean age of 50 and a mean BMI of 41.2. Repeated ANOVAs detected significant differences on the mental component summary of the SF-36v2: this score improved from baseline (M=44.1) to 12-weeks (M=50.7) but decreased at 24-weeks (M=47.9) (p=.000). The four domains (vitality, social functioning, role emotional, mental health) were also significantly different over the three data collection points. The findings have significant implications for psychiatric nurses in terms of education, clinical practice, and future research. The study contributed to the participants' mental health through the various group

A Report to the Legislature on Women in Athletic Programs at the University of California.

ERIC Educational Resources Information Center

California Univ., Berkeley.

This document presents a summary report on the status of University of California athletic programs and on progress made in expanding opportunities for women. Each of five areas of campus athletic programs is reviewed in some detail for each sex, including: intercollegiate athletics, intramural sports, recreational club sports, physical education…

76 FR 31998 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2012

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-02

... OFFICE OF PERSONNEL MANAGEMENT Federal Employees Health Benefits Program: Medically Underserved Areas for 2012 AGENCY: U.S. Office of Personnel Management. ACTION: Notice. SUMMARY: The U.S. Office of... Underserved Areas under the Federal Employees Health Benefits (FEHB) Program for calendar year 2012. This is...

Underserved Gifted Populations: Responding to Their Needs and Abilities. Perspectives on Creativity Research.

ERIC Educational Resources Information Center

Smutny, Joan Franklin, Ed.

Twenty-five papers address issues of the underserved gifted, including environmental influences, multicultural and global factors, special learning problems, and the highly gifted and creatively gifted. The papers are: "Twenty-five Teaching Strategies that Promote Learning Success for Underserved Gifted Populations" (Jerry Flack); "The Invisible…

A Report on the Status of Women Employed in the Library of the University of California, Berkeley, with Recommendations for Affirmative Action.

ERIC Educational Resources Information Center

Lipow, Anne; And Others

This report deals with discrimination against women employed as librarians and library assistants at the University of California, Berkeley Library. The report demonstrates that (1) library professional, technical and clerical personnel--both women and men--work in "women's occupations," and, therefore, are underpaid when compared to…

Occupational safety and health education and training for underserved populations.

PubMed

O'Connor, Tom; Flynn, Michael; Weinstock, Deborah; Zanoni, Joseph

2014-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting underserved communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

PubMed

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes

Characteristics of women who refuse an offer of prenatal diagnosis: data from the California maternal serum alpha fetoprotein blood test experience.

PubMed

Press, N; Browner, C H

1998-08-06

This paper presents data from the California maternal serum alpha fetoprotein (MSAFP) program in order to explore the effect and interaction of various factors, especially ethnicity, abortion history and attitudes, religion, and religiosity on MSAFP test decision. The intent is to describe which women are more likely to reject MSAFP screening and also to understand the reasons for refusal and the meanings associated with it. We obtained data on sociodemographics and reproductive history from 595 obstetrical patient charts; we conducted semistructured interviews with an additional 158 pregnant women who were European-American, English-speaking Latina, or Spanish-speaking Latina. All of the women had been offered screening within the context of California's MSAFP Program. We found that women who had never terminated a pregnancy, Spanish-speaking Latinas, and women who scored high on a religiosity scale were significantly more likely to refuse testing. However, we found that all of those factors were strongly mediated by the effects of ethnicity and acculturation, producing different patterns of association in different groups of women.

OCCUPATIONAL SAFETY AND HEALTH EDUCATION AND TRAINING FOR UNDERSERVED POPULATIONS

PubMed Central

O’CONNOR, TOM; FLYNN, MICHAEL; WEINSTOCK, DEBORAH; ZANONI, JOSEPH

2015-01-01

This article presents an analysis of the essential elements of effective occupational safety and health education and training programs targeting under-served communities. While not an exhaustive review of the literature on occupational safety and health training, the paper provides a guide for practitioners and researchers to the key factors they should consider in the design and implementation of training programs for underserved communities. It also addresses issues of evaluation of such programs, with specific emphasis on considerations for programs involving low-literacy and limited-English-speaking workers. PMID:25053607

The AHEC library program and consortia development in California.

PubMed

Jensen, M A; Maddalena, B

1986-07-01

A brief history of the first Area Health Education Center (AHEC) Library Program in California is presented, with a description of methodology and results. The goals of this program were to develop and improve hospital library resources and services, to train hospital library personnel, and to promote resource sharing in a medically underserved area. The health sciences library consortium that evolved became a model for the ten other library consortia in the state. Based on AHEC's twelve years' experience with consortia, from 1973 to 1985, recommendations are made as to size, composition, leadership, outside funding, group participation, publicity, and linkages.

A Systematic Review of the Literature Addressing Veterinary Care for Underserved Communities.

PubMed

LaVallee, Elizabeth; Mueller, Megan Kiely; McCobb, Emily

2017-01-01

Currently, there is a care gap in veterinary medicine affecting low-income and underserved communities, resulting in decreased nonhuman-animal health and welfare. The use of low-price and community veterinary clinics in underserved populations is a strategy to improve companion-animal health through preventative care, spay/neuter, and other low-price care programs and services. Little research has documented the structure and effectiveness of such initiatives. This systematic review aimed to assess current published research pertaining to accessible health care, community-based veterinary medicine, and the use of community medicine in teaching programs. The review was an in-depth literature search identifying 51 publications relevant to the importance, benefits, drawbacks, and use of low-price and community clinics in underserved communities. These articles identified commonly discussed barriers to care that may prevent underserved clientele from seeking veterinary care. Five barriers were identified including the cost of veterinary care, accessibility of care, problems with or lack of veterinarian-client communication, culture/language, and lack of client education. The review also identified a need for additional research regarding evidence of effectiveness and efficiency in community medicine initiatives.

76 FR 54996 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-06

... Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting... of Medically Underserved Populations and Health Professional Shortage Areas on September 20, 21, and 22, 2011. The dates of the meeting and contact information were incorrect. Correction In the Federal...

Teledentistry in rural California: a USC initiative.

PubMed

Chang, Su-Wen; Plotkin, Daniel R; Mulligan, Roseann; Polido, José C; Mah, James K; Meara, John G

2003-08-01

Dentistry, in a synergistic combination with telecommunications technology and the Internet, has yielded a relatively new and exciting field that has endless potential. "Teledentistry" emerges from the fusion of dental practice and technology and can take on two forms--real-time consultation and "store and forward." The first entity to put teledentistry into practice was the Army, which, in 1994, successfully undertook consultations between dentists and service personnel located more than 100 miles apart. Since then, various institutions and organizations in the United States and farther afield have practiced teledentistry, with varying degrees of success. The Children's Hospital Los Angeles Teledentistry Project, being run in association with the University of Southern California's Mobile Dental Clinic, seeks to increase and enhance the quality of oral health care that is provided to children living in remote rural areas of California, areas often severely underserved by dental health providers. The project has three phases: Phase I involves the establishment and organization of the teledentistry network; Phase II will introduce technologies to provide orthodontic consultation and treatment; and Phase III will expand the network and provide increased specialty care into further areas of California and beyond, providing services to more children in desperate need of dental health care.

Outcomes of a Breast Health Project for Hmong Women and Men in California

PubMed Central

Tanjasiri, Sora Park; Valdez, Annalyn; Yu, Hongjian; Foo, Mary Anne

2009-01-01

Objectives. We used a community-based research approach to test a culturally based breast cancer screening program among low-income Hmong women in central and southern California. Methods. We designed a culturally informed educational program with measures at baseline and 1-year follow-up in 2 intervention cities and 1 comparison city. Measures included changes in breast cancer screening, knowledge, and attitudes. Results. Compared with women in the comparison community, women in the intervention community significantly improved their attitudes toward, and increased their knowledge and receipt of, breast cancer screenings. Odds of women in the intervention group having had a mammogram, having had a clinical breast examination, and having performed breast self-examination was 6.75, 12.16, and 20.06, respectively, compared with women in the comparison group. Conclusions. Culturally informed education materials and intervention design were effective methods in conveying the importance of maintaining and monitoring proper breast health. The strength of community collaboration in survey development and intervention design highlighted the challenges of early detection and screening programs among newer immigrants, who face significant language and cultural barriers to care, and identified promising practices to overcome these health literacy challenges. PMID:19443830

Restaurant and food shopping selections among Latino women in Southern California.

PubMed

Ayala, Guadalupe X; Mueller, Kristin; Lopez-Madurga, Eva; Campbell, Nadia R; Elder, John P

2005-01-01

This study describes and examines determinants of restaurant and food store selections in a sample of Latino women. Data were collected at the baseline home-based interview from women involved in a randomized community trial to improve dietary behaviors. The interview consisted of both a structured interview and the measurements of height, weight, and waist-to-hip ratio. Participants included 357 Latino women recruited via random-digit dial in the Southern and Central areas of San Diego County, California. Women were included if they were between 18 and 67 years of age, not currently pregnant, and Spanish-language dominant; women were excluded if a family member was on a special diet or was planning to leave the area during the study. Means and frequencies were used to describe preference for various types of restaurants and food stores based on the North American Industry Classification System (NAICS). Independent samples t tests examined differences in levels of importance for preferring fast-food vs other restaurants and supermarkets/produce markets vs other grocery stores. Logistic regression models examined correlates of preferring fast-food restaurants vs all other restaurants and preferring supermarkets/produce markets vs all other grocery stores. More women reported eating at fast-food restaurants, followed by full-service restaurants and cafeterias. Younger women, employed women, women living in higher income households, and women living in the United States for a greater number of years preferred fast food. Supermarkets; grocery stores; and discount, bulk-purchase stores were equally represented as the primary food store. Women who lived in smaller households, had a smaller measured body mass, were married, and were more acculturated to the Anglo culture were more likely to shop at supermarkets compared with women who shopped at other grocery stores. Our findings suggest specific recommendations for targeting dietary interventions for the growing Latino

78 FR 28274 - Council on Underserved Communities, Re-Establishment

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-14

... underserved communities. Its members provide an essential connection between SBA and small businesses in inner... economic growth, job creation, competiveness, and sustainability. Council members bring a number of...

Honoring the Ways of American Indian Women: A Group Therapy Intervention

ERIC Educational Resources Information Center

McWhirter, Paula T.; Robbins, Rockey; Vaughn, Karen; Youngbull, Natalie; Burks, Derek; Willmon-Haque, Sadie; Schuetz, Suzan; Brandes, Joyce A.; Nael, Andrea Zainab Omidy

2010-01-01

A culturally grounded group intervention for a typically underserved population of urban American Indian women is described. The intervention is designed to increase interpersonal connection, improve inter-tribal acceptance and trust, and enhance psychological well being of marginalized urban American Indian women. Topics used to structure the…

24 CFR 81.13 - Central Cities, Rural Areas, and Other Underserved Areas Housing Goal.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 24 Housing and Urban Development 1 2011-04-01 2011-04-01 false Central Cities, Rural Areas, and...) Housing Goals § 81.13 Central Cities, Rural Areas, and Other Underserved Areas Housing Goal. (a) Purpose... cities, rural areas, and other underserved areas is intended to achieve increased purchases by the GSEs...

24 CFR 81.13 - Central Cities, Rural Areas, and Other Underserved Areas Housing Goal.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Central Cities, Rural Areas, and...) Housing Goals § 81.13 Central Cities, Rural Areas, and Other Underserved Areas Housing Goal. (a) Purpose... cities, rural areas, and other underserved areas is intended to achieve increased purchases by the GSEs...

Leadership Advocacy: Bringing Nursing to the Homeless and Underserved.

PubMed

Porter-OʼGrady, Tim

Nurses have historically played a key role in advocacy and service for all members of the community, including those who are traditionally underserved by other providers or the health system. Nurses from a local Atlanta community health system, both clinical and administrative, have continued this tradition by developing an advocacy and service program for the downtown homeless of Atlanta. From its beginnings as a highly informal volunteer program to its current structure as a strongly integrated community health center for the underserved and homeless of Atlanta, local nurses have demonstrated their strong value of service advocacy. Their leadership, insight, discipline, and strategic development have facilitated the growth of a focused, viable health service network for marginalized people of the city of Atlanta.

Preconception Health Behaviors of Low-Income Women.

PubMed

Ayoola, Adejoke B; Sneller, Krista; Ebeye, Tega D; Dykstra, Megan Jongekrijg; Ellens, Victoria L; Lee, HaEun Grace; Zandee, Gail L

2016-01-01

Preconception behaviors have a significant impact on birth outcomes, particularly among low-income minority groups, and women with unplanned pregnancies. This study examined women's perceived health status and behaviors such as drinking, smoking, exercise, and use of multivitamins and folic acid. This was a descriptive study based on a convenience sample of women living in urban underserved neighborhoods. Univariate and bivariate analyses were conducted using STATA 13. The sample consisted of 123 women ages 18 to 51 years (mean = 30.57); 51.22% were Hispanic, 36.59% African American, and 12.2% Caucasian. Over 70% had a household income of less than $20,000, 57.72% had no health insurance in the last year, and 58.54% were not married. These women were below the Healthy People 2020 goals for drinking, smoking, and multivitamin use, especially those who were planning to get pregnant in the next 6 months or not sure of their pregnancy planning status. There were no significant differences on any of the preconception health behavior variables based on pregnancy intention. Nurses and healthcare providers should emphasize importance of practicing healthy behaviors during the preconception period among low-income ethnic minority women specifically those living in urban medically underserved areas who are unsure of their pregnancy planning status or are at risk of unintended pregnancy.

Creating a Culturally Appropriate Web-Based Behavioral Intervention for American Indian/Alaska Native Women in Southern California: The Healthy Women Healthy Native Nation Study

ERIC Educational Resources Information Center

Gorman, Jessica R.; Clapp, John D.; Calac, Daniel; Kolander, Chelsea; Nyquist, Corinna; Chambers, Christina D.

2013-01-01

Health disparities in fetal alcohol spectrum disorders (FASD) are of high importance to American Indian/Alaska Native (AI/AN) communities. We conducted focus groups and interviews with 21 AI/AN women and key informants in Southern California to modify a brief, Web-based program for screening and prevention of prenatal alcohol use. This process…

Physical activity promotion among underserved adolescents: "make it fun, easy, and popular".

PubMed

Louise Bush, Paula; Laberge, Suzanne; Laforest, Sophie

2010-05-01

There is a paucity of studies regarding noncurricular physical activity promotion interventions among adolescents, and even less such research pertaining to underserved youth. This article describes the development and implementation of a noncurricular, school-based physical activity promotion program designed for a multiethnic, underserved population of adolescents. The program's impact on leisure-time physical activity (LTPA) and on physical activity enjoyment (PAE) is also presented. The 16-week program, named FunAction, utilizes social marketing principles. Control (n = 90) and intervention (n = 131) students are assessed pre- and postintervention for levels of LTPA and PAE. Results indicate that although the program did not contribute to an increase in LTPA or PAE among intervention group students, participation in the program was elevated. This study offers preliminary evidence that noncurricular physical activity promotion programs that apply social marketing principles can be effective in engaging multiethnic, underserved adolescents in physical activity.

Breast cancer incidence patterns among California Hispanic women: Differences by nativity and residence in an enclave

PubMed Central

Keegan, Theresa H.M.; John, Esther M.; Fish, Kari M.; Alfaro-Velcamp, Theresa; Clarke, Christina A.; Gomez, Scarlett L.

2010-01-01

Background Breast cancer incidence is higher in US-born Hispanic women than foreign-born Hispanics, but no studies have examined how these rates have changed over time. To better inform cancer control efforts, we examined incidence trends by nativity and incidence patterns by neighborhood socioeconomic status (SES) and Hispanic enclave (neighborhoods with high proportions of Hispanics or Hispanic immigrants). Methods Information regarding all Hispanic women diagnosed with invasive breast cancer between 1988 and 2004 were obtained from the California Cancer Registry. Nativity was imputed from Social Security number for the 27% of cases with missing birthplace information. Neighborhood variables were developed from Census data. Results From 1988 to 2004, incidence rates for US-born Hispanics were parallel, but lower than, those of non-Hispanic whites, showing an annual 6% decline from 2002 to 2004. Foreign-born Hispanics had an annual 4% increase in incidence rates from 1995 to 1998 and a 1.4% decline thereafter. Rates were 38% higher for US- than foreign-born Hispanics, with elevations more pronounced for localized than regional/distant disease, and for women > 50 years of age. Residence in higher SES and lower Hispanic enclave neighborhoods were independently associated with higher incidence, with Hispanic enclave having a stronger association than SES. Conclusions Compared to foreign-born, US-born Hispanic women in California had higher prevalence of breast cancer risk factors, suggesting that incidence patterns largely reflects these differences in risk factors. Impact Further research is needed to separate the effects of individual- and neighborhood-level factors that impact incidence in this large and growing population. PMID:20447917

Impact of selection strategies on representation of underserved populations and intention to practise: international findings.

PubMed

Larkins, Sarah; Michielsen, Kristien; Iputo, Jehu; Elsanousi, Salwa; Mammen, Marykutty; Graves, Lisa; Willems, Sara; Cristobal, Fortunato L; Samson, Rex; Ellaway, Rachel; Ross, Simone; Johnston, Karen; Derese, Anselme; Neusy, André-Jacques

2015-01-01

Socially accountable medical schools aim to reduce health inequalities by training workforces responsive to the priority health needs of underserved communities. One key strategy involves recruiting students from underserved and unequally represented communities on the basis that they may be more likely to return and address local health priorities. This study describes the impacts of different selection strategies of medical schools that aspire to social accountability on the presence of students from underserved communities in their medical education programmes and on student practice intentions. A cross-sectional questionnaire was administered to students starting medical education in five institutions with a social accountability mandate in five different countries. The questionnaire assessed students' background characteristics, rurality of background, and practice intentions (location, discipline of practice and population to be served). The results were compared with the characteristics of students entering medical education in schools with standard selection procedures, and with publicly available socio-economic data. The selection processes of all five schools included strategies that extended beyond the assessment of academic achievement. Four distinct strategies were identified: the quota system; selection based on personal attributes; community involvement, and school marketing strategies. Questionnaire data from 944 students showed that students at the five schools were more likely to be of non-urban origin, of lower socio-economic status and to come from underserved groups. A total of 407 of 810 (50.2%) students indicated an intention to practise in a non-urban area after graduation and the likelihood of this increased with increasing rurality of primary schooling (p = 0.000). Those of rural origin were statistically less likely to express an intention to work abroad (p = 0.003). Selection strategies to ensure that members of underserved communities

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

PubMed

Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

2016-05-01

Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

Asilomar Leadership Skills Seminar: The Career Preparation, Advancement, and Enhancement of Women in California Community College Leadership

ERIC Educational Resources Information Center

Castillo-Garrison, Estella M.

2012-01-01

This mixed-methods research study examined the effects on the career preparation, advancement, and enhancement of women from California community college leadership who participated in the Asilomar Leadership Skills Seminar (Asilomar) from 2005-2011. Data were collected during the 2011-2012 academic year and were gathered from the results of 67…

Community Perspectives on Cultural Considerations for Breast and Cervical Cancer Education among Marshallese Women in Orange County, California

PubMed Central

Briand, Greta; Peters, Ruth

2017-01-01

The Marshallese community of Orange County California is a part of a highly mobile population that migrates between Hawai‘i, Arkansas, Washington, and California. In Orange County, the Marshallese community is primarily centered on faith-based organization in the city of Costa Mesa. Culture and language strengthen the bonds between different Marshallese communities across the U.S., and churches serve as conduits for communication between groups. Culture also places an important role in guiding behavior pertaining to health and social interaction. For instance, as in many other cultures, Marshallese men and women do not speak to each other about health, particularly reproductive health, in an open social setting. In Orange County, one female Marshallese health educator promotes breast and cervical cancer screening by talking informally with women, usually in faith-based settings and in-home visits. This community commentary describes the key cultural considerations and strategies used by the health educator to reach and educate the community. PMID:29805327

Factors Limiting Youth Participation in 4-H and Other Youth Development Programs in Underserved Communities

ERIC Educational Resources Information Center

Avent, Martellis D.; Jayaratne, K. S. U.

2017-01-01

The purpose of the study described here was to identify factors limiting children's participation in youth development programs in underserved communities and ways to overcome those limitations. Findings are based on focus group interviews conducted with members of two underserved communities in North Carolina. Lack of awareness about the 4-H…

Unique Challenges to Preventing Perinatal HIV Transmission among Hispanic Women in California: Results of a Needs Assessment

ERIC Educational Resources Information Center

Kropp, Rhonda Y.; Montgomery, Elizabeth T.; Hill, David W.; Ruiz, Juan D.; Maldonado, Yvonne A.

2005-01-01

To identify rates and factors associated with timely prenatal care (PNC) initiation, HIV test counseling, test offering, and test offer acceptance, we conducted a semistructured survey of a convenience sample of pregnant/recently delivered Hispanic women (n = 453, 418 with analyzable data) in four California counties in 2000. Only 68.4% and 43.5%…

The challenges of working in underserved areas: a qualitative exploratory study of views of policy makers and professionals.

PubMed

AbuAlRub, Raeda F; El-Jardali, Fadi; Jamal, Diana; Iblasi, Abdulkareem S; Murray, Susan F

2013-01-01

The inadequate number of health care providers, particularly nurses, in underserved areas is one of the biggest challenges for health policymakers. There is a scarcity of research in Jordan about factors that affect nurse staffing and retention in underserved areas. To elucidate the views of staff nurses working in underserved areas, directors of health facilities in underserved areas and key informants from the policy and education arena on issues of staffing and retention of nurses in underserved areas. An exploratory study using a qualitative approach with semi-structured interviews was utilized to elucidate the views of 22 key informants from the policy and education arena, 11 directors of health centers, and 19 staff nurses on issues that contribute to low staffing and retention of nurses in underserved areas. The five stage 'framework approach' proposed by Bryman et al. (1993) was utilized for data analysis. Nursing shortage in underserved areas in Jordan are exacerbated by a lack of financial incentives, poor transportation and remoteness of these areas, bad working conditions, and lack of health education institutions in these areas, as well as by opportunities for internal and external migration. Young Jordanian male nurses usually grab any opportunity to migrate and work outside the country to improve their financial conditions; whereas, female nurses are more restricted and not encouraged to travel abroad to work. Several strategies are suggested to enhance retention in these areas, such as promoting financial incentives for staff to work there, enhancing the transportation system, and promoting continuous and academic education. Nurses' administrators and health care policy makers could utilize the findings of the present study to design and implement comprehensive interventions to enhance retention of staff in underserved areas. Copyright © 2012 Elsevier Ltd. All rights reserved.

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

PubMed Central

Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

2016-01-01

Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast

Redefining Science, Technology, Engineering, and Mathematics (STEM) Educational Opportunities for Underserved and Underrepresented Students at NASA

ERIC Educational Resources Information Center

Hackler, Amanda Smith

2011-01-01

Underserved and underrepresented students consistently leave science, technology, engineering, and mathematics (STEM) degree fields to pursue less demanding majors. This perpetual problem slowed the growth in STEM degree fields (United States Department of Labor, 2007). Declining enrollment in STEM degree fields among underserved and…

The central city site: an urban underserved family medicine training track.

PubMed

Bade, Elizabeth; Baumgardner, Dennis; Brill, John

2009-01-01

We describe the development of an urban track in family medicine residency designed to recruit a high percentage of minority students and promote their future practice in urban, underserved areas of Milwaukee. We report here on the residents and their first practice location and compared this information to what occurred in our original "main" residency program. Information about the program's development was obtained through testimonials from faculty and residency graduates and review of the original accreditation application to the Residency Review Committee. Information about the residents and their practice locations was obtained from the National Resident Matching Program and graduate placement data. The goal of training more minority doctors in Milwaukee was met, with eight of 16 (50%) residents at our urban-track site from minority groups. This compared to only 12% at our main program. Thirty-eight percent of graduates stayed to practice in an underserved area, compared to only 21% in our main program. Development of an urban track for our family medicine residency increased the number of minority physicians trained and the number of physicians practicing in underserved areas after graduation.

Crowdsourced Microfinance for Energy Efficiency in Underserved Communities

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baird, Donnel; Cox, Morris; Harmarneh, Sarey

BlocPower’s mission is to provide access to energy efficiency financing for underserved communities across the United States. This project, “Crowdsourced Microfinance for Energy Efficiency in Underserved Communities,” is an extension of that goal and is grounded in the principles of providing engineering and financing services to those in need. The project is based on the creation of a BlocPower Marketplace as a central hub for connecting shovel-ready green buildings to institutional investors. This ‘connection’ entails using online crowdfunding to aggregate debt and equity capital from institutional investors to connect to customers (building owners) across various financial portfolios. BlocPower Marketplace ismore » intended to bring social, environmental, and financial returns to investors while also decreasing investor risk by loaning out funds for energy installations in individual buildings. In detail, the intended benefits of crowdsourcing are two-sided. Firstly, for building owners, clean energy retrofit installations improve building operations, reduce utility costs, and reduce harmful impacts to their surrounding environment. Secondly, for institutional investors, they gain access to a new market of energy efficiency and are able to provide debt or equity capital with high financial returns. This gives investors the opportunity to create social and environmental impact in communities around the country as well. With this in mind, BlocPower designed the marketplace to specifically answer exploratory research questions with respect to the pricing of energy financing. Institutional investors typically charge high rates on project financing solutions in the energy space, particularly in low and middle-income communities, because of fears that required debt service will not be made. This makes access to energy capital exorbitantly difficult for those that need it the most. Through this project, BlocPower tested investor appetite to determine if

Economic feasibility of alternative practitioners for provision of dental care to the underserved.

PubMed

Matthiesen, Anne

2012-01-01

This study assesses the viability of three alternative practitioner types for provision of dental care to the underserved. Key factors modeled include compensation, training and practice costs, productivity, and payer mix scenarios. Utilizing dental therapists or dental health aide therapists is cost-effective for enhancing access. However, to be sustainable, the practices will require a subsidy or a better reimbursement than modeled. Without tuition support, the debt burden will deter applicants mostlikely to treat the underserved.

A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

PubMed

Flaer, Paul J; Younis, Mustafa Z; Benjamin, Paul L; Al Hajeri, Maha

2010-01-01

Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Evidence-based practice (i.e., based on research using the scientific method) has been

A Report on the Status of Women in Education: Achieving Gender Equity for Women and Girls

ERIC Educational Resources Information Center

Mobley, Pamela Rios

2010-01-01

In 2005, the National Education Association (NEA) began publishing a series of reports on the status of underserved groups in education. This report on the status of women and girls is based on the principle that every student has the human and civil right to a quality public education. America's public schools are expected to serve the needs of…

Curriculum Recommendations of the AACP-PSSC Task Force on Caring for the Underserved

PubMed Central

Roche, Victoria F.; Assemi, Mitra; Conry, John M.; Shane-McWhorter, Laura; Sorensen, Todd D.

2008-01-01

A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy. The AACP-PSSC curriculum framework was shared with the academy in 2007. Schools and Colleges are urged to share experiences with implementation so that the impact of the tool can be evaluated. The task force recommends that the AACP Institutional Research Advisory Committee be involved in gathering assessment data. Implementation of the curriculum framework can help the academy fulfill the professional mandate to proactively provide the highest quality care to all, including underserved populations. PMID:18698398

Clinical medical education in rural and underserved areas and eventual practice outcomes: A systematic review and meta-analysis.

PubMed

Raymond Guilbault, Ryan William; Vinson, Joseph Alexander

2017-01-01

Undergraduate medical students are enrolled in clinical education programs in rural and underserved urban areas to increase the likelihood that they will eventually practice in those areas and train in a primary care specialty to best serve those patient populations. MEDLINE and Cochrane Library online databases were searched to identify articles that provide a detailed description of the exposure and outcome of interest. A qualitative review of articles reporting outcome data without comparison or control groups was completed using the Medical Education Research Study Quality Instrument (MERSQI). A meta-analysis of articles reporting outcome data with comparison or control groups was completed with statistical and graphical summary estimates. Seven hundred and nine articles were retrieved from the initial search and reviewed based on inclusion and exclusion criteria. Of those, ten articles were identified for qualitative analysis and five articles included control groups and thus were included in the quantitative analysis. Results indicated that medical students with clinical training in underserved areas are almost three times as likely to practice in underserved areas than students who do not train in those areas (relative risk [RR] = 2.94; 95% confidence interval [CI]: 2.17, 4.00). Furthermore, medical students training in underserved areas are about four times as likely to practice primary care in underserved areas than students who do not train in those locations (RR = 4.35; 95% CI: 1.56, 12.10). These estimates may help guide medical school administrators and policymakers to expand underserved clinical training programs to help relieve some of the problems associated with access to medical care among underserved populations.

An Exploration of How Marital Expectations and Socio-Economic Status Impact Post-Secondary Educational and Professional Goals of Northern California Asian Indian Immigrant Women

ERIC Educational Resources Information Center

Bhatia, Aparna

2013-01-01

This phenomenological study explored the impact of marital expectations and socio-economic status on post-secondary educational and professional goals of Northern California Asian Indian immigrant women both before and after marriage. For the purposes of this study, 15 Southeast Asian Indian immigrant women from the Sacramento metropolitan region…

The Online-Counseling Debate: A View toward the Underserved

ERIC Educational Resources Information Center

Sanchez-Page, Delida

2005-01-01

This article responds to some important issues that Mallen, Vogel, Rochlen, and Day raise in "Online Counseling: Reviewing the Literature from a Counseling Psychology Framework." This reaction reviews the appropriateness of online counseling for underserved populations. The author provides suggestions for better serving historically undeserved…

Thyroid Hormones and Moderate Exposure to Perchlorate during Pregnancy in Women in Southern California.

PubMed

Steinmaus, Craig; Pearl, Michelle; Kharrazi, Martin; Blount, Benjamin C; Miller, Mark D; Pearce, Elizabeth N; Valentin-Blasini, Liza; DeLorenze, Gerald; Hoofnagle, Andrew N; Liaw, Jane

2016-06-01

Findings from national surveys suggest that everyone in the United States is exposed to perchlorate. At high doses, perchlorate, thiocyanate, and nitrate inhibit iodide uptake into the thyroid and decrease thyroid hormone production. Small changes in thyroid hormones during pregnancy, including changes within normal reference ranges, have been linked to cognitive function declines in the offspring. We evaluated the potential effects of low environmental exposures to perchlorate on thyroid function. Serum thyroid hormones and anti-thyroid antibodies and urinary perchlorate, thiocyanate, nitrate, and iodide concentrations were measured in 1,880 pregnant women from San Diego County, California, during 2000-2003, a period when much of the area's water supply was contaminated from an industrial plant with perchlorate at levels near the 2007 California regulatory standard of 6 μg/L. Linear regression was used to evaluate associations between urinary perchlorate and serum thyroid hormone concentrations in models adjusted for urinary creatinine and thiocyanate, maternal age and education, ethnicity, and gestational age at serum collection. The median urinary perchlorate concentration was 6.5 μg/L, about two times higher than in the general U.S. Adjusted associations were identified between increasing log10 perchlorate and decreasing total thyroxine (T4) [regression coefficient (β) = -0.70; 95% CI: -1.06, -0.34], decreasing free thyroxine (fT4) (β = -0.053; 95% CI: -0.092, -0.013), and increasing log10 thyroid-stimulating hormone (β = 0.071; 95% CI: 0.008, 0.133). These results suggest that environmental perchlorate exposures may affect thyroid hormone production during pregnancy. This could have implications for public health given widespread perchlorate exposure and the importance of thyroid hormone in fetal neurodevelopment. Steinmaus C, Pearl M, Kharrazi M, Blount BC, Miller MD, Pearce EN, Valentin-Blasini L, DeLorenze G, Hoofnagle AN, Liaw J. 2016. Thyroid

Physician assistants as servant leaders: meeting the needs of the underserved.

PubMed

Huckabee, Michael J; Wheeler, Daniel W

2011-01-01

The purpose of this study was to determine if the level of servant leader characteristics in clinically practicing physician assistants (PAs) in underserved populations differed from PAs serving in other locales. Five subscales of servant leadership: altruistic calling, emotional healing, wisdom, persuasive mapping, and organizational stewardship, were measured in a quantitative study of clinically practicing PAs using a self-rating survey and a similar survey by others rating the PA. Of 777 PAs invited, 321 completed the survey. On a scale of 1 to 5, mean PA self-ratings ranged from 3.52 (persuasive mapping) to 4.05 (wisdom). Other raters' scores paired with the self-rated PA scores were comparable in all subscales except wisdom, which was rated higher by the other raters (4.32 by other raters, 4.01 by PAs, P= .002). There was no significant difference in the measures of servant leadership reported by PAs serving the underserved compared to PAs serving in other populations. Servant leader subscales were higher for PAs compared to previous studies of other health care or community leader populations. The results found that the PA population studied had a prominent level of servant leadership characteristics that did not differ between those working with underserved and nonunderserved populations.

Conceptualizing the Issue of Underserved Populations of Gifted Students.

ERIC Educational Resources Information Center

Whitmore, Joanne

1987-01-01

Among the underserved are gifted students who lack achievement motivation or environmental nurturance or have developmental delays or learning disabilities. Unified efforts by those involved in the education of the handicapped and the gifted can improve the identification of individual needs and individualization of instruction. (Author/CB)

76 FR 42760 - SBA Council on Underserved Communities Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-19

... SMALL BUSINESS ADMINISTRATION SBA Council on Underserved Communities Meeting AGENCY: U.S. Small Business Administration (SBA). ACTION: Notice of Federal advisory committee meeting. SUMMARY: The SBA is... meeting will be held at the U.S. Small Business Administration: 409 3rd St SW., Eisenhower Conference Room...

The Affordable Care Act and genetic testing for inheritable cancer syndromes: impact on high-risk underserved minorities.

PubMed

Walcott, Farzana L; Dunn, Barbara K; DeShields, Mary; Baquet, Claudia

2014-02-01

Genetic testing for inheritable cancer syndromes is becoming a critical part of preventive health services. The Patient Protection and Affordable Care Act (PPACA) Essential Health Benefits package addresses breast cancer susceptibility-gene testing for women who are unaffected by cancer. The absence of provisions for 1) men, 2) cancer patients, 3) other inheritable cancer syndromes, and 4) risk-reducing interventions are limitations of PPACA. We discuss provisions and limitations of PPACA pertaining to genetic testing and effects on high-risk populations, in particular minorities. The PPACA is the beginning of an ongoing process of incorporating genetic testing in the armamentarium of cancer prevention. Future efforts should focus on ensuring equitable access to genetic testing as a preventive service under PPACA to high-risk populations other than women. Consideration should also be given to provisions for risk-reducing interventions, especially in underserved minority populations, who are known to underutilize genetic testing and may have limited financial resources for medical intervention.

"Are you eating healthy?" Nutrition discourse in Midwestern clinics for the underserved.

PubMed

Curtis, Stephanie M; Willis, Mary S

2016-10-01

To investigate nutrition information provided and exchanged between patients and health providers in Midwestern clinics for underserved populations. Forty-six clinic visits were observed to determine content and direction of nutrition information. In-depth data were collected with clinicians and clinic administrators regarding nutrition education provided to patients. All patients were diagnosed with multiple obesity-related morbidities. Although women more often posed nutrition questions, few patients asked about dietary intake. Two-thirds of healthcare professionals initiated discussion about dietary intake; however, nutrition education was not provided regardless of clinician's profession. Patients did not appear to link morbidity with diet. Providers did not share comprehensive nutrition knowledge during clinic visits. Dietitians, who specialize in nutrition education, rarely had access to patients. Nutrition education during clinic visits is essential for reducing obesity rates. Nutrition students need clinic experience and could provide important patient education at low cost. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Engaging diverse underserved communities to bridge the mammography divide.

PubMed

Engelman, Kimberly K; Cupertino, Ana Paula; Daley, Christine M; Long, Trish; Cully, Angelia; Mayo, Matthew S; Ellerbeck, Edward F; Geana, Mugur V; Greiner, Allen

2011-01-21

Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas-Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer prevention informational

Engaging diverse underserved communities to bridge the mammography divide

PubMed Central

2011-01-01

Background Breast cancer screening continues to be underutilized by the population in general, but is particularly underutilized by traditionally underserved minority populations. Two of the most at risk female minority groups are American Indians/Alaska Natives (AI/AN) and Latinas. American Indian women have the poorest recorded 5-year cancer survival rates of any ethnic group while breast cancer is the number one cause of cancer mortality among Latina women. Breast cancer screening rates for both minority groups are near or at the lowest among all racial/ethnic groups. As with other health screening behaviors, women may intend to get a mammogram but their intentions may not result in initiation or follow through of the examination process. An accumulating body of research, however, demonstrates the efficacy of developing 'implementation intentions' that define when, where, and how a specific behavior will be performed. The formulation of intended steps in addition to addressing potential barriers to test completion can increase a person's self-efficacy, operationalize and strengthen their intention to act, and close gaps between behavioral intention and completion. To date, an evaluation of the formulation of implementation intentions for breast cancer screening has not been conducted with minority populations. Methods/Design In the proposed program, community health workers will meet with rural-dwelling Latina and American Indian women one-on-one to educate them about breast cancer and screening and guide them through a computerized and culturally tailored "implementation intentions" program, called Healthy Living Kansas - Breast Health, to promote breast cancer screening utilization. We will target Latina and AI/AN women from two distinct rural Kansas communities. Women attending community events will be invited by CHWs to participate and be randomized to either a mammography "implementation intentions" (MI2) intervention or a comparison general breast cancer

Pediatric and Adolescent Issues in Underserved Populations.

PubMed

Desai, Neerav; Romano, Mary Elizabeth

2017-03-01

Children and adolescents in underserved populations have health care risks that are different from those of the adult population. Providers need to be aware of these needs and the available resources. Providers should work with school and community organizations to provide timely and appropriate preventive health care and screen for medical and mental health problems that occur more commonly in these high-risk patient populations. Copyright © 2016 Elsevier Inc. All rights reserved.

Consumption habits of pregnant women and implications for developmental biology: a survey of predominantly Hispanic women in California.

PubMed

Santiago, Sarah E; Park, Grace H; Huffman, Kelly J

2013-07-01

Healthy post-pregnancy outcomes are contingent upon an informed regimen of prenatal care encouraging healthy maternal consumption habits. In this article, we describe aspects of maternal intake of food, drink, and medication in a population of predominantly Hispanic women in Southern California. Potential implications for unhealthy prenatal dietary choices are discussed. The Food, Beverage, and Medication Intake Questionnaire (FBMIQ) measures common practices of maternal consumption during pregnancy. The FBMIQ was administered to English and Spanish speaking pregnant and recently pregnant (36 weeks pregnant - 8 weeks post-partum) women over the age of 18 who were receiving care from a private medical group in Downey CA. A total of 200 women completed the FBMIQ. Consumption habits of healthy foods and beverages, unhealthy foods, unhealthy beverages, and medication are characterized in this article. Data indicate widespread consumption of fresh fruit, meats, milk and juice and indicate most women used prenatal vitamin supplements. Studies in developmental neuroscience have shown that certain substances may cause teratogenic effects on the fetus when ingested by the mother during pregnancy. Those potentially harmful substances included in our study were Bisphenol-A (BPA), methylmercury, caffeine, alcohol and certain medications. Our results show that a proportion of the women surveyed in our study consumed BPA, methylmercury, caffeine, alcohol, and certain medications at varied levels during pregnancy. This represents an interesting finding and suggests a disconnect between scientific data and general recommendations provided to pregnant mothers by obstetricians. The results of our study demonstrate that a proportion of pregnant women consume substances that are potentially teratogenic and may impact the health and well being of the offspring. It is important to appraise healthy and unhealthy consumption habits in order to encourage healthy practices and alleviate

Consumption habits of pregnant women and implications for developmental biology: a survey of predominantly Hispanic women in California

PubMed Central

2013-01-01

Background Healthy post-pregnancy outcomes are contingent upon an informed regimen of prenatal care encouraging healthy maternal consumption habits. In this article, we describe aspects of maternal intake of food, drink, and medication in a population of predominantly Hispanic women in Southern California. Potential implications for unhealthy prenatal dietary choices are discussed. Methods The Food, Beverage, and Medication Intake Questionnaire (FBMIQ) measures common practices of maternal consumption during pregnancy. The FBMIQ was administered to English and Spanish speaking pregnant and recently pregnant (36 weeks pregnant - 8 weeks post-partum) women over the age of 18 who were receiving care from a private medical group in Downey CA. Results A total of 200 women completed the FBMIQ. Consumption habits of healthy foods and beverages, unhealthy foods, unhealthy beverages, and medication are characterized in this article. Data indicate widespread consumption of fresh fruit, meats, milk and juice and indicate most women used prenatal vitamin supplements. Studies in developmental neuroscience have shown that certain substances may cause teratogenic effects on the fetus when ingested by the mother during pregnancy. Those potentially harmful substances included in our study were Bisphenol-A (BPA), methylmercury, caffeine, alcohol and certain medications. Our results show that a proportion of the women surveyed in our study consumed BPA, methylmercury, caffeine, alcohol, and certain medications at varied levels during pregnancy. This represents an interesting finding and suggests a disconnect between scientific data and general recommendations provided to pregnant mothers by obstetricians. Conclusions The results of our study demonstrate that a proportion of pregnant women consume substances that are potentially teratogenic and may impact the health and well being of the offspring. It is important to appraise healthy and unhealthy consumption habits in order to

Exercise and Sports Medicine Issues in Underserved Populations.

PubMed

Morelli, Vincent; Bedney, Daniel L; Eric Dadush, Arie

2017-03-01

Primary care providers can make a strong argument for exercise promotion in underserved communities. The benefits are vitally important in adolescent physical, cognitive, and psychological development as well as in adult disease prevention and treatment. In counseling such patients, we should take into account a patient's readiness for change and the barriers to exercise. Copyright © 2016 Elsevier Inc. All rights reserved.

Unintended Consequences of Smoke-Free Bar Policies for Low-SES Women in Three California Counties

PubMed Central

Moore, Roland S.; Annechino, Rachelle M.; Lee, Juliet P.

2009-01-01

Background To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. Methods The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Results Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Conclusions Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular. PMID:19591753

Unintended consequences of smoke-free bar policies for low-SES women in three California counties.

PubMed

Moore, Roland S; Annechino, Rachelle M; Lee, Juliet P

2009-08-01

To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

HRSA's collaborative efforts with national organizations to expand primary care for the medically underserved.

PubMed Central

Crane, A B

1991-01-01

As the Federal agency that provides leadership in expanding access to primary health care, the Health Resources and Services Administration (HRSA) manages some 50 programs directed toward the delivery of services and strengthening the base of national health resources. An enabling element of the agency's strategy is the expansion of partnerships with national associations, private foundations, and other entities that share a concern for the health care of the medically underserved. Cooperative efforts with national organizations are intended to promote the integration of public and private resources and encourage adoption of efficient approaches to organizing and financing health care. Medical education in the primary care specialties, State programs for women and children, involvement of managed care organizations with low-income populations, and programs concerning the uninsured are the foci of some of these collaborative relationships. PMID:1899932

Welfare and immigration reform and use of prenatal care among women of Mexican ethnicity in San Diego, California.

PubMed

Loue, Sana; Cooper, Marlene; Lloyd, Linda S

2005-01-01

Foreign-born women and, in particular, Hispanic foreign-born women, are less likely to have insurance, are less likely to have insurance that covers prenatal care, and are less likely to utilize prenatal care compared with US-born Hispanic women. Significant concern has been raised regarding the ability of immigrant women to access prenatal care services because of severe restrictions imposed on immigrants' eligibility for Medicaid-funded services following the passage in 1996 of the federal Personal Responsibility and Work Opportunity Reform Act (PRWORA) and the Illegal Immigration Reform and Immigrant Responsibility Act (IIRAIRA). We conducted an interview-based study of prenatal care utilization with women of Mexican ethnicity and diverse immigration statuses in San Diego County, California. Our findings indicate that, despite increased levels of fear associated with recent immigration and with undocumented status, there were no statistically significant differences across immigration statuses in length of time to receipt of medical care for gynecological events and for prenatal care.

Medical students' attitudes toward underserved populations: changing associations with choice of primary care versus non-primary care residency.

PubMed

Wayne, Sharon; Timm, Craig; Serna, Lisa; Solan, Brian; Kalishman, Summers

2010-05-01

The number of medical students entering primary care residencies continues to decrease. The association between student attitudes toward underserved populations and residency choice has received little attention even though primary care physicians see a larger proportion of underserved patients than most other specialists. We evaluated attitudes toward underserved populations in 826 medical students using a standardized survey, and used logistic regression to assess the effect of attitudes, along with other variables, on selection of a primary care residency. We compared results between two groups defined by year of entry to medical school (1993-99 and 2000-05) to determine whether associations differed by time period. Students' attitudes regarding professional responsibility toward underserved populations remained high over the study period; however, there was a statistically. significant association between positive attitudes and primary care residency in the early cohort only. This association was not found in the more recent group.

Breast cancer screening practices and correlates among American Indian and Alaska Native women in California, 2003

PubMed Central

Eberth, Jan M.; Huber, John Charles; Rene, Antonio

2010-01-01

Background Breast cancer incidence and mortality have been increasing among American Indian and Alaska Native (AI/AN) women, and their survival rate is the lowest of all racial/ethnic groups. Nevertheless, knowledge of AI/AN women’s breast cancer screening practices and their correlates is limited. Methods Using the 2003 California Health Interview Survey, we 1) compared the breast cancer screening practices of AI/AN women to other groups and 2) explored the association of several factors known or thought to influence AI/AN women’s breast cancer screening practices. Findings Compared to other races, AI/AN women had the lowest rate of mammogram screening (ever and within the past 2 years). For clinical breast exam receipt, Asian women had the lowest rate, followed by AI/AN women. Factors associated with AI/AN women’s breast cancer screening practices included older age, having a high school diploma or some college education, receipt of a Pap test within the past 3 years, and having visited a doctor within the past year. Conclusions Significant differences in breast cancer screening practices were noted between races, with AI/AN women often having significantly lower rates. Integrating these epidemiological findings into effective policy and practice requires additional applied research initiatives. PMID:20211430

Personal values of family physicians, practice satisfaction, and service to the underserved.

PubMed

Eliason, B C; Guse, C; Gottlieb, M S

2000-03-01

Personal values are defined as "desirable goals varying in importance that serve as guiding principles in people's lives," and have been shown to influence specialty choice and relate to practice satisfaction. We wished to examine further the relationship of personal values to practice satisfaction and also to a physician's willingness to care for the underserved. We also wished to study associations that might exist among personal values, practice satisfaction, and a variety of practice characteristics. We randomly surveyed a stratified probability sample of 1224 practicing family physicians about their personal values (using the Schwartz values questionnaire), practice satisfaction, practice location, breadth of practice, demographics, board certification status, teaching involvement, and the payor mix of the practice. Family physicians rated the benevolence (motivation to help those close to you) value type highest, and the ratings of the benevolence value type were positively associated with practice satisfaction (correlation coefficient = 0.14, P = .002). Those involved in teaching medical trainees were more satisfied than those who were not involved (P = .009). Some value-type ratings were found to be positively associated with caring for the underserved. Those whose practices consisted of more than 40% underserved (underserved defined as Medicare, Medicaid, and indigent populations) rated the tradition (motivation to maintain customs of traditional culture and religion) value type significantly higher (P = .02). Those whose practices consisted of more than 30% indigent care rated the universalism (motivation to enhance and protect the well-being of all people) value type significantly higher (P = .03). Family physicians who viewed benevolence as a guiding principle in their lives reported a higher level of professional satisfaction. Likewise, physicians involved in the teaching of medical trainees were more satisfied with their profession. Family physicians

Exploring religious mechanisms for healthy alcohol use: religious messages and drinking among Korean women in California.

PubMed

Ayers, John W; Hofstetter, C Richard; Hughes, Suzanne C; Irvin, Veronica L; Sim, D Eastern Kang; Hovell, Melbourne F

2009-11-01

This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California. Data were drawn from telephone interviews with female adults (N = 591) selected from a random sampling of persons in California with Korean surnames during 2007. Approximately 70% of attempted interviews were completed, with 92% conducted in Korean. Respondents were asked about any lifetime drinking (yes/no), drinking rate (typical number of drinks consumed on drinking days among current drinkers), and messages discouraging "excessive drinking" from religious leaders or congregants. Bivariable and multivariable regressions were used for analysis. Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1.10 (1.22) drinks on drinking days. About 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability (odds ratio = 0.775, 95% confidence interval [CI]: 0.626, 0.959) of any lifetime drinking. also, each congregant's message was associated with a 13.8% (B = -0.138; 95% CI: -0.306, 0.029) lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate. Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors.

Climate Change and Underserved Communities.

PubMed

Ziegler, Carol; Morelli, Vincent; Fawibe, Omotayo

2017-03-01

Climate change is the greatest global health threat of the twenty-first century, yet it is not widely understood as a health hazard by primary care providers in the United States. Aside from increasing displacement of populations and acute trauma resulting from increasing frequency of natural disasters, the impact of climate change on temperature stress, vector-borne illnesses, cardiovascular and respiratory illnesses, and mental health is significant, with disproportionate impact on underserved and marginalized populations. Primary care providers must be aware of the impact of climate change on the health of their patients and advocate for adaptation and mitigation policies for the populations they serve. Copyright © 2016 Elsevier Inc. All rights reserved.

Show me the money! An analysis of underserved stakeholders' funding priorities in Patient Centered Outcomes Research domains.

PubMed

Cargill, Stephanie Solomon; Baker, Lauren Lyn; Goold, Susan Dorr

2017-07-01

Develop an accessible exercise to engage underserved populations about research funding priorities; analyze the criteria they use to prioritize research; contrast these criteria to those currently used by Patient Centered Outcomes Research Institute (PCORI). Academic and community partners collaborated to develop an Ipad exercise to facilitate group deliberation about PCOR funding priorities. 16 groups (n = 183) of underserved individuals in both urban and rural areas participated. Recordings were qualitatively analyzed for prioritization criteria. Analysis yielded ten codes, many of which were similar to PCORI criteria, but all of which challenged or illuminated these criteria. Directly involving underserved populations in determining funding criteria is both feasible and important, and can better fulfill PCORI's goal of incorporating patient priorities.

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

PubMed

El-Jardali, Fadi; Alameddine, Mohamad; Jamal, Diana; Dimassi, Hani; Dumit, Nuhad Y; McEwen, Mary K; Jaafar, Maha; Murray, Susan F

2013-09-30

Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried

Exploring the relationship between work environment, job satisfaction, and intent to stay of Jordanian nurses in underserved areas.

PubMed

AbuAlRub, Raeda; El-Jardali, Fadi; Jamal, Diana; Abu Al-Rub, Nawzat

2016-08-01

The aims of this study are to (1) examine the relationships between work environment, job satisfaction and intention to stay at work; and (2) explore the predicting factors of intention to stay at work among nurses in underserved areas. Developing and fostering creative work environment are paramount especially in underserved areas, where the work conditions present many challenges. A descriptive correlational design was utilized to collect data from 330 hospital nurses who worked in two underserved governorates in Jordan. A set of instruments were used to measure the variables of the study. The results showed a strong positive association between job satisfaction and work environment. The results of logistic regression indicated receiving housing, job satisfaction, and work environment were the predicting variables of the level of intention to stay at work. It is critical to improve work conditions and create a culture of supportive work environment in underserved area. Copyright © 2015 Elsevier Inc. All rights reserved.

Intrinsic rewards experienced by a group of dentists working with underserved populations.

PubMed

Gardner, S P; Roberts-Thomson, K F; Winning, T A; Peterson, R

2014-09-01

The aim of this study was to explore, using qualitative methods, the intrinsic reasons why dentists work with underserved groups. Minority and marginalized groups of Australians suffer a greater burden of dental disease than the general population due to disparities in accessing care. Recruitment and retention of dentists to care for underserved groups is problematic due to personal, professional and structural reasons. What drives dentists to work with underserved groups is not widely known. Sixteen dentists were recruited using 'snowball' purposeful sampling. Semi-structured in-depth interviews were conducted. Thematic analysis was conducted on the transcriptions to identify themes. Five key themes emerged: (1) 'tapped on the shoulder', being personally approached or invited; (2) 'dental school experience', the challenges faced as a student; (3) 'empathic concern', the non-judgemental expressions of care toward others; (4) 'resilience', the ability to bounce back after setbacks; (5) 'intrinsic reward', the personal gain and satisfaction received. This study focuses on the intrinsic rewards which were found to be simple, unexpected, and associated with relieving pain, community engagement and making a difference. Emphasizing personal fulfilment and intrinsic reward could be useful when promoting dentistry as a career and when encouraging graduates to consider working with disadvantaged groups. © 2014 Australian Dental Association.

Dissemination of physical activity promotion interventions in underserved populations.

PubMed

Yancey, Antronette K; Ory, Marcia G; Davis, Sally M

2006-10-01

Achieving minimum physical activity levels of 30 or more minutes per day will require a variety of intervention strategies to engage each segment of an aging and increasingly ethnically diverse U.S. population. This article presents a focused review of the sparse literature on the diffusion of evidence-based physical activity interventions that are culturally appropriate for underserved populations. Related literature and experiential insights inform this discussion, because so few published studies report outcome data beyond the first diffusion phase of intervention development and evaluation. Three brief case studies are presented to further illustrate and exemplify key concepts and processes at several different stages in diffusing physical activity interventions. Successful engagement of underserved populations reflects a delicate balance between embracing group customs and values and recognizing the nonmonolithic nature of any sociodemographically defined group. The costs of failing to promulgate effective physical activity interventions in these groups continue to mount, in dollars, health, and lives. Researchers, practitioners, decision makers, and policymakers must partner to bridge the evidentiary gap so that the physically active lifestyle choices become the easier choices.

Fulfilling the Promise: Do MOOCS Reach the Educationally Underserved?

ERIC Educational Resources Information Center

Schmid, Lorrie; Manturuk, Kim; Simpkins, Ian; Goldwasser, Molly; Whitfield, Keith E.

2015-01-01

When massive open online courses (MOOCs) began, they held the promise of bringing high-quality, college-level courses from leading academic institutions to people who otherwise would not have access to that type of content. In the ensuing years, it has become clear that the majority of MOOC students are not underserved in terms of educational…

Action Research Approach on Mobile Learning Design for the Underserved

ERIC Educational Resources Information Center

Kim, Paul H.

2009-01-01

This paper discusses an action research study focused on developing a mobile learning model of literacy development for underserved migrant indigenous children in Latin America. The research study incorporated a cyclical action model with four distinctive stages (Strategize, Apply, Evaluate, and Reflect) designed to guide constituencies involved…

Healthcare Mistreatment and Continuity of Cancer Screening among Latino and Anglo American Women in Southern California

PubMed Central

Betancourt, Hector; Flynn, Patricia M.; Ormseth, Sarah R.

2011-01-01

The aim of this research was to examine the relation of perceptions of healthcare mistreatment and related emotions to continuity of cancer screening care among women who reported healthcare mistreatment. The structure of relations among cultural beliefs about healthcare professionals, perceptions of mistreatment, mistreatment-related emotions, and continuity of screening was investigated. Participants included 313 Anglo and Latino American women of varying demographic characteristics from Southern California who were recruited using multistage stratified sampling. Structural equation modeling confirmed the relation of perceptions of mistreatment to continuity of care for both Anglo and Latino American women, with ethnicity moderating this association. For Anglo Americans, greater perceptions of mistreatment were negatively related to continuity of screening. However, for Latinas the relation was indirect, through mistreatment-related anger. While greater perceptions of mistreatment were associated with higher levels of anger for both ethnic groups, anger was negatively related to continuity of care for Latino but not for Anglo women. Furthermore, cultural beliefs about professionals were indirectly related to continuity of screening through perceptions of mistreatment and/or mistreatment-related anger. These findings highlight the importance of the role of cultural and psychological factors in research and interventions aimed at improving patient-professional relations with culturally diverse women. PMID:21391158

Nativity and neighborhood characteristics and cervical cancer stage at diagnosis and survival outcomes among Hispanic women in California.

PubMed

Gomez, Nicole; Guendelman, Sylvia; Harley, Kim G; Gomez, Scarlett Lin

2015-03-01

We examined stage of diagnosis and survival after cervical cancer among Hispanic women, and their associations with Hispanic nativity, and explored whether neighborhood socioeconomic status (SES) and residence in a Hispanic enclave modify the association of nativity with stage and survival. We used California Cancer Registry data (1994-2009) to identify 7958 Hispanic women aged 21 years and older with invasive cervical cancer. We used logistic and Cox proportional hazards models to estimate the associations between stage and mortality with nativity, neighborhood factors, and other covariates. Foreign-born women had similar adjusted relative odds of being diagnosed with stages II through IV (vs stage I) cervical cancer compared with US-born Hispanic women. However, among foreign-born women, those in low-SES-low-enclave neighborhoods were more likely to have late-stage disease than those in high-SES-low-enclave neighborhoods (adjusted odds ratio=1.91; 95% confidence interval=1.18, 3.07). Foreign-born women had lower cervical cancer mortality (adjusted hazard ratio=0.67; 95% confidence interval=0.58, 0.76) than US-born women, but only in high enclaves. Among Hispanic women, nativity, neighborhood enclaves, and SES interact in their influence on stage and survival of cervical cancer.

Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women

ERIC Educational Resources Information Center

Shah, Megha K.; Kieffer, Edith C.; Choi, Hwajung; Schumann, Christina; Heisler, Michele

2015-01-01

Background. Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar,…

Diet and Obesity Issues in the Underserved.

PubMed

Mejia de Grubb, Maria C; Levine, Robert S; Zoorob, Roger J

2017-03-01

The goal of this article is to inform new directions for addressing inequalities associated with obesity by reviewing current issues about diet and obesity among socioeconomically vulnerable and underserved populations. It highlights recent interventions in selected high-risk populations, as well as gaps in the knowledge base. It identifies future directions in policy and programmatic interventions to expand the role of primary care providers, with an emphasis on those aimed at preventing obesity and promoting healthy weight. Copyright © 2016 Elsevier Inc. All rights reserved.

Alumni Engaging Students from Under-Served Groups in Southern Appalachia

ERIC Educational Resources Information Center

Williams, Mitchell R.; Leatherwood, Laura; Byrd, Laura; Boyd, Monica S.; Pennington, Kevin

2010-01-01

The study explores how alumni can help community colleges in Southern Appalachia to create greater access for people in groups which are traditionally under-served by higher education. Semi-structured interviews conducted with alumni program directors and admissions officers at seven community colleges in the Southern Appalachian Region explore…

Exploring Religious Mechanisms for Healthy Alcohol Use: Religious Messages and Drinking Among Korean Women in California*

PubMed Central

Ayers, John W.; Hofstetter, C. Richard; Hughes, Suzanne C.; Irvin, Veronica L.; Kang Sim, D. Eastern; Hovell, Melbourne F.

2009-01-01

Objective: This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California. Method: Data were drawn from telephone interviews with female adults (N = 591) selected from a random sampling of persons in California with Korean surnames during 2007. Approximately 70% of attempted interviews were completed, with 92% conducted in Korean. Respondents were asked about any lifetime drinking (yes/no), drinking rate (typical number of drinks consumed on drinking days among current drinkers), and messages discouraging “excessive drinking” from religious leaders or congregants. Bivariable and multivariable regressions were used for analysis. Results: Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1.10 (1.22) drinks on drinking days. About 30.8%reported about 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability (odds ratio = 0.775, 95% confidence interval [CI]: 0.626, 0.959) of any lifetime drinking. Also, each congregant's message was associated with a 13.8% (B = -0.138; 95% CI: -0.306, 0.029) lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate. Conclusions: Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors. PMID:19895765

Dermatologic care in the homeless and underserved populations: observations from the Venice Family Clinic.

PubMed

Grossberg, Anna L; Carranza, Dafnis; Lamp, Karen; Chiu, Melvin W; Lee, Catherine; Craft, Noah

2012-01-01

Dermatologic care in the homeless and impoverished urban underserved populations is rarely described despite the wide prevalence of skin concerns in this population. Because the homeless population may be subject to increased sun exposure compared to the nonhomeless population, they also may be at increased risk for skin cancer. We sought to describe the spectrum of dermatologic diseases seen in a free clinic in Venice, California--the Venice Family Clinic (VFC)--as well as the differences in diagnoses between the homeless and nonhomeless patients seen at this clinic. A retrospective chart review was performed of dermatology patients (N = 82) seen at VFC throughout the 2006 calendar year. The homeless population (n = 22) was found to have more diagnoses of malignant/premalignant growths (25% [16/64] of all homeless diagnoses) compared to their nonhomeless (n = 60) counterparts (6.1% [8/132] of all nonhomeless diagnoses; P < .0001). This difference was sustained when ethnicity was controlled, with 29.6% [16/54] of diagnoses in the homeless white group consisting of malignant/ premalignant growths compared to 8.9% [4/45] of diagnoses in the nonhomeless white cohort (P < .005). Homeless patients may have a higher incidence of skin cancers and precancerous skin lesions due to increased sun exposure and/or limited access to dermatologic care.

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

PubMed

Dowling, Patrick T; Bholat, Michelle Anne

2012-12-01

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial. Copyright © 2012 Elsevier Inc. All rights reserved.

A national study on nurses’ retention in healthcare facilities in underserved areas in Lebanon

PubMed Central

2013-01-01

Background Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. Methods This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student’s t-test and ANOVA) tests to describe the respondents and examine the significance between nurses’ characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses’ intent to stay in underserved areas. Results A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to

The Physician Pipeline to Rural and Underserved Areas in Pennsylvania

ERIC Educational Resources Information Center

Schwartz, Myron R.

2008-01-01

Context: An implicit objective of a state's investments in medical education is to promote in-state practice of state educated physicians. Purpose: To present a tool for evaluating this objective by analyzing the "pipeline" from medical education to patient care, primary care, rural areas, and underserved areas in Pennsylvania. Methods:…

Coronary artery disease in women: an unsolved dilemma.

PubMed

Aziz, Fahad

2014-04-01

Cardiovascular disease (CVD) is the leading cause of death in women, as well as an important cause of disability, although many women and their physicians underestimate the risk. The pathogenesis, presentation and diagnosis of CVDs are different in women than men, which make the women prone to under-treatment for these diseases. More gender-based research regarding the management of coronary artery disease (CAD) in women needs to be done. Exercise, hypertension treatment, smoking cessation and aspirin therapy are effective measures for the primary prevention of CAD in women. The roles of hormone replacement therapy in primary prevention are not well established. Hormone replacement therapy has not been effective in lowering the risk of recurrent myocardial infarction. Cardiologists and family physicians should emphasize the use of proven treatments, with particular attention given to underserved populations.

Web-Based Intervention for Alcohol Use in Women of Childbearing Potential

ERIC Educational Resources Information Center

Howlett, Katia Delrahim

2010-01-01

There is a need for more effective assessment and primary prevention programs aimed at accurately measuring and reducing alcohol consumption among women before conception in underserved, high-risk populations. Health Information Technology (HIT) may serve this purpose; however, the effectiveness of such tools is not known. We conducted a…

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers.

PubMed

Hébert, James R; Braun, Kathryn L; Kaholokula, Joseph Keawe'aimoku; Armstead, Cheryl A; Burch, James B; Thompson, Beti

2015-01-01

Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians ('Imi Hale-Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities.

Human papillomavirus vaccine use among adolescent girls and young adult women: an analysis of the 2007 California Health Interview Survey.

PubMed

Tiro, Jasmin A; Tsui, Jennifer; Bauer, Heidi M; Yamada, Eileen; Kobrin, Sarah; Breen, Nancy

2012-06-01

Administration of the human papillomavirus (HPV) vaccine is recommended for adolescent girls and young adult women. Little is known about the factors associated with vaccination. This study examined prevalence and correlates of HPV vaccine initiation (≥1 dose) among a statewide representative sample of adolescent and young adult females living in California. HPV vaccination data on 3615 parents of adolescent girls aged 12-17 and 2068 young adult women aged 18-27 from the 2007 California Health Interview Survey (CHIS) were examined by sociodemographic, healthcare access, and health behavior factors using chi-square and multivariable logistic regression models. Nineteen percent of adolescent girls and 11% of young adult women had initiated the HPV vaccine series. In both groups, lower educational attainment (parental/own) was associated with lack of vaccine initiation. For adolescents, vaccine initiation was also significantly lower among those whose parents had low incomes or no usual source of care. For young adults, initiation was lower among the older group and those who spent less time in the United States, had public insurance, had no recent provider visit, or had fewer sexual partners. In a statewide representative sample, different correlates of early initiation of HPV vaccination emerged for Californian adolescent girls and young adult women. These different patterns may be due to differential access to programs that provide free or low-cost HPV vaccines. Because several of these factors are associated with disparities in use of Pap tests, disparities will persist or even worsen unless greater effort is placed on vaccinating populations at highest risk for cervical cancer.

Transformative Vocational Education: Bridging Transitions of Underserved Urban Adult Learners

ERIC Educational Resources Information Center

Adkisson, Anthony C.; Monaghan, Catherine H.

2014-01-01

How our culture thinks about particular events as linear, normal, and expected does not always fit with the experiences of every learner, particularly underserved urban adult learners. As adult educators in this context, are there ways we might improve or change our pedagogy of instruction by developing a better understanding of transitional life…

42 CFR 5a.3 - Definition of Underserved Rural Community.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 1 2012-10-01 2012-10-01 false Definition of Underserved Rural Community. 5a.3 Section 5a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Professions Shortage Area, (under section 332(a)(1)(A) of the Public Health Service Act) or (2) Federally...

42 CFR 5a.3 - Definition of Underserved Rural Community.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Definition of Underserved Rural Community. 5a.3 Section 5a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Professions Shortage Area, (under section 332(a)(1)(A) of the Public Health Service Act) or (2) Federally...

42 CFR 5a.3 - Definition of Underserved Rural Community.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Definition of Underserved Rural Community. 5a.3 Section 5a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Professions Shortage Area, (under section 332(a)(1)(A) of the Public Health Service Act) or (2) Federally...

42 CFR 5a.3 - Definition of Underserved Rural Community.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false Definition of Underserved Rural Community. 5a.3 Section 5a.3 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Professions Shortage Area, (under section 332(a)(1)(A) of the Public Health Service Act) or (2) Federally...

Tennessee long-range transportation plan : traditionally underserved populations outreach and analysis approach

DOT National Transportation Integrated Search

2006-01-01

This report describes efforts undertaken during the preparation of the Tennessee Long-Range Transportation Plan to engage traditionally underserved populations of the state and to provide opportunities for members of those populations to provide inpu...

Why Women Living in an Obstetric Care Underserved Area Do Not Utilize Their Local Hospital Supported by Korean Government for Childbirth.

PubMed

Kim, Jung-Eun; Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2016-09-01

This study aimed to understand why mothers do not utilize the prenatal care and delivery services at their local hospital supported by the government program, the Supporting Program for Obstetric Care Underserved Area (SPOU). We conducted a focus group interview by recruiting four mothers who delivered in the hospital in their community (a rural underserved obstetric care area) and another four mothers who delivered in the hospital outside of the community. From the finding, the mothers were not satisfied with the quality of services that the community hospital provided, in terms of professionalism of the obstetric care team, and the outdated medical device and facilities. Also, the mothers believed that the hospital in the metropolitan city is better for their health as well as that of their babies. The mothers who delivered in the outside community hospital considered geographical closeness less than they did the quality of obstetric care. The mothers who delivered in the community hospital gave the reason why they chose the hospital, which was convenience and emergency preparedness due to its geographical closeness. However, they were not satisfied with the quality of services provided by the community hospital like the other mothers who delivered in the hospital outside of the community. Therefore, in order to successfully deliver the SPOU program, the Korean government should make an effort in increasing the quality of maternity service provided in the community hospital and improving the physical factors of a community hospital such as outdated medical equipment and facilities. Copyright © 2016. Published by Elsevier B.V.

Women's Education and Earnings in California

ERIC Educational Resources Information Center

Werschkul, Misha; Gault, Barbara; Caiazza, Amy; Hartmann ,Heidi

2005-01-01

This publication is part of a joint project of the American Association of University Women Educational Foundation and the Institute for Women's Policy Research to analyze women's educational status in the 50 states, the District of Columbia, and Puerto Rico. The report includes detailed information on the educational status of women and the…

Orientations to motherhood and male partner support among women in Mexico and Mexican-origin women in the United States.

PubMed

Guendelman, S; Malin, C; Herr-Harthorn, B; Vargas, P N

2001-06-01

Previous studies suggest that favorable pregnancy outcomes among Mexican immigrant women in the United States may be attributed to a protective sociocultural orientation, but few have explored the attitudes and values that shape Mexican women's perceptions of motherhood. This exploratory study examines orientation towards motherhood among Mexican and Mexican-origin women living in Mexico and the United States and their perceptions of their male partners' attitudes and roles. Focus groups were conducted with 60 pregnant low-income women in rural and urban communities in Mexico with high rates of migration to the US, among immigrant communities in rural and urban California and with US-born women of Mexican descent (Mexican Americans) in urban California. Notable differences were observed between women in Mexico and the US and between immigrant and Mexican American women in California as more women articulated life plans. Life plans seemed to reflect both processes of individuation and changing gender roles. While participants in Mexico largely abided by the conventional discourse on motherhood and domesticity, immigrants in California alternated between this ethos and the discourse of working mother, depending on financial resources. In contrast, Mexican American participants assumed multiple roles. These differing orientations may be linked to other factors, including fertility control, the amount and type of partner support, and stress during pregnancy.

Future implications of eHealth interventions for chronic pain management in underserved populations.

PubMed

DeMonte, Colette M; DeMonte, William D; Thorn, Beverly E

2015-01-01

Many underserved communities, especially those in rural settings, face unique challenges that make high quality healthcare less accessible. The implementation of eHealth technologies has become a potentially valuable option to disseminate interventions. The authors' work in rural Alabama Federally Qualified Health Centers provide insights into the access to technology as well as the likelihood of utilizing eHealth technology in underserved communities. This paper will review current challenges related to digital dissemination of behavioral health interventions for chronic pain. Two major concerns are the lack of technological resources and the lack of appropriate materials for patients who may have low levels of reading, health and/or digital literacy. We will propose some recommendations to address common barriers faced by those providing care.

Multicultural Milky Way: Ethnoastronomy and Planetarium Shows for Under-served Arizonans

NASA Astrophysics Data System (ADS)

Knierman, Karen

2018-01-01

The astronomy outreach initiative, Multicultural Milky Way, partners the School of Earth and Space Exploration (SESE) at Arizona State University (ASU) with under-served populations in Arizona in learning about our Milky Way and other galaxies. Arizona is home to many diverse populations with rich cultural histories such as Mayan, Navajo, and Apache. Linking astronomy practiced by one’s indigenous culture to that of Western astronomy may increase the interest in science. Through multicultural planetarium shows and associated hands-on activities, under-served students and families will learn how the Milky Way is represented in different cultures and about the science of galaxies. New planetarium shows using the Mesa Community College (MCC) Digital Planetarium and STARLAB portable planetarium explore how the Milky Way is interpreted in different cultures. STARLAB shows and associated new hands-on activities have been featured during school visits, teacher trainings, and Community Astronomy Nights around Arizona. For authentic assessment, evaluation techniques and procedures were developed.

Considering the Role of Stress in Populations of High-Risk, Underserved Community Networks Program Centers

PubMed Central

Hébert, James R.; Braun, Kathryn L.; Kaholokula, Joseph Keawe‘aimoku; Armstead, Cheryl A.; Burch, James B.; Thompson, Beti

2015-01-01

Background Cancer disparities are associated with a broad range of sociocultural determinants of health that operate in community contexts. High-risk populations may be more vulnerable to social and environmental factors that lead to chronic stress. Theoretical and empirical research indicates that exposure to contextual and sociocultural stress alters biological systems, thereby influencing cancer risk, progression, and, ultimately, mortality. Objective We sought to describe contextual pathways through which stress likely increases cancer risk in high-risk, underserved populations. Methods This review presents a description of the link between contextual stressors and disease risk disparities within underserved communities, with a focus on 1) stress as a proximal link between biological processes, such as cytokine responses, inflammation, and cancer and 2) stress as a distal link to cancer through biobehavioral risk factors such as poor diet, physical inactivity, circadian rhythm or sleep disruption, and substance abuse. These concepts are illustrated through application to populations served by three National Cancer Institute-funded Community Networks Program Centers (CNPCs): African Americans in the Deep South (the South Carolina Cancer Disparities Community Network [SCCDCN]), Native Hawaiians (‘Imi Hale—Native Hawaiian Cancer Network), and Latinos in the Lower Yakima Valley of Washington State (The Center for Hispanic Health Promotion: Reducing Cancer Disparities). Conclusions Stress experienced by the underserved communities represented in the CNPCs is marked by social, biological, and behavioral pathways that increase cancer risk. A case is presented to increase research on sociocultural determinants of health, stress, and cancer risk among racial/ethnic minorities in underserved communities. PMID:26213406

STRUCTURAL INEQUALITY AND SOCIAL SUPPORT FOR WOMEN PRISONERS RELEASED TO RURAL COMMUNITIES

PubMed Central

Nicdao, Ethel G.; Trott, Elise M.; Kellett, Nicole C.

2016-01-01

Incarceration and community reentry for rural women reflect gendered processes. We draw upon in-depth semi-structured interviews and focus groups to examine the return of women prisoners to underserved rural communities, while attending to the perspectives of their closest social supporters. Our findings underscore the complexity of the reentry process for rural women and its particular impact on their families. We challenge dominant discourses of personal responsibility that detract from the structura violence and injustice shaping reentry experiences for women and their social supporters. We also consider the policy implications of discharge and reentry planning for rural women and their families, as well as strategies to reduce recidivism. PMID:27274615

Strategies for Enrolling Traditionally Underserved Families in Early Childhood Education Programs

ERIC Educational Resources Information Center

Fowler, Susan A.; Thomas, Dawn V.; Tompkins, Jill; Hartle, Luminita; Corr, Catherine

2013-01-01

Six agencies in Illinois received 18 months of funding from the governor's office to develop effective and innovative strategies to recruit young children from traditionally underserved families into early childhood education (ECE) programs. The five agencies that provided families with immediate follow-up and some services shortly after…

School Counselors: Key Stakeholders Helping Underserved Students to Be Career Ready

ERIC Educational Resources Information Center

Paolini, Allison C.

2015-01-01

This paper addresses the role that school counselors play in assisting underserved students to be prepared for post-secondary enrollment and/or career entry upon high school graduation. Counselors' responsibilities are outlined, including assisting students in identifying their strengths and inner resources, in order to achieve their goals.…

Promising Practices: A Literature Review of Technology Use by Underserved Students

ERIC Educational Resources Information Center

Zielezinski, Molly B.; Darling-Hammond, Linda

2016-01-01

How can technologies and digital learning experiences be used to support underserved, under-resourced, and underprepared students? For many years, educators, researchers, and policy makers looking for strategies to close the achievement gap and improve student learning have sought solutions involving new uses of technology, especially for students…

An early stage evaluation of the Supporting Program for Obstetric Care Underserved Areas in Korea.

PubMed

Na, Baeg Ju; Kim, Hyun Joo; Lee, Jin Yong

2014-06-01

"The Supporting Program for Obstetric Care Underserved Areas (SPOU)" provides financial aids to rural community (or district) hospitals to reopen prenatal care and delivery services for regions without obstetrics and gynecology clinics or hospitals. The purpose of this study was to evaluate the early stage effect of the SPOU program. The proportion of the number of birth through SPOU was calculated by each region. Also survey was conducted to investigate the extent of overall satisfaction, elements of dissatisfaction, and suggestions for improvement of the program; 209 subjects participated from 7 to 12 December, 2012. Overall, 20% of pregnant women in Youngdong (71 cases) and Gangjin (106 cases) used their community (or district) hospitals through the SPOU whereas Yecheon (23 cases) was 8%; their satisfaction rates were high. Short distance and easy accessibility was the main reason among women choosing community (or district) hospital whereas the reasons of not selecting the community (or district) hospital were favor of the outside hospital's facility, system, and trust in the medical staffs. The SPOU seems to be currently effective at an early stage. However, to successfully implement this program, the government should make continuous efforts to recruit highly qualified medical staffs and improve medical facility and equipment.

Developing a Culturally Responsive Breast Cancer Screening Promotion with Native Hawaiian Women in Churches

ERIC Educational Resources Information Center

Kaopua, Lana Sue

2008-01-01

This article presents findings from research to develop the promotional component of a breast cancer screening program for Native Hawaiian women associated with historically Hawaiian churches in medically underserved communities. The literature on adherence to health recommendations and health promotions marketing guided inquiry on screening…

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved

PubMed Central

Inrig, Stephen J.; Tiro, Jasmin A.; Melhado, Trisha V.; Argenbright, Keith E.; Craddock Lee, Simon J.

2017-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. Objectives To better understand how to implement a decentralized regional delivery “hub & spoke” model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow’s RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Methods and Design The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow’s RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. Discussion This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and

Evaluating a De-Centralized Regional Delivery System for Breast Cancer Screening and Patient Navigation for the Rural Underserved.

PubMed

Inrig, Stephen J; Tiro, Jasmin A; Melhado, Trisha V; Argenbright, Keith E; Craddock Lee, Simon J

2014-01-01

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas. To better understand how to implement a decentralized regional delivery "hub & spoke" model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow's RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance). The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow's RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed. This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates

Breast cancer in the Middle Eastern population of California, 1988-2004.

PubMed

Nasseri, Kiumarss

2009-01-01

This report presents the patterns of incidence, survival, and mortality of breast cancer in the Middle Eastern (ME) population of California. Cases were identified through surname recognition and population estimates were obtained from census public use files. Rates, trends, and survival in this ethnic group were compared with the non-Hispanic White (NHW) of California, as well as natives in the Middle East. Age-adjusted incidence rates for the insitu (22.8), invasive (126.2), and mortality (23.2) in ME women were significantly lower than similar rates of 26.0, 146.9, and 30.6 in the NHW women. Incidence rate in ME women in California was higher than rates in women in the Middle East. Lower rates for early stage and higher rates for late stage diagnoses in this ethnic population suggest lack of optimal access to preventive healthcare. Relative survival in the two groups is negatively associated with stage at diagnosis and is slightly higher in ME women, probably due to large numbers of lost to follow-up in ME women suggesting the presence of salmon bias. Positive association with socioeconomic standing was detected only in the NHW women. Incidence of breast cancer in ME men was significantly higher than that of NHW men.

Can Religion Help Prevent Obesity?: Religious Messages and the Prevalence of Being Overweight or Obese among Korean Women in California

PubMed Central

Ayers, John W.; Irvin, Veronica L.; Park, Hae-Ryun; Hovell, Melbourne F.; Hofstetter, Richard C.; Song, Yoonju; Paik, Hee-Yong

2010-01-01

This research examines the influence of messages from religious leaders and congregants on whether Korean women are overweight or obese. Data were drawn from telephone interviews with a probability sample (N=591) of women of Korean descent living in California. Overweight or obese prevalence was measured using World Health Organization standards for Asians (BMI>23). Respondents reported the frequency of messages discouraging “excessive eating” or encouraging “exercise” from religious leaders and congregants during a typical month. When conditioned on leaders’ messages, the frequency of congregants’ messages was associated with a significantly lower probability of being overweight or obese, although messages from either in the absence of the other were unassociated with being overweight or obese. At least for Korean women, religion may help prevent obesity via religious-based social mechanisms. PMID:20886700

Breaking Barriers to Bike Share: Insights from Residents of Traditionally Underserved Neighborhoods

DOT National Transportation Integrated Search

2017-06-01

Evidence has shown that higher income and white populations are overrepresented in both access to and use of bike share. Efforts to overcome underserved communities barriers to access and use of bike share have been initiated in a number of cities...

Disparities in Underserved White Populations: The Case of Cancer-Related Disparities in Appalachia

PubMed Central

Paskett, Electra D.; Lengerich, Eugene J.; Schoenberg, Nancy E.; Kennedy, Stephenie K.; Conn, Mary Ellen; Roberto, Karen A.; Dwyer, Sharon K.; Fickle, Darla; Dignan, Mark

2011-01-01

There are meaningful cancer-related disparities in the Appalachian region of the U.S. To address these disparities, the Appalachia Community Cancer Network (ACCN), a collaboration of investigators and community partners in five states (Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia), is involved in increasing cancer education and awareness, conducting community-based participatory research (CBPR), and creating mentorship and training opportunities. The primary objective of this paper is to describe cancer-related disparities in the Appalachian region of the U.S. as an example of the disparities experienced by underserved, predominantly white, rural populations, and to describe ACCN activities designed to intervene regarding these disparities. An ACCN overview/history and the diverse activities of ACCN-participating states are presented in an effort to suggest potential useful strategies for working to reduce health-related disparities in underserved white populations. Strengths that have emerged from the ACCN approach (e.g., innovative collaborations, long-standing established networks) and remaining challenges (e.g., difficulties with continually changing communities, scarce resources) are described. Important recommendations that have emerged from the ACCN are also presented, including the value of allowing communities to lead CBPR efforts. Characteristics of the community-based work of the ACCN provide a framework for reducing health-related disparities in Appalachia and in other underserved white and rural populations. PMID:21873582

Mammographic Breast Density in a Cohort of Medically Underserved Women

DTIC Science & Technology

2011-10-01

1.08 relative to ញ years) or birth order (2+ OR 0.99, 95% CI 0.67-1.46 relative to 1) and breast cancer. However, there was a significant...increase in breast cancer risk among women whose mothers smoked during pregnancy (OR 1.73, 95% CI 1.04-2.88). With the exception of birth order , our

Federal Employees Health Benefits Program miscellaneous changes: Medically Underserved Areas. Direct final rule.

PubMed

2014-12-17

The U.S. Office of Personnel Management (OPM) is issuing a direct final rule to discontinue the annual determination of the Medically Underserved Areas (MUAs) for the Federal Employees Health Benefits (FEHB) Program.

Reasons for HCV non-treatment in underserved African Americans: implications for treatment with new therapeutics.

PubMed

Schaeffer, Sarah; Khalili, Mandana

2015-01-01

African Americans are disproportionately affected by hepatitis C (HCV) and are less likely to undergo HCV treatment. Underserved populations are especially at risk for experiencing health disparity. Aim. To identify reasons for HCV non-treatment among underserved African Americans in a large safetynet system. Medical records of HCV-infected African Americans evaluated at San Francisco General Hospital liver specialty clinic from 2006-2011 who did not receive HCV treatment were reviewed. Treatment eligibility and reasons for non-treatment were assessed. Factors associated with treatment ineligibility were assessed using logistic regression modeling. Among 118 patients, 42% were treatment ineligible, 18% treatment eligible, and 40% were undergoing work-up to determine eligibility. Reasons for treatment ineligibility were medical (54%), non-medical (14%), psychiatric (4%), or combined (28%). When controlling for age and sex, active/recent substance abuse (OR 6.65, p = 0.001) and having two or more medical comorbidities (OR 3.39, p = 0.005) predicted treatment ineligibility. Excluding those ineligible for treatment, 72% of all other patients were lost to follow-up; they were older (55 vs. 48 years, p = 0.01) and more likely to be undergoing work up to determine treatment eligibility (86 vs. 21%, p < 0.0001) than those not lost to follow-up. Medical comorbidities and substance abuse predicted HCV treatment ineligibility in underserved African Americans. Importantly, the majority of those undergoing work-up to determine HCV treatment eligibility were lost to follow-up. While newer anti-HCV agents may increase treatment eligibility, culturally appropriate interventions to increase compliance with evaluation and care remain critical to HCV management in underserved African Americans.

The association between global health training and underserved care: early findings from two longstanding tracks.

PubMed

Liaw, Winston; Bazemore, Andrew; Xierali, Imam; Walden, John; Diller, Phillip; Morikawa, Masahiro J

2013-04-01

Global health tracks (GHTs) improve knowledge and skills, but their impact on career plans is unclear. The objective of this analysis was to determine whether GHT participants are more likely to practice in underserved areas than nonparticipants. In this retrospective cohort study, using the 2009 American Medical Association Masterfile, we assessed the practice location of the 480 graduates from 1980--2008 of two family medicine residencies-Residency 1 and Residency 2. The outcomes of interest were the percentage of graduates in health professional shortage areas (HPSAs), medically underserved areas (MUAs), rural areas, areas of dense poverty, or any area of underservice. Thirty-seven percent of Residency 1 participants and 20% of nonparticipants practiced in HPSAs; 69% of Residency 2 participants and 55.5% of nonparticipants practiced in areas of dense poverty. All other combined and within-residency differences were not statistically significant. These findings neither confirm nor refute the results of prior surveys suggesting that global health training is associated with increased interest in underserved care. Studies involving more GHTs and complimentary methods are needed to more precisely elucidate the impact of this training.

A Qualitative Assessment of Community-Based Breast Health Navigation Services for Southeast Asian Women in Southern California: Recommendations for Developing a Navigator Training Curriculum

PubMed Central

Tran, Jacqueline H.; Kagawa-Singer, Marjorie; Foo, Mary Anne

2011-01-01

Objectives. We identified key elements required for a training curriculum for Southeast Asian community-based health navigators (CBHNs), who help low-income, immigrant Cambodian, Laotian, Thai, and Vietnamese women negotiate cultural and systemic barriers to breast cancer screening and care in the United States. Methods. We gathered the perspectives of 3 groups: CBHNs, community members, and their providers. We conducted 16 focus groups with 110 women representing different stages of the cancer care continuum and in-depth interviews with 15 providers and 10 navigators to identify the essential roles, skills, and interpersonal qualities that characterize successful CBHNs. Results. The most important areas identified for training CBHNs were information (e.g., knowing pertinent medical information and how to navigate resources), logistics (transportation, interpretation), and affective interpersonal skills (understanding the language and cultural beliefs of patients, communicating with providers, establishing trust). Conclusions. CBHNs serve a crucial role in building trust and making screening practices culturally meaningful, accessible, usable, and acceptable. Future research should focus on developing training curricula, policies, resources, and funding to better maximize the expertise and services that CBHNs provide and to expand our findings to other underserved communities. PMID:21088273

A qualitative assessment of community-based breast health navigation services for Southeast Asian women in Southern California: recommendations for developing a navigator training curriculum.

PubMed

Nguyen, Tu-Uyen N; Tran, Jacqueline H; Kagawa-Singer, Marjorie; Foo, Mary Anne

2011-01-01

We identified key elements required for a training curriculum for Southeast Asian community-based health navigators (CBHNs), who help low-income, immigrant Cambodian, Laotian, Thai, and Vietnamese women negotiate cultural and systemic barriers to breast cancer screening and care in the United States. We gathered the perspectives of 3 groups: CBHNs, community members, and their providers. We conducted 16 focus groups with 110 women representing different stages of the cancer care continuum and in-depth interviews with 15 providers and 10 navigators to identify the essential roles, skills, and interpersonal qualities that characterize successful CBHNs. The most important areas identified for training CBHNs were information (e.g., knowing pertinent medical information and how to navigate resources), logistics (transportation, interpretation), and affective interpersonal skills (understanding the language and cultural beliefs of patients, communicating with providers, establishing trust). CBHNs serve a crucial role in building trust and making screening practices culturally meaningful, accessible, usable, and acceptable. Future research should focus on developing training curricula, policies, resources, and funding to better maximize the expertise and services that CBHNs provide and to expand our findings to other underserved communities.

Potential cost savings for Medi-Cal, AFDC, food stamps, and WIC programs associated with increasing breast-feeding among low-income Hmong women in California.

PubMed

Tuttle, C R; Dewey, K G

1996-09-01

To determine the potential cost savings for four social service programs if breast-feeding rates increased among Hmong women in California. Cost-savings analysis. Hmong women in California. In this population, breast-feeding is currently uncommon, and use of contraceptives is minimal. Savings were based on estimates of the resulting decrease in infant morbidity, maternal fertility, and formula purchases (Special Supplemental Nutrition Program for Women, Infants, and Children) if women breast-fed each child for at least 6 months. Costs were projected over a 7.5-year period and future values were discounted with annual interest rates of 2% or 4%. Substantial savings estimates were associated with breast-feeding for all four programs. The total projected savings over the 7.5-year period ranges from $3,442 to $4,944 (4% discount) to $4,475 to $6,0960 (0% discount) per family enrolled in all four programs. This translates into an estimated yearly savings of between $459 and $659 (4% discount) and $597 and $808 (0% discount) per family. Although health care providers generally accept that breast-feeding is the preferred method for feeding infants, many still view the choice as a neutral one; that is, they consider low breast-feeding rates in the United States a cultural choice with no cost to society. This analysis provides evidence that breast-feeding is economically advantageous for individuals and society.

The Quick Peek Program: A Model for Developmental Screening within Underserved Communities

ERIC Educational Resources Information Center

Harris, Jill; Norton, Amy

2016-01-01

Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within…

A Smart Partnership: Integrating Educational Technology for Underserved Children in India

ERIC Educational Resources Information Center

Charania, Amina; Davis, Niki

2016-01-01

This paper explores the evolution of a large multi-stakeholder partnership that has grown since 2011 to scale deep engagement with learning through technology and decrease the digital divide for thousands of underserved school children in India. Using as its basis a case study of an initiative called integrated approach to technology in education…

Use of clinical placements as a means of recruiting health care students to underserviced areas in Southeastern Ontario: part 1 - student perspectives.

PubMed

MacRae, Michelle; van Diepen, Kelly; Paterson, Margo

2007-02-01

This two-part study examines the present gap between financial and educational incentives required and the recruitment strategies used to draw health science students to underserviced areas in Southeastern Ontario. Part 1 explores the impact of offering travel stipends, rent-free accommodation and interprofessional educational opportunities to health science students on their willingness to participate in clinical placements in underserviced areas. Mixed-method two-part study using a self-administered questionnaire. Canadian university campus. Four hundred and sixty-eight senior level medical, nursing, occupational therapy, physical therapy and X-ray technology students from a Canadian university and affiliated professional school. The influence of currently established incentives on student willingness to complete a clinical placement in designated underserviced communities in Southeastern Ontario. Based on a 75% response rate, the results demonstrate that, in general, students agree that they are more willing to complete a clinical placement in an underserviced community if provided travel stipends (75%), rent-free housing (92%) and interprofessional educational opportunities (65%). Students also identified 15 additional factors influencing willingness. Students are more willing to complete clinical placements in underserviced communities if provided incentives. The findings of this study support an interprofessional clinical education and recruitment enhancement program in Southeastern Ontario.

The excess burden of breast carcinoma in minority and medically underserved communities: application, research, and redressing institutional racism.

PubMed

Shinagawa, S M

2000-03-01

In 1998, the American Cancer Society, the National Cancer Institute, and the Centers for Disease Control and Prevention reported an overall downward trend in cancer incidence and mortality between 1990 and 1995 for all cancers combined. Many minority and medically underserved populations, however, did not share equally in these improvements. A review of surveillance and other reports and recent literature on disparities in cancer incidence and mortality in minority and medically underserved communities was conducted 1) to ascertain the extent to which these communities bear an excess cancer burden, and 2) to explore the macrosocietal and microinstitutional barriers to equitable benefits in cancer health care delivery. Tragic disparities in cancer incidence and mortality in minority and medically underserved communities continue to be inadequately addressed. Overall improvements in U.S. cancer incidence and mortality rates are not shared equally by all segments of our society. While numerous individual and cultural barriers to optimal cancer control and care exist in minority and medically underserved communities, a major factor precluding these populations from sharing equally in advances in cancer research is prevailing societal and institutional racism. Immediate and equitable application of existing cancer control interventions and quality treatment options will significantly decrease cancer incidence and mortality. Enhanced surveillance efforts and a greater investment in targeted cancer research in those communities with the greatest disparities must be employed immediately if we are to achieve the goal of the president of the United States of eliminating racial and ethnic disparities in cancer and other diseases by 2010. Unless we acknowledge and redress institutionalized racism, the miscarriage of health justice will be perpetuated while celebrated advances in cancer research leading to declining incidence and mortality rates continue to evade our nation

Comparative Effectiveness of Fecal Immunochemical Test Outreach, Colonoscopy Outreach, and Usual Care for Boosting Colorectal Cancer Screening Among the Underserved

PubMed Central

Gupta, Samir; Halm, Ethan A.; Rockey, Don C.; Hammons, Marcia; Koch, Mark; Carter, Elizabeth; Valdez, Luisa; Tong, Liyue; Ahn, Chul; Kashner, Michael; Argenbright, Keith; Tiro, Jasmin; Geng, Zhuo; Pruitt, Sandi; Skinner, Celette Sugg

2017-01-01

IMPORTANCE Colorectal cancer (CRC) screening saves lives, but participation rates are low among underserved populations. Knowledge on effective approaches for screening the underserved, including best test type to offer, is limited. OBJECTIVE To determine (1) if organized mailed outreach boosts CRC screening compared with usual care and (2) if FIT is superior to colonoscopy outreach for CRC screening participation in an underserved population. DESIGN, SETTING, AND PARTICIPANTS We identified uninsured patients, not up to date with CRC screening, age 54 to 64 years, served by the John Peter Smith Health Network, Fort Worth and Tarrant County, Texas, a safety net health system. INTERVENTIONS Patients were assigned randomly to 1 of 3 groups. One group was assigned to fecal immunochemical test (FIT) outreach, consisting of mailed invitation to use and return an enclosed no-cost FIT (n = 1593). A second was assigned to colonoscopy outreach, consisting of mailed invitation to schedule a no-cost colonoscopy (n = 479). The third group was assigned to usual care, consisting of opportunistic primary care visit-based screening (n = 3898). In addition, FIT and colonoscopy outreach groups received telephone follow-up to promote test completion. MAIN OUTCOME MEASURES Screening participation in any CRC test within 1 year after randomization. RESULTS Mean patient age was 59 years; 64% of patients were women. The sample was 41% white, 24% black, 29% Hispanic, and 7% other race/ethnicity. Screening participation was significantly higher for both FIT (40.7%) and colonoscopy outreach (24.6%) than for usual care (12.1%) (P < .001 for both comparisons with usual care). Screening was significantly higher for FIT than for colonoscopy outreach (P < .001). In stratified analyses, screening was higher for FIT and colonoscopy outreach than for usual care, and higher for FIT than for colonoscopy outreach among whites, blacks, and Hispanics (P < .005 for all comparisons). Rates of CRC

Recreational physical activity and risk of papillary thyroid cancer among women in the California Teachers Study

PubMed Central

Cash, Stephanie Whisnant; Ma, Huiyan; Horn-Ross, Pamela L.; Reynolds, Peggy; Canchola, Alison J.; Sullivan-Halley, Jane; Beresford, Shirley A.A.; Neuhouser, Marian L.; Vaughan, Thomas L.; Heagerty, Patrick J.; Bernstein, Leslie

2012-01-01

Purpose Little is known about the relationship between physical activity and thyroid cancer risk, and few cohort data on this association exist. Thus, the present study aimed to prospectively examine long-term activity and risk of papillary thyroid cancer among women. Methods 116,939 women in the California Teachers Study, aged 22 to 79 years with no history of thyroid cancer at cohort entry, were followed from 1995-1996 through 2009; 275 were diagnosed with invasive papillary thyroid cancer. Cox proportional-hazards regression provided relative risk (RR) estimates and 95% confidence intervals (CI) for associations between thyroid cancer and combined strenuous and moderate recreational physical activity both in the long-term (high school through age 54 years or current age if younger than 54 years) and recently (during the three years prior to joining the cohort). Results Overall, women whose long-term recreational physical activity averaged at least 5.5 MET-hours/week (i.e. were active) had a non-significant 23% lower risk of papillary thyroid cancer than inactive women (RR=0.77, 95% CI: 0.57, 1.04). RR estimates were stronger among normal weight or underweight women (body mass index, BMI<25.0 kg/m2, trend p=0.03) than among overweight or obese women (trend p=0.35; homogeneity-of-trends p=0.03). A similar pattern of risk was observed for recent activity (BMI<25 kg/m2, trend p=0.11; BMI≥25 kg/m2, trend p=0.16; homogeneity-of-trends p=0.04). Associations for long-term activity did not appear to be driven by activity in any particular life period (e.g. youth, adulthood). Conclusions Long-term physical activity may reduce papillary thyroid cancer risk among normal weight and underweight women. PMID:23116823

Training Medical Students for Rural, Underserved Areas: A Rural Medical Education Program in California.

PubMed

Eidson-Ton, W Suzanne; Rainwater, Julie; Hilty, Donald; Henderson, Stuart; Hancock, Christine; Nation, Cathryn L; Nesbitt, Thomas

2016-01-01

The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.

American Dental Association White Paper Targets Dental Care for the Underserved

ERIC Educational Resources Information Center

Berthold, Mark

2005-01-01

Reaffirming its leadership role toward better oral health for all Americans, the ADA has produced a white paper that also challenges policy-makers and the US to improve access to dental services. The white paper, "State and Community Models for Improving Access to Dental Care for the Underserved," was presented October 1 to the House of…

Adaptation of Consultation Planning for Native American and Latina Women with Breast Cancer

ERIC Educational Resources Information Center

Belkora, Jeffrey; Franklin, Lauren; O'Donnell, Sara; Ohnemus, Julie; Stacey, Dawn

2009-01-01

Context: Resource centers in rural, underserved areas are implementing Consultation Planning (CP) to help women with breast cancer create a question list before a doctor visit. Purpose: To identify changes needed for acceptable delivery of CP to rural Native Americans and Latinas. Methods: We interviewed and surveyed 27 Native American and Latino…

Desegregating California Schools. California Current Review of Human Resources, Number 3, November 1969.

ERIC Educational Resources Information Center

California League of Women Voters, San Francisco.

This bulletin, prepared by the League of Women Voters, attempts to summarize popularly used methods of desegregation and to make specific suggestions for use in the State of California. State responsibilities for desegregation are presented against the background of Federal and State court decisions. The status of racial imbalance in California…

Pollution, Poverty, and Potentially Preventable Childhood Morbidity in Central California.

PubMed

Lessard, Lauren N; Alcala, Emanuel; Capitman, John A

2016-01-01

To measure ecological relationships between neighborhood pollution burden, poverty, race/ethnicity, and pediatric preventable disease hospitalization rates. Preventable disease hospitalization rates were obtained from the 2012 California Office of Statewide Health Planning and Development database, for 8 Central Valley counties. US Census Data was used to incorporate zip code level factors including racial diversity and poverty rates. The pollution burden score was calculated by the California Office of Environmental Health Hazard Assessment using 11 indicators. Poisson-based negative binomial regression was used for final analysis. Stratification of sample by age, race/ethnicity, and insurance coverage was also incorporated. Children experiencing potentially preventable hospitalizations are disproportionately low income and under the age of 4 years. With every unit increase in pollution burden, preventable disease hospitalizations rates increase between 21% and 32%, depending on racial and age subgroups. Although living in a poor neighborhood was not associated with potentially avoidable hospitalizations, children enrolled in Medi-Cal who live in neighborhoods with lower pollution burden and lower levels of poverty, face 32% lower risk for ambulatory care sensitive condition hospitalization. Children living in primary care shortage areas are at increased risk of preventable hospitalizations. Preventable disease hospitalizations increase for all subgroups, except white/non-Hispanic children, as neighborhoods became more racially diverse. Understanding the geographic distribution of disease and impact of individual and community level factors is essential to expanding access to care and preventive resources to improve the health of children in California's most polluted and underserved region. Copyright © 2016 Elsevier Inc. All rights reserved.

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities.

PubMed

Uscher-Pines, Lori; Rudin, Robert; Mehrotra, Ateev

2017-06-01

Many disadvantaged communities lack sufficient numbers of local primary care and specialty physicians. Yet tens of thousands of physicians, in particular those who are retired or semiretired, desire meaningful volunteer opportunities. Multiple programs have begun to use telehealth to bridge the gap between volunteer physicians and underserved patients. In this brief, we describe programs that are using this model and discuss the promise and pitfalls. Physician volunteers in these programs report that the work can be fulfilling and exciting, a cutting-edge yet convenient way to remain engaged and contribute. Given the projected shortfall of physicians in the United States, recruiting retired and semiretired physicians to provide care through telehealth increases the total supply of active physicians and the capacity of the existing workforce. However, programs typically use volunteers in a limited capacity because of uncertainty about the level and duration of commitment. Acknowledging this reality, most programs only use volunteer physicians for curbside consults rather than fully integrating them into longitudinal patient care. The part-time availability of volunteers may also be difficult to incorporate into the workflow of busy safety net clinics. As more physicians volunteer in a growing number of telehealth programs, the dual benefits of enriching the professional lives of volunteers and improving care for underserved communities will make further development of these programs worthwhile.

Welfare reform and the perinatal health and health care use of Latino women in California, New York City, and Texas.

PubMed

Joyce, T; Bauer, T; Minkoff, H; Kaestner, R

2001-11-01

This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996. We used a pre-post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998. The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P <.05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996. There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.

Using ICT for Education and Sustainable Development among the Underserved in Africa

ERIC Educational Resources Information Center

Kwapong, Olivia A. T. Frimpong

2009-01-01

The potential of ICT for education and sustainable development cannot be underestimated. Using cases from some African countries and data from deprived regions in Ghana, this paper discusses the opportunities and challenges in ICT for education and sustainable development in underserved areas in Africa. Much as infrastructural development,…

Preparing Historically Underserved Students for STEM Careers: The Role of an Inquiry-based High School Science Sequence Beginning with Physics

NASA Astrophysics Data System (ADS)

Bridges, Jon P.

Improving the STEM readiness of students from historically underserved groups is a moral and economic imperative requiring greater attention and effort than has been shown to date. The current literature suggests a high school science sequence beginning with physics and centered on developing conceptual understanding, using inquiry labs and modeling to allow students to explore new ideas, and addressing and correcting student misconceptions can increase student interest in and preparation for STEM careers. The purpose of this study was to determine if the science college readiness of historically underserved students can be improved by implementing an inquiry-based high school science sequence comprised of coursework in physics, chemistry, and biology for every student. The study used a retrospective cohort observational design to address the primary research question: are there differences between historically underserved students completing a Physics First science sequence and their peers completing a traditional science sequence in 1) science college-readiness test scores, 2) rates of science college-and career-readiness, and 3) interest in STEM? Small positive effects were found for all three outcomes for historically underserved students in the Physics First sequence.

Liability concerns and shared use of school recreational facilities in underserved communities.

PubMed

Spengler, John O; Connaughton, Daniel P; Maddock, Jason E

2011-10-01

In underserved communities, schools can provide the physical structure and facilities for informal and formal recreation as well as after-school, weekend, and summer programming. The importance of community access to schools is acknowledged by authoritative groups; however, fear of liability is believed to be a key barrier to community access. The purpose of this study was to investigate perceptions of liability risk and associated issues among school administrators in underserved communities. A national survey of school administrators in underserved communities (n=360, response rate of 21%) was conducted in 2009 and analyzed in 2010. Liability perceptions in the context of community access were assessed through descriptive statistics. The majority of respondents (82.2%) indicated concern for liability should someone be injured on school property after hours while participating in a recreational activity. Among those that did not allow community access, 91% were somewhat to very concerned about liability and 86% believed that stronger legislation was needed to better protect schools from liability for after-hours recreational use. Among those who claimed familiarity with a state law that offered them limited liability protection, nearly three fourths were nevertheless concerned about liability. Liability concerns are prevalent among this group of school administrators, particularly if they had been involved in prior litigation, and even if they indicated they were aware of laws that provide liability protection where use occurs after hours. Reducing these concerns will be important if schools are to become locations for recreational programs that promote physical activity outside of regular school hours. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

HealthATM: personal health cyberinfrastructure for underserved populations.

PubMed

Botts, Nathan E; Horan, Thomas A; Thoms, Brian P

2011-05-01

There is an opportunity for personal health record (PHR) systems to play a vital role in fostering health self-management within underserved populations. If properly designed and promoted, it is possible that patients will use PHRs to become more empowered in taking an active role toward managing their health needs. This research examines the potential of a cyberinfrastructure-based PHR to encourage patient activation in health care, while also having population health implications. A multi-phased, iterative research approach was used to design and evaluate a PHR system called HealthATM, which utilizes services from a cloud computing environment. These services were integrated into an ATM-style interface aimed at providing a broad range of health consumers with the ability to manage health conditions and encourage accomplishment of health goals. Evaluation of the PHR included 115 patients who were clients of several free clinics in Los Angeles County. The majority of patients perceived ease of use (74%) and confidence (73%) in using the HealthATM system, and thought they would like to use it frequently (73%). Patients also indicated a belief in being responsible for their own health. However, fewer felt as though they were able to maintain necessary life changes to improve their health. Findings from the field tests suggest that PHRs can be a beneficial health management tool for underserved populations. In order for these types of tools to be effective within safety-net communities, they must be technically accessible and provide meaningful opportunities to increase patient engagement in their health care. Copyright © 2011. Published by Elsevier Inc.

The Reality of Evaluating Community-Based Sport and Physical Activity Programs to Enhance the Development of Underserved Youth: Challenges and Potential Strategies

ERIC Educational Resources Information Center

Whitley, Meredith A.; Forneris, Tanya; Barker, Bryce

2014-01-01

In recent years, underserved communities have received much attention within the field of positive youth development (PYD). While there are an increasing number of opportunities for underserved youth to join PYD-based programs, there is growing concern surrounding the lack of critical evaluation of these programs (Kidd, 2008). Unfortunately, there…

Older women and breast cancer screening: research synthesis.

PubMed

Yarbrough, Suzanne S

2004-01-01

To identify the most beneficial ways to support older women as they make screening decisions using a systematic, epidemiologic, narrative review of research regarding benefits and burdens of breast cancer screening and treatment. Medical and nursing research databases emphasizing women aged 60 and older. Older women can tolerate screening and treatment, yet they are underserved. The most frequently cited reason to explain this phenomenon is declining health status associated with aging. Research evidence does not support this claim. No evidence clearly describes relationships among health status, aging, and less screening or less aggressive treatment. Older women experience varied health problems. However, indications that they are less able than their younger counterparts to tolerate screening or treatment for breast cancer do not exist. Further research in all aspects of breast cancer care in older women is required to define and describe risks and benefits of screening within a context of aging and changing health. Nurses should discuss the risks and benefits of screening with older women.

Clinician-Patient Communication about Physical Activity in an Underserved Population

PubMed Central

Carroll, Jennifer K.; Fiscella, Kevin; Meldrum, Sean C.; Williams, Geoffrey C.; Sciamanna, Christopher N.; Jean-Pierre, Pascal; Morrow, Gary R.; Epstein, Ronald M.

2010-01-01

Introduction The 5A (Ask, Advise, Agree, Assist, Arrange) model, used to promote patient behavior changes in primary care, can also be applied to physical activity. Our goal was to assess primary care physicians’ use of the 5As in discussions about physical activity with underserved populations. Methods We analyzed 51 audiorecorded, transcribed office visits on randomly selected patient care days and post-visit patient surveys with adults in two community health centers in Rochester, New York. Results The patient sample was 51% African American, predominantly female (70%), with the majority having a high school level education or less (66%) and an annual household income less than $39,000 (57%). Physical activity was discussed during 19 of the 51 visits, which included 16 (84%) visits with "Ask", ten (53%) with “Advise”, four (21%) with "Agree", five (26%) with "Assist", and 0 with "Arrange" statements. Most discussions of physical activity contained several Ask or Advise statements, but few Agree, Assist, or Arrange statements. Conclusion Communication about physical activity that included Agree, Arrange, and Assist statements of the 5As was infrequent. Health promotion interventions in underserved populations should target these steps and prompt patients to initiate communication to improve physical activity. PMID:18343859

Very low food security predicts obesity predominantly in California Hispanic men and women.

PubMed

Leung, Cindy W; Williams, David R; Villamor, Eduardo

2012-12-01

A high prevalence of food insecurity has persisted in the USA for the past two decades. Previous studies suggest that the association between food insecurity and obesity may vary by gender and race/ethnicity. We examined whether food insecurity was associated with BMI and obesity within gender and racial/ethnic groups in a large, diverse sample of low-income adults. A cross-sectional analysis of a large population-based health survey. We compared the distribution of BMI and obesity by food security levels within gender and racial/ethnic categories. Data were derived from the 2003-2009 waves of the California Health Interview Survey. The study sample included 35 747 non-elderly adults with households ≤200 % of the federal poverty level. Among Hispanic men, very low food security was associated with a 1.0 kg/m2 higher BMI (95 % CI 0.3, 1.7 kg/m2) and a 36 % higher prevalence of obesity (95 % CI 17, 58 %) after multivariate adjustment. Among Hispanic women, very low food security was associated with a 1.1 kg/m2 higher BMI (95 % CI 0.4, 1.9 kg/m2) and a 22 % higher prevalence of obesity (95 % CI 8, 38 %). Positive associations were also observed for Asian women and multi-racial men. No significant associations were observed for non-Hispanic whites, African Americans, Asian men or multi-racial women. Our results suggest that the association of food insecurity and obesity is limited to individuals of certain low-income, minority racial/ethnic groups. Whether targeted interventions to address food insecurity in these individuals may also decrease obesity risk deserves further investigation.

Arts Infusion and Literacy Achievement within Underserved Communities: A Matter of Equity

ERIC Educational Resources Information Center

Carney, Charles L.; Weltsek, Gustave J.; Hall, M. Lynne; Brinn, Ginger

2016-01-01

There is ample evidence that arts added to the K-12 curriculum can have many positive learning impacts. Nevertheless, many states do not promote such instruction as an integral part of classroom plans. For particular schools with underserved populations, arts-enhanced curricula can be a powerful learning tool. Beyond arts integration, arts…

Establishing Community Learning and Information Centers (CLICs) in Underserved Malian Communities. Final Report

ERIC Educational Resources Information Center

Academy for Educational Development, 2005

2005-01-01

The purpose of the Community Learning and Information Center (CLIC) project was "to accelerate economic, social and political growth by providing residents in twelve underserved Malian communities with access to easily accessible development information and affordable access to information and communication technology (ICT), high-value…

Women Superintendents: Overcoming Constraints.

ERIC Educational Resources Information Center

McCabe, Donna Hagen; Dobberteen, Kathie Ward

This paper aims to identify critical constraints as perceived by U.S. and California women superintendents and to determine how these women overcame them. The Survey of Influences on Female Superintendents' Careers (SIFSC) was used in two studies to collect quantitative and qualitative data on women superintendents in the United States and in…

Sharing Gravity's Microscope: Star Formation and Galaxy Evolution for Underserved Arizonans

NASA Astrophysics Data System (ADS)

Knierman, Karen A.; Monkiewicz, Jacqueline A.; Bowman, Catherine DD; Taylor, Wendy

2016-01-01

Learning science in a community is important for children of all levels and especially for many underserved populations. This project combines HST research of galaxy evolution using gravitationally lensed galaxies with hands-on activities and the Starlab portable planetarium to link astronomy with families, teachers, and students. To explore galaxy evolution, new activities were developed and evaluated using novel evaluation techniques. A new set of galaxy classification cards enable inquiry-based learning about galaxy ages, evolution, and gravitational lensing. Activities using new cylinder overlays for the Starlab transparent cylinder will enable the detailed examination of star formation and galaxy evolution as seen from the viewpoint inside of different types of galaxies. These activities were presented in several Arizona venues that enable family and student participation including ASU Earth and Space Open House, Arizona Museum of Natural History Homeschooling Events, on the Salt River Pima-Maricopa Indian Community, and inner city Phoenix schools serving mainly Hispanic populations. Additional events targeted underserved families at the Phoenix Zoo, in Navajo County, and for the Pascua Yaqui Tribe. After evaluation, the activities and materials will also be shared with local teachers and nationally.

76 FR 53377 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-26

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 5 Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting AGENCY: Health Resources and Services Administration, HHS. ACTION: Negotiated Rulemaking Committee...

76 FR 10825 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-28

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 5 Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting AGENCY: Health Resources and Services Administration, HHS. ACTION: Negotiated Rulemaking Committee...

76 FR 61294 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-04

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 5 Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting AGENCY: Health Resources and Services Administration, HHS. ACTION: Negotiated Rulemaking Committee...

Enrolling Minority and Underserved Populations in Cancer Clinical Research

PubMed Central

Wallington, Sherrie Flynt; Dash, Chiranjeev; Sheppard, Vanessa B.; Goode, Tawara D.; Oppong, Bridget A.; Dodson, Everett E.; Hamilton, Rhonda N.; Adams-Campbell, Lucile L.

2015-01-01

Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials—a “gold standard.” Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six non-therapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients—their physical locales, cultural values, and environments in which they live—is essential to recruiting culturally and ethnically diverse population samples. PMID:26470805

HPV Vaccine Acceptance in a Clinic-Based Sample of Women in the Rural South

ERIC Educational Resources Information Center

Brandt, Heather M.; Sharpe, Patricia A.; McCree, Donna H.; Wright, Marcie S.; Davis, Jennifer; Hutto, Brent E.

2009-01-01

Background: Human papillomavirus (HPV) is a very common sexually transmitted infection linked to cervical disease. Vaccines for some types of HPV were in development at the time of the study. Purpose: The study examined HPV vaccine acceptability among underserved women in a rural region of the southeastern U.S. with high rates of cervical cancer…

Disseminating relevant health information to underserved audiences: implications of the Digital Divide Pilot Projects*

PubMed Central

Kreps, Gary L.

2005-01-01

Objective: This paper examines the influence of the digital divide on disparities in health outcomes for vulnerable populations, identifying implications for medical and public libraries. Method: The paper describes the results of the Digital Divide Pilot Projects demonstration research programs funded by the National Cancer Institute to test new strategies for disseminating relevant health information to underserved and at-risk audiences. Results: The Digital Divide Pilot Projects field-tested innovative systemic strategies for helping underserved populations access and utilize relevant health information to make informed health-related decisions about seeking appropriate health care and support, resisting avoidable and significant health risks, and promoting their own health. Implications: The paper builds on the Digital Divide Pilot Projects by identifying implications for developing health communication strategies that libraries can adopt to provide digital health information to vulnerable populations. PMID:16239960

Investigating the Factors of Resiliency among Exceptional Youth Living in Rural Underserved Communities

ERIC Educational Resources Information Center

Curtin, Kevin A.; Schweitzer, Ashley; Tuxbury, Kristen; D'Aoust, Janelle A.

2016-01-01

Resilience is an important social justice concept that has important implications for educators working with exceptional youth in rural underserved communities who may suffer from the consequences associated with economic hardships. This multi-school qualitative study examined resilience among exceptional youth living in rural poverty through the…

Effects of dance on depression, physical function, and disability in underserved adults.

PubMed

Murrock, Carolyn J; Graor, Christine Heifner

2014-07-01

This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p < .001, and disability, t = -2.70, p = .014, and significantly increased physical function, t = -2.74, p = .013. The results indicate that the 12-week dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

With Educational Benefits for All: Campus Inclusion through Learning Communities Designed for Underserved Student Populations

ERIC Educational Resources Information Center

Fink, John E.; Hummel, Mary L.

2015-01-01

This chapter explores the practices of learning communities designed for specific, underserved student populations, highlighting on-campus examples and culminating with a synthesized list of core practices from these "inclusive" learning communities.

Country Schoolwomen: Teaching in Rural California, 1850-1950.

ERIC Educational Resources Information Center

Weiler, Kathleen

This book focuses on the lives and work of women teachers in two rural California counties between 1850 and 1950. It explores the social context of teaching and what teaching meant and provided to women teachers. Chapter 1 explores the shifts between 1840 and 1930 in representations of the woman teacher in the United States. Chapter 2 discusses…

Medical women of the West.

PubMed Central

Scully, A L

1988-01-01

The presence in the West of women physicians with degrees from regular medical schools spans a period of approximately 130 years. Women's Medical College of Pennsylvania graduated many of these early women physicians. The first woman medical graduate of a western school was Lucy M. Field Wanzer, who finished in 1876 at the Department of Medicine, University of California in San Francisco. Soon thereafter, schools that would become Stanford University and the Oregon Health Sciences University schools of medicine, as well as the newly founded University of Southern California, were contributing to the pool of women physicians. The University of Michigan Medical School, the first coeducational state medical school, also educated some of the western women physicians, who by 1910 numbered about 155. This regional account of the progress of women physicians as they strove to become an integral part of the profession emphasizes the familiar themes of altruism, ingenuity, and perseverance that characterized their efforts. Images PMID:3074578

Weight Status as a Moderator of the Relationship Between Motivation, Emotional Social Support, and Physical Activity in Underserved Adolescents

PubMed Central

Wilson, Dawn K.; Lawman, Hannah G.; Van Horn, M. Lee

2013-01-01

Objective This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Methods Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Results Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. Conclusions A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change. PMID:23378172

Weight status as a moderator of the relationship between motivation, emotional social support, and physical activity in underserved adolescents.

PubMed

St George, Sara M; Wilson, Dawn K; Lawman, Hannah G; Van Horn, M Lee

2013-05-01

This study examined weight status as a moderator of the relationship between motivation (controlled, autonomous, regulatory), emotional social support (parents, peers) and moderate-to-vigorous physical activity (MVPA) in underserved adolescents (ethnic minority, low-income). Participants from the Active by Choice Today Trial (n = 1,416; 54% girls, 73% African American, 52% overweight/obese) completed baseline measures, including height and weight, psychosocial surveys, and 7-day accelerometry estimates. Weight status was defined by body mass index z-score (zBMI). Weight status moderated the effects of controlled, autonomous, and regulatory motivation on MVPA, such that these variables were more strongly associated with MVPA in adolescents with lower versus higher zBMI scores. A better understanding of why motivation is not related to MVPA in underserved youth with a higher weight status is needed. Future pediatric obesity treatment in underserved youth may need to move beyond motivation into environmental factors associated with long-term behavior change.

Prevalence of birth defects among American-Indian births in California, 1983-2010.

PubMed

Aggarwal, Deepa; Warmerdam, Barbara; Wyatt, Katrina; Ahmad, Shabbir; Shaw, Gary M

2015-02-01

Approximately 6.3 million live births and fetal deaths occurred during the ascertainment period in the California Birth Defects Monitoring Program registry. American-Indian and non-Hispanic white women delivered 40,268 and 2,044,118 births, respectively. While much information has been published about non-Hispanic white infants, little is known regarding the risks of birth defects among infants born to American-Indian women. This study used data from the California Birth Defects Monitoring Program to explore risks of selected birth defects in offspring of American-Indian relative to non-Hispanic white women in California. The study population included all live births and fetal deaths 20 weeks or greater from 1983 to 2010. Prevalence ratios and corresponding 95% confidence intervals (CI) were computed using Poisson regression for 51 groupings of birth defects. Prevalence ratios were estimated for 51 groupings of birth defects. Of the 51, nine had statistically precise results ranging from 0.78 to 1.85. The eight groups with elevated risks for American-Indian births were reduction deformities of brain, anomalies of anterior segments, specified anomalies of ear, ostium secundum type atrial septal defect, specified anomalies of heart, anomalies of the aorta, anomalies of great veins, and cleft lip with cleft palate. Our results suggest that American-Indian women having babies in California may be at higher risk for eight birth defect phenotypes compared with non-Hispanic whites. Further research is needed to determine whether these risks are observed among other populations of American-Indian women or when adjusted for potential covariates. © 2015 Wiley Periodicals, Inc.

Garment workers in California: health outcomes of the Asian Immigrant Women Workers Clinic.

PubMed

Burgel, Barbara J; Lashuay, Nan; Israel, Leslie; Harrison, Robert

2004-11-01

In this cross sectional descriptive study, the demographics, risk factors, and health outcomes of a volunteer, symptomatic sample of monolingual Cantonese garment workers in the Oakland, California Chinatown area are documented. Methods included a questionnaire and clinical examination and treatment at the Asian Immigrant Women Workers Clinic, a free clinic providing culturally focused occupational health consultation and treatment for painful musculoskeletal disorders. Because garment work involves highly repetitious, sustained awkward postures, focused education on stretching and ergonomics also was provided. Results from the first 100 clients revealed a highly symptomatic sample, with an average age of 48.7 years. Sixty-six percent rated their health status as fair or poor. Sixteen percent of the sample had nerve entrapments, and 99% had a diagnosed strain or sprain of the spine or upper extremities. This population did not file workers' compensation claims because of a lack of knowledge and a fear of reprisal. This study documented the barriers to seeking care for this low wage, immigrant population.

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 13 2011-01-01 2009-01-01 true Housing in Underserved Areas C Exhibit C to Subpart L... Allocation of Loan and Grant Program Funds Pt. 1940, Subpt. L, Exh. C Exhibit C to Subpart L of Part 1940... precedence over other processing priority methods. C. Colonias may access pooled RHTSA funds as provided in...

7 CFR Exhibit C to Subpart L of... - Housing in Underserved Areas

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 13 2012-01-01 2012-01-01 false Housing in Underserved Areas C Exhibit C to Subpart L... Allocation of Loan and Grant Program Funds Pt. 1940, Subpt. L, Exh. C Exhibit C to Subpart L of Part 1940... precedence over other processing priority methods. C. Colonias may access pooled RHTSA funds as provided in...

76 FR 43964 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations (MUPs) and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-22

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 5 Negotiated Rulemaking Committee on Designation of Medically Underserved Populations (MUPs) and Health Professional Shortage Areas (HPSAs) AGENCY: Health Resources and Services Administration, Department of Health and Human Services. ACTION: Notice of...

Meeting EFA: Reaching the Underserved through Complementary Models of Effective Schooling. Working Paper

ERIC Educational Resources Information Center

DeStefano, Joseph; Moore, Audrey-Marie Schuh; Balwanz, David; Hartwell, Ash

2007-01-01

In 2004, the United States Agency for International Development (USAID)-funded Educational Quality Improvement Program 2 (EQUIP2) began investigating community-based schools as a mechanism for reaching the underserved populations. The team identified nine models that successfully organized schooling in regions least served by the formal education…

78 FR 50119 - Federal Employees Health Benefits Program: Medically Underserved Areas for 2014

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-16

... Areas for 2014 AGENCY: U.S. Office of Personnel Management. ACTION: Notice of Medically Underserved Areas for 2014. SUMMARY: The U.S. Office of Personnel Management (OPM) has completed its annual... Benefits (FEHB) Program for calendar year 2014. This is necessary to comply with a provision of the FEHB...

Recommendations of the Committee to Study Underserved Areas: Enhancing Educational Opportunities. Item #6.

ERIC Educational Resources Information Center

Illinois State Board of Higher Education, Springfield.

This document presents recommendations of the Illinois Committee to Study Underserved Areas concerning areas of the state in need of additional educational services. The document urges the Illinois' Board of Higher Education to adopt the Committee's recommendations as the Board's official policy. In summary, the Committee proposes the…

Patient Navigation in Medically Underserved Areas study design: A trial with implications for efficacy, effect modification, and full continuum assessment.

PubMed

Molina, Yamile; Glassgow, Anne E; Kim, Sage J; Berrios, Nerida M; Pauls, Heather; Watson, Karriem S; Darnell, Julie S; Calhoun, Elizabeth A

2017-02-01

The Patient Navigation in Medically Underserved Areas study objectives are to assess if navigation improves: 1) care uptake and time to diagnosis; and 2) outcomes depending on patients' residential medically underserved area (MUA) status. Secondary objectives include the efficacy of navigation across 1) different points of the care continuum among patients diagnosed with breast cancer; and 2) multiple regular screening episodes among patients who did not obtain breast cancer diagnoses. Our randomized controlled trial was implemented in three community hospitals in South Chicago. Eligible participants were: 1) female, 2) 18+years old, 3) not pregnant, 4) referred from a primary care provider for a screening or diagnostic mammogram based on an abnormal clinical breast exam. Participants were randomized to 1) control care or 2) receive longitudinal navigation, through treatment if diagnosed with cancer or across multiple years if asymptomatic, by a lay health worker. Participants' residential areas were identified as: 1) established MUA (before 1998), 2) new MUA (after 1998), 3) eligible/but not designated as MUA, and 4) affluent/ineligible for MUA. Primary outcomes include days to initially recommended care after randomization and days to diagnosis for women with abnormal results. Secondary outcomes concern days to treatment initiation following a diagnosis and receipt of subsequent screening following normal/benign results. This intervention aims to assess the efficacy of patient navigation on breast cancer care uptake across the continuum. If effective, the program may improve rates of early cancer detection and breast cancer morbidity. Copyright © 2016 Elsevier Inc. All rights reserved.

Risk factors for Chlamydia among young women in a northern california juvenile detention facility: implications for community intervention.

PubMed

McDonnell, Diana D; Levy, Vivian; Morton, Theresa J M

2009-02-01

Chlamydia infections are increasing in California, with rates highest in young women aged 15 to 24. Juvenile detention facilities are important venues for screening high-risk youth who may not otherwise access care. We, therefore, sought to identify risk factors for urogenital chlamydia among young women in a county juvenile detention facility between 2002 and 2005. With the state Chlamydia Screening Project (ClaSP), young women booked into the county detention facility were offered urine-based screening for urogenital chlamydia. Demographics, sexual history, and behavioral risk factors were self-reported through questionnaires completed during specimen collection. Nine hundred and thirty-nine young women were screened for chlamydia. The 5% positivity rate remained steady over the 33-month study. Vaginal sex was reported by 82% of women, oral sex by 50%, and anal sex by 30%. Only 9% reporting anal sex always used condoms. In multivariate analysis, little distinguished those with urogenital chlamydia. Women from the southern region of the county (adjusted odds ratio, 3.5; 1.4-8.7) and surrounding urban centers (3.7; 1.2-11.4) had higher odds of infection, as did those with 2 to 3 lifetime partners (3.2; 1.2-8.2)-although there was no linear relationship between partner number and infection. Those who had been in drug/alcohol treatment had lower odds of infection (0.1; 0.01-0.6). Our findings support universal chlamydia testing of young women detainees. The high prevalence of unprotected anal sex highlights an important modifiable HIV risk behavior in these adolescents. Risk factors reported here should inform the integration of prevention and treatment services in correctional settings and substance abuse treatment centers.

Community health navigators for breast- and cervical-cancer screening among Cambodian and Laotian women: intervention strategies and relationship-building processes.

PubMed

Ngoc Nguyen, Tu-Uyen; Tanjasiri, Sora Park; Kagawa-Singer, Marjorie; Tran, Jacqueline H; Foo, Mary Anne

2008-10-01

In recent years, there has been a growing number of programs employing health navigators to assist underserved individuals in overcoming barriers to obtaining regular and quality health care. This article describes the perspectives and experiences of community-based health navigators in the Cambodian and Laotian communities involved in a REACH 2010 project to reduce health disparities in breast and cervical cancer among Pacific Islander and Southeast Asian communities in California. These community health navigators, who have extensive training and knowledge about the cultural, historical, and structural needs and resources of their communities, are well equipped to build trusting relationships with community members traditionally ignored by the mainstream medical system. By comparing the different social support roles and intervention strategies employed by community health navigators in diverse communities, we can better understand how these valuable change agents of the health workforce are effective in improving health access and healthy behaviors for underserved communities.

Marine diet and tobacco exposure affects mercury concentrations in pregnant women (I) from Baja California Sur, Mexico.

PubMed

Gaxiola-Robles, Ramón; Bentzen, Rebecca; Zenteno-Savín, Tania; Labrada-Martagón, Vanessa; Castellini, J Margaret; Celis, Alfredo; O'Hara, Todd; Celina Méndez-Rodríguez, Lía

2014-01-01

Seafood provides essential polyunsaturated fatty acids (PUFA) and other nutrients to pregnant women and their fetus(es) while a diet rich in finfish can be a major pathway of monomethyl mercury (MeHg + ) exposure. We measured total mercury concentration ([THg]) in hair samples provided by 75 women in Baja California Sur (BCS) to assess its relationship with age, parity, tobacco smoke exposure, and diet based on survey methodologies. Generalized linear models (GLM) were used to explain the possible association of the different variables with [THg] in hair. Median [THg] in hair was 1.52 µgg -1 , ranging from 0.12 to 24.19 µgg -1 and varied significantly by segment. Approximately 72% (54/75) of those evaluated exceed 1 µgg -1 [THg] and 8% (6/75) exceed 5 µgg -1 [THg] in hair. Although frequency of fish consumption contributed significantly to explaining hair [THg], fish consumption only explained 43% of [THg] in a GLM incorporating tobacco exposure and body mass index. This study establishes possible relationships among multiple potential sources of exposure and other factors related to [THg] in hair of women in the prenatal period. A more detailed examination of other sources of exposure and factors contributing to [THg] is warranted.

Diabetes and Your Eyes: A Pilot Study on Multimedia Education for Underserved Populations

ERIC Educational Resources Information Center

Lawless, Kimberly; Smolin, Louanne; Gerber, Ben; Brodsky, Irwin; Girotti, Mariela; Pelaez, Lourdes; Eiser, Arnold

2005-01-01

There is a growing interest in the use of multimedia educational materials for individuals with chronic diseases. However, there is little data available regarding the use by underserved populations, particularly urban African-Americans and Latinos. The purpose of this pilot study was to create a multimedia lesson providing instruction on…

76 FR 22070 - Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-20

... DEPARTMENT OF HEALTH AND HUMAN SERVICES 42 CFR Part 5 Negotiated Rulemaking Committee on Designation of Medically Underserved Populations and Health Professional Shortage Areas; Notice of Meeting Correction Proposed Rule document 2011-9081 was inadvertently published in the Rules section of the issue of...

Enrolling Minority and Underserved Populations in Cancer Clinical Research.

PubMed

Wallington, Sherrie F; Dash, Chiranjeev; Sheppard, Vanessa B; Goode, Tawara D; Oppong, Bridget A; Dodson, Everett E; Hamilton, Rhonda N; Adams-Campbell, Lucile L

2016-01-01

Research suggests that community involvement is integral to solving public health problems, including involvement in clinical trials-a gold standard. Significant racial/ethnic disparities exist in the accrual of participants for clinical trials. Location and cultural aspects of clinical trials influence recruitment and accrual to clinical trials. It is increasingly necessary to be aware of defining characteristics, such as location and culture of the populations from which research participants are enrolled. Little research has examined the effect of location and cultural competency in adapting clinical trial research for minority and underserved communities on accrual for clinical trials. Utilizing embedded community academic sites, the authors applied cultural competency frameworks to adapt clinical trial research in order to increase minority participation in nontherapeutic cancer clinical trials. This strategy resulted in successful accrual of participants to new clinical research trials, specifically targeting participation from minority and underserved communities in metropolitan Washington, DC. From 2012 to 2014, a total of 559 participants enrolled across six nontherapeutic clinical trials, representing a 62% increase in the enrollment of blacks in clinical research. Embedding cancer prevention programs and research in the community was shown to be yet another important strategy in the arsenal of approaches that can potentially enhance clinical research enrollment and capacity. The analyses showed that the capacity to acquire cultural knowledge about patients-their physical locales, cultural values, and environments in which they live-is essential to recruiting culturally and ethnically diverse population samples. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

75 FR 80562 - Council on Underserved Communities, Establishment of and Request for Nominations

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-22

... Underserved Communities may be directed to Dan Jones, telephone (202) 205-7583, fax (202) 481-6536, e-mail dan... made. Nominees may be asked to submit additional information. Nominations must be sent to Dan Jones at [email protected] . Dated: December 16, 2010. Dan Jones, SBA Committee Management Officer. [FR Doc. 2010...

An Analysis of Oppression and Health Education for Underserved Populations in the United States: The Issues of Acculturation, Patient-Provider Communication, and Health Education

ERIC Educational Resources Information Center

Weaver, Shannon; Gull, Bethany; Ashby, Jeanie; Kamimura, Akiko

2017-01-01

The oppression of underserved populations is pervasive throughout the history of the United States (U.S.), especially in health care. Brazilian educator Paulo Freire's controversial ideas about systems of power can be aptly applied to health care. This paper focuses specifically on arguably the most medically underserved group in the U.S.…

Reducing Underserved Children’s Exposure to Secondhand Smoke

PubMed Central

Collins, Bradley N.; Nair, Uma S.; Hovell, Melbourne F.; DiSantis, Katie I.; Jaffe, Karen; Tolley, Natalie; Wileyto, E. Paul; Audrain-McGovern, Janet

2015-01-01

Introduction Addressing maternal smoking and child secondhand smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child secondhand smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant’s and preschooler’s secondhand smoke exposure. Design A two-arm randomized trial: experimental behavior counseling versus enhanced standard care (control). Assessment staff members were blinded. Setting/participants Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline. Intervention Philadelphia Family Rules for Establishing Smokefree Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive–behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging secondhand smoke exposure–protective behaviors with the eventual goal of establishing a smokefree home. Main outcome measures Primary outcomes were end-of-treatment child cotinine and reported secondhand smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status. Results Participation in FRESH behavioral counseling was associated with lower child cotinine (β= −0.18, p=0.03) and secondhand smoke exposure (β= −0.57, p=0.03) at end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β= –1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ2=10.56, p<0.01). There was no moderating effect of other smokers living at home. Conclusions FRESH behavioral counseling reduces child secondhand smoke exposure and promotes smoking quit

A Preliminary Test of a Student-Centered Intervention on Increasing Physical Activity in Underserved Adolescents

PubMed Central

Wilson, Dawn K.; Evans, Alexandra E.; Williams, Joel; Mixon, Gary; Sirard, John R.; Pate, Russell

2008-01-01

Background Previous studies have shown that choice and self-initiated behavior change are important for increasing intrinsic motivation and physical activity (PA), however, little of this research has focused on underserved adolescents. Purpose This study examined the effects of a 4-week student-centered intervention on increasing PA in underserved adolescents. Methods Twenty-eight students in the intervention school were matched (on race, percentage on free or reduced-price lunch program, gender, and age) with 20 students from another school who served as the comparison group (30 girls, 18 boys; ages 10–12 years; 83% African American; 83% on free or reduced-price lunch). The student-centered intervention was consistent with self-determination (motivation) theory and social cognitive theory in that it emphasized increasing intrinsic motivation and behavioral skills for PA. Intervention adolescents took ownership in selecting a variety of PA activities in which to participate, and they generated coping strategies for making effective PA behavior changes. Results Intervention participants showed greater increases in accelerometer estimates of time spent in moderate PA, moderate-to-vigorous PA, and vigorous PA from baseline to Week 4 of the intervention than the comparison group. Intervention participants also showed greater increases in PA motivation and positive self-concept for PA than comparison adolescents. Conclusions This study provides preliminary evidence that increasing adolescent involvement and choice of activities may be important in developing future PA interventions for underserved adolescents. PMID:16173908

Examining the sexual harassment experiences of Mexican immigrant farmworking women.

PubMed

Waugh, Irma Morales

2010-03-01

This study examined sexual harassment experiences of Mexican immigrant farmworking women (n = 150) employed on California farms. Of the estimated one million California farmworkers, 78% are Latino, mostly from Mexico, and 28% are women. Unlike gender-segregated worksites of Mexico, women farmworkers in the United States labor alongside men, facilitating harassment from coworkers and supervisors. Simultaneous sexist, racist, and economic discrimination are comparable to converging lanes of automobile traffic (Crenshaw, 2000) that women, standing at the intersections, manage to avoid harm. Findings highlight how discrimination shapes women's experiences and demonstrate the need for institutional policies to protect them.

Effect of Health Literacy on Decision-Making Preferences among Medically Underserved Patients.

PubMed

Seo, Joann; Goodman, Melody S; Politi, Mary; Blanchard, Melvin; Kaphingst, Kimberly A

2016-05-01

Participation in the decision-making process and health literacy may both affect health outcomes; data on how these factors are related among diverse groups are limited. This study examined the relationship between health literacy and decision-making preferences in a medically underserved population. We analyzed a sample of 576 primary care patients. Multivariable logistic regression was used to examine the independent association of health literacy (measured by the Rapid Estimate of Adult Literacy in Medicine-Revised) and patients' decision-making preferences (physician directed or patient involved), controlling for age, race/ethnicity, and gender. We tested whether having a regular doctor modified this association. Adequate health literacy (odds ratio [OR] = 1.7;P= 0.009) was significantly associated with preferring patient-involved decision making, controlling for age, race/ethnicity, and gender. Having a regular doctor did not modify this relationship. Males were significantly less likely to prefer patient-involved decision making (OR = 0.65;P= 0.024). Findings suggest health literacy affects decision-making preferences in medically underserved patients. More research is needed on how factors, such as patient knowledge or confidence, may influence decision-making preferences, particularly for those with limited health literacy. © The Author(s) 2016.

Expanding the Reach of Extension to Underserved Audiences through Study Circles in Rural Idaho

ERIC Educational Resources Information Center

Cummins, Melissa; Petty, Barbara; Hansen, Lyle; Hoffman, Katie; Wittman, Grace

2012-01-01

Extension educators expanded the reach of their programming to underserved audiences through the implementation of Study Circles in rural Southern Idaho. Study Circles gave educators entry into communities by establishing relationships necessary for long-term change. Study Circle discussions in rural Southern Idaho led to stronger relationships…

Learning from Math Circles: Providing Underserved Students of Color with Accessibility to Mathematics Education

ERIC Educational Resources Information Center

Winful, Audrey M.

2009-01-01

Consistently high minority failure rates in high school and college mathematics, the noticeable decrease in access to mathematics education for our underserved students of color, and this mathematics educator's genuine belief in the global necessity, desirability, and applicability of engaging our youth in learning mathematics through Math…

Screening for autism spectrum disorder in underserved communities: Early childcare providers as reporters.

PubMed

Janvier, Yvette M; Harris, Jill F; Coffield, Caroline N; Louis, Barbara; Xie, Ming; Cidav, Zuleyha; Mandell, David S

2016-04-01

Early diagnosis of autism typically is associated with earlier access to intervention and improved outcomes. Daycares and preschools largely have been ignored as possible venues for early identification. This may be especially important for minority children in the United States who are typically diagnosed with autism later than White children, limiting their access to early specialized interventions and possibly resulting in poorer outcomes. Early childcare providers within underserved communities completed autism screening tools for a sample of low-risk young children (n = 967) in their programs. Early childcare providers returned screening tools for 90% of the children for whom parental consent had been received. A total of 14% of children screened positive for autism spectrum disorder and 3% of the sample met criteria for autism spectrum disorder. Among those who screened positive, 34% were lost to follow-up. Findings suggest that early childcare providers can effectively screen young children for autism spectrum disorder in preschool/daycare settings, thus improving access to early diagnosis and reducing potential healthcare disparities among underserved populations. © The Author(s) 2015.

Smoke-free policies among Asian-American women: comparisons by education status.

PubMed

Tong, Elisa K; Tang, Hao; Tsoh, Janice; Wong, Candice; Chen, Moon S

2009-08-01

California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms. The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.

Relationship of body mass index and psychosocial factors on physical activity in underserved adolescent boys and girls.

PubMed

Kitzman-Ulrich, Heather; Wilson, Dawn K; Van Horn, M Lee; Lawman, Hannah G

2010-09-01

Previous research indicates that body mass index (BMI) and sex are important factors in understanding physical activity (PA) levels. The present study examined the influence of BMI on psychosocial variables (self-efficacy, social support) and PA in underserved (ethnic minority, low income) boys in comparison with girls. Participants (N = 669; 56% girls; 74% African American) were recruited from the "Active by Choice Today" trial. BMI ʐ score was calculated from objectively collected height and weight data, and PA was assessed with 7-day accelerometry estimates. Self-report questionnaires were used to measure self-efficacy and social support (family, peers) for PA. A 3-way interaction between BMI z score, sex, and family support on PA was shown such that family support was positively associated with PA in normal-weight but not overweight or obese boys, and was not associated with PA in girls. Self-efficacy had the largest effect size related to PA in comparison with the other psychosocial variables studied. Self-efficacy was found to be an important variable related to PA in underserved youth. Future studies should evaluate possible barriers to PA in girls, and overweight youth, to provide more effective family support strategies for underserved adolescents' PA. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Association between Family Communication and Health Literacy among Underserved Racial/Ethnic Women.

PubMed

Zambrana, Ruth E; Meghea, Cristian; Talley, Costellia; Hammad, Adnan; Lockett, Murlisa; Williams, Karen Patricia

2015-05-01

Health literacy and the family can be used to promote cancer screenings. We examined the associations of socio-demographic factors, family communication, and cancer literacy in a diverse population. Baseline data from the Kin Keeper(SM) Cancer Prevention randomized controlled trial were analyzed for Black (n=216), Latino (n=65), and Arab (n=235) women. Key variables were based on the Family Adaptability and Cohesion Scale IV, and the Cancer Literacy Assessment Tool. Among Blacks, cervical cancer literacy was positively associated with family communication. Cancer literacy was associated with higher educational level, employment, and family self-rated health status among Black and Arab women. Among Latinas, who were the least educated and had the lowest literacy scores, family communication was inversely related to breast cancer literacy. Family-centered networks may be a viable resource for the transmission of health cancer literacy information, inform health care decision-making, and contribute to decreasing breast and cervical cancer mortality.

The Women Entrepreneurs Project. Final Report.

ERIC Educational Resources Information Center

McCaslin, Barbara S.; And Others

Business ownership training materials appropriate for uses in vocational education settings with women clients were developed and tested. A survey of California women business owners was made to identify the characteristics and needs of women entrepreneurs. A series of eight self-paced, student-centered Learning Activities Packages (LAP's) was…

Effect of Active Videogames on Underserved Children's Classroom Behaviors, Effort, and Fitness.

PubMed

Gao, Zan; Lee, Jung Eun; Pope, Zachary; Zhang, Dachao

2016-09-30

The purpose of this study was to examine the effect of active videogames (AVGs) on underserved minority children's on-task classroom behavior, academic effort, and fitness. A one group pre- and posttest repeated measures design was used. In Fall 2013, 95 fourth grade children (57 boys, 38 girls; 96% of minority) from three classes at an underserved urban elementary school participated in teacher-supervised AVG activities (e.g., Wii Sports, Xbox Just Dance). Specifically, students participated in a 50-minute weekly AVG program at school for 6 weeks. Children's academic effort was evaluated by classroom teachers using a validated scale that assessed activity, attention, conduct, and social/emotional behavior. Moreover, children's classroom behavior was observed immediately before and after each AVG session by trained researchers. Finally, cardiovascular fitness was also measured. A paired t-test was used to assess teacher-rated student effort, while one-way (gender) analysis of variance (ANOVA) with repeated measures was performed to analyze children's on-task classroom behavior. There was a significant effect on children's effort between the first (mean = 3.24, SD = 0.75) and last week (mean = 3.41, SD = 0.73) assessments, t = 2.42, P = 0.02. In addition, there was a significant effect on classroom behavior, F = 33.103, P < 0.01. In detail, children scored significantly higher on on-task behavior during the post-AVG observation (mean = 81.4, SD = 12.3) than seen during the pre-AVG observation (mean = 69.8, SD = 14.9). However, no main effect was indicated for gender, F = 0.39, P = 0.54. No significant improvement in cardiovascular fitness was observed, although slight improvements were seen. Offering an AVG program at school could improve underserved minority children's classroom on-task behavior and academic effort. Future studies may include a control group to further confirm the effectiveness of AVG

Big Gay Church: Sermons to and for an Underserved Population in Art Education Settings

ERIC Educational Resources Information Center

Rhoades, Mindi; Cosier, Kim; Davenport, Melanie G.; Sanders, James H., III; Wolfgang, Courtnie N.

2013-01-01

While the past decade shows dramatic progress in tolerance, acceptance, and support for lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people/rights in the United States, this population remains underserved. Statistics on LGBTQ youth suicide remain troublingly high; yet, when LGBTQ youth attend schools with Gay-Straight…

A Qualitative Inquiry Into the Challenges of Medical Education for Retention of General Practitioners in Rural and Underserved Areas of Iran

PubMed Central

2016-01-01

Objectives General practitioners (GPs) retention in rural and underserved areas highly effects on accessibility of healthcare facilities across the country. Education seems to be a critical factor that affects GPs retention. Thus, the present study aimed at inquiry into medical education challenges that limit their retention in rural and underserved areas. Methods A qualitative approach was applied for the aim of this study. Data were gathered via 28 semi-structured interviews with experts at different levels of Iran’s health system as well as GPs who retained and refused to retain working in rural settings. Interviews mainly were performed face-to-face and in some cases via telephone during 2015 and then coded and analyzed using content analysis approach. Results Iran’s medical education is faced with several challenges that were categorized in four main themes including student selection, medical students’ perception about their field of study, education setting and approach, curriculum of medical education. According to experts this challenges could results in making GP graduates disinterested for practicing in rural and underserved areas. Conclusions Challenges that were found could have negative effects on retention. Modification in student’s perception about rural practice could be done via changing education setting and approach and curriculum. These modifications could improve GPs retention in rural and underserved areas. PMID:27951631

Understanding the increased risk of neural tube defect-affected pregnancies among Mexico-born women in California: immigration and anthropometric factors.

PubMed

Velie, Ellen M; Shaw, Gary M; Malcoe, Lorraine H; Schaffer, Donna M; Samuels, Steven J; Todoroff, Karen; Block, Gladys

2006-05-01

Mexico-born women in the United States have an unexplained twofold increased risk of neural tube defect (NTD)-affected pregnancies. We examined whether immigration characteristics were associated with the NTD risk and whether anthropometric factors contributed to the increased risk among Mexico-born women. Data were derived from a large population-based case-control study in California. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD-affected fetuses/infants and mothers of 539 (88%) randomly selected non-malformed control infants. The crude odds ratio (OR) for NTDs among all Mexico-born women, women residing <2 years in the US, and women >16 years old at immigration compared with non-Hispanic white women was 2.4 [95% confidence interval (CI) = 1.8, 3.3], 7.2 [95% CI = 3.7, 14.0] and 3.0 [95% CI = 2.0, 4.4], respectively. Risk for second- or third-generation Mexican-Americans was similar to that of white women. The crude OR for all Mexico-born women was reduced from 2.4 to 2.0 [95% CI = 1.3, 3.0] and for those residing <2 years in the US from 8.4 to 7.1 [95% CI = 3.2, 15.3] after adjustment for maternal body mass index (BMI), height, compromised diet, diabetes, and other known risk factors. In term pregnancies, additional adjustment for pregnancy weight gain reduced the OR in all Mexico-born women and recent immigrants by 16% and 25%, respectively. Low pregnancy weight gain (<10 vs. 10-14 kg) was particularly associated with increased NTD risk among Mexico-born women (OR(ADJ) = 5.8; 95% CI = 2.1, 15.8). Findings indicate that recent Mexican immigrants have a sevenfold increased risk for NTDs. Maternal BMI and height contributed very little, and inadequate weight gain contributed modestly to the NTD risk disparity for Mexican immigrants.

Preventive Care for Women in Prison: A Qualitative Community Health Assessment of the Papanicolaou Test and Follow-Up Treatment at a California State Women’s Prison

PubMed Central

Magee, Catherine G.; Hult, Jen R.; Turalba, Ruby; McMillan, Shelby

2005-01-01

Growing evidence indicates that women in prison are particularly vulnerable to many negative health outcomes, including cervical cancer. The Papanicolaou (Pap) test is an effective tool to screen for this disease. To determine what is and is not working with the Pap test and follow-up treatment, we performed qualitative interviews with women prisoners and key informants at a California state women’s prison. Our assessment revealed that the process of administering Pap tests at this institution was not meeting the health care needs of the women interviewed. Women reported having negative experiences during the test and with their health care providers. Additionally the prison’s culture and infrastructure create obstacles that hinder prisoners from receiving quality care and providers from delivering that care. In response, women prisoners use self-and community advocacy to meet their health care needs and cope with these challenges. PMID:16186450

Last resort or roll of the die? Exploring the role of metaphors in cancer clinical trials education among medically underserved populations.

PubMed

Krieger, Janice L

2014-01-01

Improving communication about cancer clinical trials may help increase patients' understanding of medical research and their interest in participating. It is unfortunate that there is little empirical research to provide guidance on how to adapt clinical trial messages to maximize cultural sensitivity. This study examines (a) how medically underserved women conceptualize clinical trials by examining the language they use to describe them and (b) how this audience interprets metaphorical language used to explain randomization in the context of Phase III cancer clinical trials. The author conducted in-depth interviews and focus groups with 41 rural, low-income older women who either had been diagnosed with cancer or were caregivers for a person with cancer. The most commonly used lay metaphors for clinical trials had strong negative connotations and included treatment by trial and error, patients are guinea pigs, and treatment of last resort. Participants also expressed strong, unfavorable responses to conventional metaphors that equate randomization with the roll of a die or use other gambling language. Low-literacy definition approaches were unexpectedly problematic, suggesting the potential effectiveness of culturally grounded metaphors for communicating about clinical trials. Ethical implications of these findings for cancer communication are discussed.

Development and First Phase Evaluation of a Maternity Leave Educational Tool for Pregnant, Working Women in California.

PubMed

Kurtovich, Elaine; Guendelman, Sylvia; Neuhauser, Linda; Edelman, Dana; Georges, Maura; Mason-Marti, Peyton

2015-01-01

Despite the provision of maternity leave offered to mothers, many American women fail to take leave. We developed an evidence-based maternity leave educational tool for working women in California using participatory design. We tested its short-term efficacy with a randomized controlled trial of pregnant English-speakers (n=155). Among intervention participants exposed to the tool, 65% reported that they learned something new; 38% were motivated to seek more information; and 49% said it helped them plan their maternity leave. Among participants who delivered at ≥ 37 weeks gestation and said the tool helped them plan their leave, 89% took more than one week of prenatal leave, a significantly higher proportion than among controls who did not receive the tool (64%, p=0.049). Other findings favored trial participants, but were not statistically significant in this small sample. More intervention participants took some prenatal leave (80%) vs. controls (74%, p=0.44). Among participants who had returned to work when surveyed (n=50), mean postnatal leave uptake was on average 1 week longer for intervention participants vs. controls (13.3 vs. 12.2 weeks, p=0.54). The first-phase evaluation of this tool shows that it successfully informed women about maternity leave options, clarified complex regulations, encouraged women to seek further information and helped plan maternity leave. Compared to controls, trial participants who used the tool to plan their leave were far more likely to take prenatal leave close to term. Future evaluation of the tool when mediated by a health provider or employer is warranted.

Engaging Youth in Underserved Communities through Digital-Mediated Arts Learning Experiences for Community Inquiry

ERIC Educational Resources Information Center

Lin, Ching-Chiu; Bruce, Bertram C.

2013-01-01

Learning for underserved youth is integral to social progress. Yet, too often, young people experience disconnects between their educational experiences and both individual and community needs. Arts can help these youth recover a unity through collective action in the community. Drawing from the experiences of a 4-year interdisciplinary research…

Substance abuse treatment services for pregnant women: psychosocial and behavioral approaches.

PubMed

Haug, Nancy A; Duffy, Megan; McCaul, Mary E

2014-06-01

Women who use tobacco, alcohol and drugs during pregnancy are at increased risk of maternal and fetal morbidity. Universal screening using empirically validated approaches can improve identification of substance-using pregnant women and facilitate comprehensive assessment of treatment needs. There is strong evidence for effectiveness of psychosocial and behavioral substance abuse treatments across a range of intensities and levels of care. In addition to addressing substance use, services for co-occurring psychiatric disorders, trauma exposure, and prenatal care are important components of coordinated systems of care. More research on and greater access to evidence-based interventions is needed for this underserved population. Copyright © 2014 Elsevier Inc. All rights reserved.

Business Ownership: A New Career Option for Women.

ERIC Educational Resources Information Center

McNamara, Patricia P.

1979-01-01

The status and barriers faced by women business owners is examined, and ways in which higher education institutions can assist women to overcome these obstacles are suggested. The Women Entrepreneurs (WE) Project is described, and a survey of women-owned businesses in California is discussed. (Author/MLW)

Smoke-Free Policies Among Asian-American Women: Comparisons by Education Status

PubMed Central

Tong, Elisa K; Tang, Hao; Tsoh, Janice; Wong, Candice; Chen, Moon S.

2009-01-01

Background California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. Methods The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (≤ high school graduate) or higher education status for smoke-free policy adoption and enforcement. Results Lower-educated and higher-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms. Conclusions The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments. PMID:19591754

Substance use among women in shelters for abused women and children. Programming opportunities.

PubMed

Greaves, Lorraine; Chabot, Cathy; Jategaonkar, Natasha; Poole, Nancy; McCullough, Lucy

2006-01-01

This study explores changes in the use of alcohol and other substances by women in British Columbia as they moved into shelters for abused women and again three months later. We see this time as a key life transition, and potentially a rich opportunity for influencing women's substance use behaviour. The purpose of this study was to document changes in the level of use of alcohol and other substances and the levels of stress among women as they moved through shelters for abused women. Standardized questionnaires augmented by qualitative interviews were employed to measure alcohol and substance use, experiences of abuse, and levels and types of stressors facing women in this situation. Significant reductions in women's use of alcohol and stimulants were observed from Interview I to Interview II, but there was no significant reduction in use of other depressants or tobacco use. Levels of stress decreased and sources of stress changed for the women after the shelter experience. Stress connected to relationship with partners had the most significant decrease, followed by mental health, housing, and legal issues. Women reported barriers to accessing financial aid and services for substance use outside of the shelter. Women's experiences of violence and substance use were found to be interconnected in complex ways and changes in substance use were affected by a range of influences, such as financial concerns, mothering, relationships, levels of social support, and physical and mental health issues. Substance-using women who have experienced violence are an underserved population and a multi-sectoral response designed to address psychosocial, relational, and structural issues could better help them improve their overall health.

Using Geographic Information Systems and Local Food Store Data in California's Low-Income Neighborhoods to Inform Community Initiatives and Resources

PubMed Central

Quinn, Valerie; Foerster, Susan B.

2010-01-01

Objectives. We examined conditions in California low-income neighborhoods that affect obesity to inform program planning, nutrition education, community participation, investment of resources, and involvement of stakeholders. Methods. Staff members in 18 local health departments were trained to use an online geographic information system (GIS) and conduct field surveys. GIS data were aggregated from 68 low-income neighborhoods of 1 or more census tracts. Data were collected in 2007 to 2009 from 473 grocery stores in 62 neighborhoods. Results. Thirty-one percent of neighborhoods mapped had no supermarket within any of their census tract boundaries, but health department staff members estimated that 74.2% of residents had access to a large grocery store within 1 mile. Eighty-one percent of small markets sold produce, and 67.6% offered 4 or more types of fresh vegetables. Conclusions. Small markets and corner stores in California's low-income neighborhoods often have fresh produce available for sale. Stores providing healthy options in typically underserved areas can be part of community efforts to promote healthy eating behaviors. PMID:20864701

Using geographic information systems and local food store data in California's low-income neighborhoods to inform community initiatives and resources.

PubMed

Ghirardelli, Alyssa; Quinn, Valerie; Foerster, Susan B

2010-11-01

We examined conditions in California low-income neighborhoods that affect obesity to inform program planning, nutrition education, community participation, investment of resources, and involvement of stakeholders. Staff members in 18 local health departments were trained to use an online geographic information system (GIS) and conduct field surveys. GIS data were aggregated from 68 low-income neighborhoods of 1 or more census tracts. Data were collected in 2007 to 2009 from 473 grocery stores in 62 neighborhoods. Thirty-one percent of neighborhoods mapped had no supermarket within any of their census tract boundaries, but health department staff members estimated that 74.2% of residents had access to a large grocery store within 1 mile. Eighty-one percent of small markets sold produce, and 67.6% offered 4 or more types of fresh vegetables. Small markets and corner stores in California's low-income neighborhoods often have fresh produce available for sale. Stores providing healthy options in typically underserved areas can be part of community efforts to promote healthy eating behaviors.

The Face of Women's Health: Helen Rodriguez-Trias

PubMed Central

Wilcox, Joyce

2002-01-01

The American Public Health Association has announced that it will establish an award in the name of Helen Rodriguez-Trias, MD, its first Latina president, who died of lung cancer on December 27, 2002. Rodriguez-Trias, a nationally known advocate for underserved communities, was awarded the Presidential Citizens Medal by President Clinton in January 2001 for her work on behalf of children, women, people with AIDS, and the poor. This article is based on a dialogue with Rodriguez-Trias that began in September 2001 and ended December 12, 2001. PMID:11919054

Impact of Patient Empathy Modeling on Pharmacy Students Caring for the Underserved

PubMed Central

Chen, Judy T.; LaLopa, Joseph

2008-01-01

Objective To determine the impact of the Patient Empathy Modeling pedagogy on students' empathy towards caring for the underserved during an advanced pharmacy practice experience (APPE). Design Pharmacy students completing an APPE at 2 primary care clinics participated in a Patient Empathy Modeling assignment for 10 days. Each student “became the patient,” simulating the life of an actual patient with multiple chronic diseases who was coping with an economic, cultural, or communication barrier to optimal healthcare. Students completed the Jefferson Scale of Physician Empathy (JSPE) before and after completing the assignment, and wrote daily journal entries and a reflection paper. Assessment Twenty-six students completed the PEM exercises from 2005-2006. Scores on the JSPE improved. Students' comments in journals and reflection papers revealed 3 major themes: greater appreciation of the difficulty patients have with adherence to medication and treatment regimens, increased empathy for patients from different backgrounds and patients with medical and psychosocial challenges, and improved ability to apply the lessons learned in the course to their patient care roles. Conclusion A Patient Empathy Modeling assignment improved pharmacy students' empathy toward underserved populations. Integrating the assignment within an APPE allowed students to immediately begin applying the knowledge and insight gained from the exercise. PMID:18483606

Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study.

PubMed

Bowling, Jessamyn; Dodge, Brian; Banik, Swagata; Rodriguez, Israel; Mengele, Shruta Rawat; Herbenick, Debby; Guerra-Reyes, Lucia; Sanders, Stephanie; Dange, Alpana; Anand, Vivek

2016-07-01

The experiences of sexual minority women (i.e., women who do not identify as 'heterosexual') in India have largely been absent in scientific literature. In partnership with India's oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women's perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.

See, Test & Treat: A 5-Year Experience of Pathologists Driving Cervical and Breast Cancer Screening to Underserved and Underinsured Populations.

PubMed

Magnani, Barbarajean; Harubin, Beth; Katz, Judith F; Zuckerman, Andrea L; Strohsnitter, William C

2016-12-01

- See, Test & Treat is a pathologist-driven program to provide cervical and breast cancer screening to underserved and underinsured patient populations. This program is largely funded by the CAP Foundation (College of American Pathologists, Northfield, Illinois) and is a collaborative effort among several medical specialties united to address gaps in the current health care system. - To provide an outline for administering a See, Test & Treat program, using an academic medical center as a model for providing care and collating the results of 5 years of data on the See, Test & Treat program's findings. - Sources include data from patients seen at Tufts Medical Center (Boston, Massachusetts) who presented to the See, Test & Treat program and institutional data between 2010 and 2014 detailing the outline of how to organize and operationalize a volunteer cancer-screening program. - During the 5-year course of the program, 203 women were provided free cervical and breast cancer screening. Of the 169 patients who obtained Papanicolaou screening, 36 (21.3%) had abnormal Papanicolaou tests. In addition, 16 of 130 patients (12.3%) who underwent mammography had abnormal findings. - In general, women from ethnic populations have barriers that prevent them from participating in cancer screening. However, the CAP Foundation's See, Test & Treat program is designed to reduce those barriers for these women by providing care that addresses cultural, financial, and practical issues. Although screening programs are helpful in identifying those who need further treatment, obtaining further treatment for these patients continues to be a challenge.

Consensus Recommendations for Advancing Breast Cancer: Risk Identification and Screening in Ethnically Diverse Younger Women

PubMed Central

Stojadinovic, Alexander; Summers, Thomas A; Eberhardt, John; Cerussi, Albert; Grundfest, Warren; Peterson, Charles M.; Brazaitis, Michael; Krupinski, Elizabeth; Freeman, Harold

2011-01-01

A need exists for a breast cancer risk identification paradigm that utilizes relevant demographic, clinical, and other readily obtainable patient-specific data in order to provide individualized cancer risk assessment, direct screening efforts, and detect breast cancer at an early disease stage in historically underserved populations, such as younger women (under age 40) and minority populations, who represent a disproportionate number of military beneficiaries. Recognizing this unique need for military beneficiaries, a consensus panel was convened by the USA TATRC to review available evidence for individualized breast cancer risk assessment and screening in young (< 40), ethnically diverse women with an overall goal of improving care for military beneficiaries. In the process of review and discussion, it was determined to publish our findings as the panel believes that our recommendations have the potential to reduce health disparities in risk assessment, health promotion, disease prevention, and early cancer detection within and in other underserved populations outside of the military. This paper aims to provide clinicians with an overview of the clinical factors, evidence and recommendations that are being used to advance risk assessment and screening for breast cancer in the military. PMID:21509152

Leveraging CyVerse Resources for De Novo Comparative Transcriptomics of Underserved (Non-model) Organisms

PubMed Central

Joyce, Blake L.; Haug-Baltzell, Asher K.; Hulvey, Jonathan P.; McCarthy, Fiona; Devisetty, Upendra Kumar; Lyons, Eric

2017-01-01

This workflow allows novice researchers to leverage advanced computational resources such as cloud computing to carry out pairwise comparative transcriptomics. It also serves as a primer for biologists to develop data scientist computational skills, e.g. executing bash commands, visualization and management of large data sets. All command line code and further explanations of each command or step can be found on the wiki (https://wiki.cyverse.org/wiki/x/dgGtAQ). The Discovery Environment and Atmosphere platforms are connected together through the CyVerse Data Store. As such, once the initial raw sequencing data has been uploaded there is no more need to transfer large data files over an Internet connection, minimizing the amount of time needed to conduct analyses. This protocol is designed to analyze only two experimental treatments or conditions. Differential gene expression analysis is conducted through pairwise comparisons, and will not be suitable to test multiple factors. This workflow is also designed to be manual rather than automated. Each step must be executed and investigated by the user, yielding a better understanding of data and analytical outputs, and therefore better results for the user. Once complete, this protocol will yield de novo assembled transcriptome(s) for underserved (non-model) organisms without the need to map to previously assembled reference genomes (which are usually not available in underserved organism). These de novo transcriptomes are further used in pairwise differential gene expression analysis to investigate genes differing between two experimental conditions. Differentially expressed genes are then functionally annotated to understand the genetic response organisms have to experimental conditions. In total, the data derived from this protocol is used to test hypotheses about biological responses of underserved organisms. PMID:28518075

Bridging Scientific Expertise to Underserved Communities: Initiating and Sustaining Local STEM Outreach

NASA Astrophysics Data System (ADS)

Anderson, Tania; Kenney, Jessica; Maple, John

2017-06-01

This presentation will feature effective outreach strategies used to recruit, engage, and sustain student involvement from underserved communities in out-of-school science outreach programs. For example, one strategy is to partner with subject matter experts to provide your audience with a deeper understanding of and a unique perspective on current science. Join us to learn more about how you can initiate and sustain a STEM based program in your local community.

Family, Children, and Poverty: Can Data Tell Us Anything? A Report from the Roundtable Project of the California Children's Council.

ERIC Educational Resources Information Center

Hailey, Jack

Current census data make clear that California's poor are poorer today than they were 10 years ago. In particular, data indicate that single working women with children earn less than working, married women with children. Because California's state-subsidized day care system directs programs to enroll children on the waiting list who are from…

The Health Needs of Young Women: Applying a Feminist Philosophical Lens to Nursing Science and Practice.

PubMed

Burton, Candace W

2016-01-01

Ongoing development of nursing science requires attention to the philosophical and theoretical bases upon which the science is built. A feminist theoretical perspective offers a useful lens for understanding the needs of both nurses and their clients. Adolescent and young adult women are an underserved and understudied population for whom nursing care can be especially beneficial. Considering the needs of this population from a philosophical perspective, through a feminist lens, is one effective means of developing nursing science approaches that contribute to and ultimately improve care for adolescent and young adult women.

The Health Needs of Young Women: Applying a feminist philosophical lens to nursing science and practice

PubMed Central

Burton, Candace W.

2016-01-01

Ongoing development of nursing science requires attention to the philosophical and theoretical basis upon which the science is built. A feminist theoretical perspective offers a useful lens for understanding the needs of both nurses and their clients. Adolescent and young adult women are an underserved and understudied population for whom nursing care can be especially beneficial. Considering the needs of this population from a philosophical perspective, through a feminist lens, is one effective means of developing nursing science approaches that contribute to and ultimately improve care for adolescent and young adult women. PMID:27149225

Effect of Computer Support on Younger Women with Breast Cancer

PubMed Central

Gustafson, David H; Hawkins, Robert; Pingree, Suzanne; McTavish, Fiona; Arora, Neeraj K; Mendenhall, John; Cella, David F; Serlin, Ronald C; Apantaku, Funmi M; Stewart, James; Salner, Andrew

2001-01-01

OBJECTIVE Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer, with particular emphasis on assisting the underserved. DESIGN Randomized controlled trial conducted between 1995 and 1998. SETTING Five sites: two teaching hospitals (Madison, Wis, and Chicago, Ill), two nonteaching hospitals (Chicago), and a cancer resource center (Indianapolis, Ill). The latter three sites treat many underserved patients. PARTICIPANTS Newly diagnosed breast cancer patients (N = 246) under age 60. INTERVENTIONS Experimental group received Comprehensive Health Enhancement Support System (CHESS), a home-based computer system providing information, decision-making, and emotional support. MEASUREMENTS AND MAIN RESULTS Pretest and two post-test surveys (at two- and five-month follow-up) measured aspects of participation in care, social/information support, and quality of life. At two-month follow-up, the CHESS group was significantly more competent at seeking information, more comfortable participating in care, and had greater confidence in doctor(s). At five-month follow-up, the CHESS group had significantly better social support and also greater information competence. In addition, experimental assignment interacted with several indicators of medical underservice (race, education, and lack of insurance), such that CHESS benefits were greater for the disadvantaged than the advantaged group. CONCLUSIONS Computer-based patient support systems such as CHESS may benefit patients by providing information and social support, and increasing their participation in health care. These benefits may be largest for currently underserved populations. PMID:11520380

Community Colleges in Higher Education: The Role of Community Colleges in Serving the Underserved Student

ERIC Educational Resources Information Center

Freeman, Jerrid P.

2007-01-01

The changing economy is increasing the significance of community colleges. While community colleges have served an important role in higher education, their importance and value to individuals and society is at an all time high. While community college characteristics have made these institutions attractive, the underserved population and the…

Building Interest in Math and Science for Rural and Underserved Elementary School Children Using Robots

ERIC Educational Resources Information Center

Matson, Eric; DeLoach, Scott; Pauly, Robyn

2004-01-01

The "Robot Roadshow Program" is designed to increase the interest of elementary school children in technical disciplines, specifically math and science. The program focuses on children from schools categorized as rural or underserved, which often have limited access to advanced technical resources. We developed the program using robots…

Development and First Phase Evaluation of a Maternity Leave Educational Tool for Pregnant, Working Women in California

PubMed Central

Kurtovich, Elaine; Guendelman, Sylvia; Neuhauser, Linda; Edelman, Dana; Georges, Maura; Mason-Marti, Peyton

2015-01-01

Background Despite the provision of maternity leave offered to mothers, many American women fail to take leave. Methods We developed an evidence-based maternity leave educational tool for working women in California using participatory design. We tested its short-term efficacy with a randomized controlled trial of pregnant English-speakers (n=155). Results Among intervention participants exposed to the tool, 65% reported that they learned something new; 38% were motivated to seek more information; and 49% said it helped them plan their maternity leave. Among participants who delivered at ≥ 37 weeks gestation and said the tool helped them plan their leave, 89% took more than one week of prenatal leave, a significantly higher proportion than among controls who did not receive the tool (64%, p=0.049). Other findings favored trial participants, but were not statistically significant in this small sample. More intervention participants took some prenatal leave (80%) vs. controls (74%, p=0.44). Among participants who had returned to work when surveyed (n=50), mean postnatal leave uptake was on average 1 week longer for intervention participants vs. controls (13.3 vs. 12.2 weeks, p=0.54). Conclusions The first-phase evaluation of this tool shows that it successfully informed women about maternity leave options, clarified complex regulations, encouraged women to seek further information and helped plan maternity leave. Compared to controls, trial participants who used the tool to plan their leave were far more likely to take prenatal leave close to term. Future evaluation of the tool when mediated by a health provider or employer is warranted. PMID:26107519

Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers?

PubMed Central

Alas, Alexandriah N.; Dunivan, Gena C.; Wieslander, Cecelia K.; Sevilla, Claudia; Barrera, Biatris; Rashid, Rezoana; Maliski, Sally; Eilber, Karen; Rogers, Rebecca G.; Anger, Jennifer Tash

2017-01-01

Objectives The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). Methods Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. Results Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. Conclusions The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care. PMID:27636216

Health Care Disparities Among English-Speaking and Spanish-Speaking Women With Pelvic Organ Prolapse at Public and Private Hospitals: What Are the Barriers?

PubMed

Alas, Alexandriah N; Dunivan, Gena C; Wieslander, Cecelia K; Sevilla, Claudia; Barrera, Biatris; Rashid, Rezoana; Maliski, Sally; Eilber, Karen; Rogers, Rebecca G; Anger, Jennifer Tash

The objective of this study was to compare perceptions and barriers between Spanish-speaking and English-speaking women in public and private hospitals being treated for pelvic organ prolapse (POP). Eight focus groups, 4 in English and 4 in Spanish, were conducted at 3 institutions with care in female pelvic medicine and reconstructive surgery. Standardized questions were asked regarding patients' emotions to when they initially noticed the POP, if they sought family support, and their response to the diagnosis and treatment. Transcripts were analyzed using grounded theory qualitative methods. Thirty-three women were Spanish-speaking and 25 were English-speaking. Spanish speakers were younger (P = 0.0469) and less likely to have a high school diploma (P < 0.0001) than English speakers. Spanish-speaking women had more concerns that the bulge or treatments could lead to cancer, were more resistant to treatment options, and were less likely to be offered surgery. Women in the private hospital desired more information, were less embarrassed, and were more likely to be offered surgery as first-line treatment. The concept emerged that patient care for POP varied based on socioeconomic status and language and suggested the presence of disparities in care for underserved women with POP. The discrepancies in care for Spanish-speaking women and women being treated at public hospitals suggest that there are disparities in care for POP treatment for underserved women. These differences may be secondary to profit-driven pressures from private hospitals or language barriers, low socioeconomic status, low health literacy, and barriers to health care.

Effects of gender discrimination and reported stress on drug use among racially/ethnically diverse women in Northern California.

PubMed

Ro, Annie; Choi, Kyung-Hee

2010-01-01

Gender discrimination has been associated with worse health outcomes for U.S. women. Using the stress and coping process framework, we examined whether lifetime gender discrimination was associated with maladaptive coping behaviors, namely, lifetime and recent hard drug use. We also considered whether reported stress from gender discrimination mediated this relationship and whether this process differed across racial/ethnic groups. We used data from a racially/ethnically diverse convenience sample of 754 women attending family planning clinics in Northern California (11% African American, 17% Latina, 10% Asian, and 62% Caucasian). To test our hypotheses, we conducted logistic regression models, controlling for sociodemographic characteristics. Gender discrimination was positively associated with both lifetime and recent hard drug use. We did not find support for the mediation hypothesis, because stress was not associated with either lifetime or recent hard drug use. There was evidence of some race moderation for the Latina sample. Among these respondents, gender discrimination was associated with higher odds of lifetime drug use, whereas stress was associated with lower odds. These results suggest that experiences of gender discrimination may still activate negative coping strategies involving drug use, regardless of the stress they cause. For Latina respondents, more research is needed to better understand the stress and coping process related to gender discrimination. Copyright 2010 Jacobs Institute of Women

Using Social Cognitive Theory to Predict Physical Activity and Fitness in Underserved Middle School Children

ERIC Educational Resources Information Center

Martin, Jeffrey J.; McCaughtry, Nate; Flory, Sara; Murphy, Anne; Wisdom, Kimberlydawn

2011-01-01

Few researchers have used social cognitive theory and environment-based constructs to predict physical activity (PA) and fitness in underserved middle-school children. Hence, we evaluated social cognitive variables and perceptions of the school environment to predict PA and fitness in middle school children (N = 506, ages 10-14 years). Using…

Increasing Educational Attainment and Aspiration in an Underserved Community: The Perspective of Urban-Community Leaders

ERIC Educational Resources Information Center

Person, Dawn; Garcia, Yvonne; Fujimoto, Eugene; Nguyen, Kayla; Saunders, Katherine; Hoffman, John

2014-01-01

Latino students are significantly underrepresented in higher education. As the largest and fastest growing racial/ethnic population in the US, this is cause for national concern. Additionally, this rapid population growth is a call for community and school leaders from underserved communities to assess their service areas and focus on…

Engaging Health Systems to Increase Colorectal Cancer Screening: Community–Clinical Outreach in Underserved Areas of Wisconsin

PubMed Central

Weeth-Feinstein, Lauren; Conlon, Amy; Scott, Sheryl

2013-01-01

Background Colorectal cancer is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related death in Wisconsin. Incidence and mortality rates for colorectal cancer vary by age, race/ethnicity, geography, and socioeconomic status. From 2010 through 2012, the Wisconsin Comprehensive Cancer Control Program awarded grants to 5 regional health systems for the purpose of planning and implementing events to increase colorectal cancer screening rates in underserved communities. Community Context Grantees were chosen for their ability to engage community partners in reaching underserved groups including African American, Hispanic/Latino, Hmong, rural, and uninsured populations in their service areas. Methods Grantees identified target populations for proposed screening events, designated institutional planning teams, engaged appropriate local partner organizations, and created plans for follow-up. All grantees implemented 1 or more colorectal cancer screening events within 6 months of receiving their awards. Events were conducted in 2 phases. Outcomes Participating health systems organized 36 screening events and distributed 633 individual test kits; 506 kits were returned, of which 57 (9%) tested positive for colorectal abnormalities. Of attendees who received screening, 63% were uninsured or underinsured, 55% had no previous screening, 46% were of a racial/ethnic minority group, 22% had a family history of cancer, and 13% were rural residents. This project strengthened partnerships between health systems and local organizations. Interpretation An effective strategy for improving colorectal cancer screening rates, particularly among underserved populations, is to award health systems grants for implementing community-based screening events in conjunction with community partners. PMID:24262024

Evaluating the Efficacy of Lay Health Advisors for Increasing Risk-appropriate Pap Test Screening: A randomized controlled trial among Ohio Appalachian women

PubMed Central

Paskett, Electra D.; McLaughlin, John M.; Lehman, Amy M.; Katz, Mira L.; Tatum, Cathy M.; Oliveri, Jill M.

2011-01-01

Background Cervical cancer is a significant health disparity among women in Ohio Appalachia. The goal of this study was to evaluate the efficacy of a lay health advisor (LHA) intervention for improving Pap testing rates, to reduce cervical cancer, among women in need of screening. Methods Women from 14 Ohio Appalachian clinics in need of a Pap test were randomized to receive either usual care or an LHA intervention over a ten-month period. The intervention consisted of two in-person visits with an LHA, two phone calls, and four post cards. Both self-report and medical record review (MRR) data (primary outcome) were analyzed. Results Of the 286 women, 145 and 141 were randomized to intervention and usual care arms, respectively. According to MRR, more women in the LHA arm had a Pap test by the end of the study compared to those randomized to usual care (51.1% vs. 42.0%; OR=1.44, 95%CI: 0.89, 2.33; p=0.135). Results of self-report were more pronounced (71.3% vs. 54.2%; OR=2.10, 95%CI: 1.22, 3.61; p=0.008). Conclusions An LHA intervention showed some improvement in the receipt of Pap tests among Ohio Appalachian women in need of screening. While biases inherent in using self-reports of screening are well known, this study also identified biases in using MRR data in clinics located in underserved areas. Impact LHA interventions show promise for improving screening behaviors among non-adherent women from underserved populations. PMID:21430302

75 FR 29447 - Public Health Service Act, Rural Physician Training Grant Program, Definition of “Underserved...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

..., identified by the Regulatory Information Number (RIN), by any of the following methods: Federal eRulemaking... assisting eligible entities in recruiting students most likely to practice medicine in underserved rural... determined that good cause exists which makes the usual notice and comment procedure impractical, unnecessary...

Attracting qualified physicians to underserved areas. Part 2. Pay physicians more to practice in underserved areas.

PubMed

Weil, T P

1999-01-01

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part I of this article, which appeared in the November/December issue of The Physician Executive, reviewed the efficacy of these approaches. The second part explores a more pragmatic option: to simply improve the working conditions and pay substantially more to physicians who practice in "less desirable" locations. Although this idea is consistent with economic principles, drawbacks must be considered, such as: (1) the American taxpayers' reluctance to finance a more costly health care delivery system for the poor; (2) the inherent conceptual difficulties of a capitated Medicaid HMO serving as the linchpin for organizing, financing, and delivering care for the underserved; and, (3) many providers being expected to react in a fairly litigious manner to such an approach.

Correlates of Cervical Cancer Screening Among Adult Latino Women: A 5-Year Follow-Up.

PubMed

Rojas, Patria; Li, Tan; Ravelo, Gira J; Dawson, Christyl; Sanchez, Mariana; Sneij, Alicia; Wang, Weize; Kanamori, Mariano; Cyrus, Elena; De La Rosa, Mario R

2017-06-01

Latinas have the highest incidence rates of cervical cancer in the United States, and Latinas in the United States are less likely to utilize cervical cancer screening. We used secondary data analysis of a non-clinical convenience sample (n=316 women at baseline; n=285 at five-year follow-up) to examine correlates of cervical cancer screening among adult Latina women. Univariate and multiple logistic regression models using Generalized Estimated Equations (GEE) algorithm were utilized to assess the influence of the independent variables. Women who reported their main healthcare source as community health clinics, women who were sexually active, and women who reported that a healthcare provider discussed HIV prevention with them were more likely to report having a cervical cancer screening (aOR=2.06; CI=1.20, 3.52). The results suggest a need for continued efforts to ensure that medically underserved women (e.g., Latina women) receive counseling and education about the importance of preventive cancer screening.

Medical School Outcomes, Primary Care Specialty Choice, and Practice in Medically Underserved Areas by Physician Alumni of MEDPREP, a Postbaccalaureate Premedical Program for Underrepresented and Disadvantaged Students.

PubMed

Metz, Anneke M

2017-01-01

Minorities continue to be underrepresented as physicians in medicine, and the United States currently has a number of medically underserved communities. MEDPREP, a postbaccalaureate medical school preparatory program for socioeconomically disadvantaged or underrepresented in medicine students, has a stated mission to increase the numbers of physicians from minority or disadvantaged backgrounds and physicians working with underserved populations. This study aims to determine how MEDPREP enhances U.S. physician diversity and practice within underserved communities. MEDPREP recruits disadvantaged and underrepresented in medicine students to complete a 2-year academic enhancement program that includes science coursework, standardized test preparation, study/time management training, and emphasis on professional development. Five hundred twenty-five disadvantaged or underrepresented students over 15 years completed MEDPREP and were tracked through entry into medical practice. MEDPREP accepts up to 36 students per year, with two thirds coming from the Midwest region and another 20% from nearby states in the South. Students complete science, test preparation, academic enhancement, and professionalism coursework taught predominantly by MEDPREP faculty on the Southern Illinois University Carbondale campus. Students apply broadly to medical schools in the region and nation but are also offered direct entry into our School of Medicine upon meeting articulation program requirements. Seventy-nine percent of students completing MEDPREP became practicing physicians. Fifty-eight percent attended public medical schools, and 62% attended medical schools in the Midwest. Fifty-three percent of program alumni chose primary care specialties compared to 34% of U.S. physicians, and MEDPREP alumni were 2.7 times more likely to work in medically underserved areas than physicians nationally. MEDPREP increases the number of disadvantaged and underrepresented students entering and graduating

Calmer Life: A Hybrid Effectiveness-implementation Trial for Late-life Anxiety Conducted in Low-income, Mental Health-Underserved Communities.

PubMed

Shrestha, Srijana; Wilson, Nancy; Kunik, Mark E; Wagener, Paula; Amspoker, Amber B; Barrera, Terri; Freshour, Jessica; Kraus-Schuman, Cynthia; Bavineau, Jane; Turner, Maria; Stanley, Melinda A

2017-05-01

Anxiety is common among older adults and is associated with multiple negative outcomes. Late-life anxiety is usually unrecognized by providers and undertreated, although evidence supports the effectiveness of psychosocial treatment. Access to mental health care is especially poor among African American seniors. New treatment models are needed to expand the reach of mental health care to minority elders. Our article outlines a study designed to test the effectiveness and implementation potential of Calmer Life (CL), a community-based, person-centered, flexible and culturally tailored intervention for late-life anxiety and worry, offered in low-income, mental health-underserved and predominantly African American communities. CL is skills-based, but also includes resource counseling and an option to integrate religion/spirituality. The study population includes individuals 50 years of age and older who are experiencing high levels of worry. The program was developed in the context of a community-academic partnership with organizations that provide services for seniors in underserved communities, and it trains nontraditional community providers to deliver the intervention. Study progress to date, challenges, and lessons learned are discussed. Data collection is ongoing, and study findings will be available in late 2017. CL will offer valuable information to help expand the reach of anxiety treatment among minority seniors living in underserved neighborhoods.

Scholarship support for Indian students in the health sciences: an alternative method to address shortages in the underserved area

PubMed Central

Weiss, Lawrence D.; Wiese, William H.; Goodman, Alan B.

1980-01-01

The University of New Mexico Area Health Education Center was established in conjunction with the Navajo Health Authority to begin health manpower development immediately in the Navajo Nation and surrounding areas (a territory approximately the size of West Virginia). To this end, a student support program was established at the Navajo Health Agency to recruit and support Indian students with scholarships, to provide them with culturally based counseling, and to reinforce the students' intentions of ultimately returning to serve Indian people. No payback penalties or other forms of coercion were used in this program to encourage students to return to the underserved Indian areas. From October 1973 through September 1977, 124 students graduated with 125 degrees or certificates in all aspects of health care. Of these 124 students, 76 were employed. The remaining were continuing their education, unemployed, untraceable, or deceased. Of the 76 employed, 61 were from tribes within the Navajo Nation; of these 61, 56 returned to their area to serve Indians. This return rate to an underserved area is substantially better than anticipated from a review of programs that employ a variety of coercive methods to encourage recipients of loans to settle in specific underserved areas after the necessary training. PMID:7384409

Swinging bridges of opportunity and challenges: memoirs of an African American nurse practitioner pioneer on providing primary care for the underserved.

PubMed

Brown, Viola D; Marfell, Julie

2005-01-01

This article presents the memoirs of Mrs. Viola D. Brown, RN, FNP, a pioneer African American nurse practitioner, on opportunities and challenges involved in providing primary and public health care for underserved populations in urban and rural areas of Kentucky. Mrs. Brown began her career with a visit to Mary Breckinridge and the Frontier Nursing Service, and she was elected into the University of Kentucky's Department of Public Health Hall of Fame in 2005. This article is an adapted version of the closing keynote address presented at the 13th Primary Care for the Underserved Conference held March 2005.

A Qualitative Study of Parental Modeling and Social Support for Physical Activity in Underserved Adolescents

ERIC Educational Resources Information Center

Wright, Marcie S.; Wilson, Dawn K.; Griffin, Sarah; Evans, Alexandra

2010-01-01

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10-14 years, 85% African-American) participated in a focus group (6-10 per group, same gender). Focus groups were…

Improvements in prenatal insurance coverage and utilization of care in California: an unsung public health victory.

PubMed

Rittenhouse, Diane R; Braveman, Paula; Marchi, Kristen

2003-06-01

To examine trends in prenatal insurance coverage and utilization of care in California over two decades in the context of expansions in Medi-Cal (California's Medicaid) and other public efforts to increase prenatal care utilization. Retrospective univariate and bivariate analysis of prenatal care coverage and utilization data from 10,192,165 California birth certificates, 1980-99; descriptive analysis of California poverty and unemployment data from the U.S. Census Bureau Current Population Survey; review of public health and social policy literature. The proportion of mothers with Medi-Cal coverage for prenatal care increased from 28.2 to 47.5% between 1989 and 1994, and the proportion uninsured throughout pregnancy decreased from 13.2 to 3.2%. Since the mid-1990s, fewer than 3% of women have had no insurance coverage for prenatal care. Between 1989 and 1999, the proportion of women with first trimester initiation of prenatal care increased from 72.6 to 83.6%, reversing the previous decade's trend, and the proportion of women with adequate numbers of visits rose from 70.7 to 83.1%. Improvements in utilization measures were greater among disadvantaged social groups. Improvements in California during the 1990s coincided with a multifaceted public health effort to increase both prenatal care coverage and utilization, and do not appear to be explained by changes in the economy, maternal characteristics, the overall organization/delivery of health care, or other social policies. While this ecologic study cannot produce definitive conclusions regarding causality, these results suggest an important victory for public health in California.

The prevalence of uncorrected refractive errors in underserved rural areas.

PubMed

Hashemi, Hassan; Abbastabar, Hedayat; Yekta, Abbasali; Heydarian, Samira; Khabazkhoob, Mehdi

2017-12-01

To determine the prevalence of uncorrected refractive errors, need for spectacles, and the determinants of unmet need in underserved rural areas of Iran. In a cross-sectional study, multistage cluster sampling was done in 2 underserved rural areas of Iran. Then, all subjects underwent vision testing and ophthalmic examinations including the measurement of uncorrected visual acuity (UCVA), best corrected visual acuity, visual acuity with current spectacles, auto-refraction, retinoscopy, and subjective refraction. Need for spectacles was defined as UCVA worse than 20/40 in the better eye that could be corrected to better than 20/40 with suitable spectacles. Of the 3851 selected individuals, 3314 participated in the study. Among participants, 18.94% [95% confidence intervals (CI): 13.48-24.39] needed spectacles and 11.23% (95% CI: 7.57-14.89) had an unmet need. The prevalence of need for spectacles was 46.8% and 23.8% in myopic and hyperopic participants, respectively. The prevalence of unmet need was 27% in myopic, 15.8% in hyperopic, and 25.46% in astigmatic participants. Multiple logistic regression showed that education and type of refractive errors were associated with uncorrected refractive errors; the odds of uncorrected refractive errors were highest in illiterate participants, and the odds of unmet need were 12.13, 5.1, and 4.92 times higher in myopic, hyperopic and astigmatic participants as compared with emmetropic individuals. The prevalence of uncorrected refractive errors was rather high in our study. Since rural areas have less access to health care facilities, special attention to the correction of refractive errors in these areas, especially with inexpensive methods like spectacles, can prevent a major proportion of visual impairment.

Differences in Self-Reported Physical Activity and Body Mass Index Among Older Hispanic and Non-Hispanic White Men and Women: Findings from the 2009 California Health Interview Survey.

PubMed

Sorkin, Dara H; Biegler, Kelly A; Billimek, John

2015-10-01

Older Hispanic Americans are a rapidly growing minority group who are disproportionately affected by diabetes mellitus and obesity. Given the importance of physical activity, particularly leisure-time activity, in the management of diabetes mellitus and obesity, the current study examined ethnic and sex differences in walking for transportation, leisure-time walking, moderate activity (not including walking), and vigorous activity between Hispanic and non-Hispanic white (NHW) older adults (age 55 and older) using the 2009 California Health Interview Survey, a population-based survey representative of California's noninstitutionalized population. The total sample consisted of 21,702 participants (20,148 NHW (7,968 men, 12,180 women) and 1,554 Hispanic (609 men, 945 women)). Multivariable logistic and linear regression analyses were adjusted for sociodemographic characteristics. The findings revealed that Hispanic men and women were significantly less likely to engage in self-reported leisure-time walking and vigorous activity than NHW men (adjusted odds ratio (aOR) = 0.71, 95% confidence interval (CI) = 0.51-0.99) and women (aOR = 0.60, 95% CI = 0.42-0.87). Regardless of ethnic group, men were more likely than women to engage in self-reported walking for transportation (aOR = 0.71, 95% CI = 0.58-0.87), moderate activity (aOR = 0.68, 95% CI = 0.57-0.81), and vigorous activity (aOR = 0.58, 95% CI = 0.50-0.68). All types of self-reported physical activity were associated with lower body mass index (BMI; P < .001), although significant interactions between sex and leisure time walking (P < .001), moderate activity (P < .001), and vigorous activity (P < .001) indicated that women who engaged in these activities reported the lowest BMIs. The findings highlight the importance of emphasizing walking in efforts to increase moderate and vigorous activity, particularly for older women. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Pop Up/Drill Down: A Traveling Exhibit Designed to Reach Underserved Communities through Art and Geosciences

NASA Astrophysics Data System (ADS)

Kurtz, N.

2017-12-01

Scientists observe the world around them in an attempt to understand it. Artists observe the world around them in an attempt to create a reflection or response to the environment. It is critical for the two fields to work together in order to engage and inform the general population. The Consortium for Ocean Leadership, the International Ocean Discovery Program and a series of collaborators are designing a traveling exhibit that will inspire underserved communities in the excitement of exploration, the process of science, and the people and tools required to get there. The project aims to learn more about how to increase access to and awareness of ocean/earth science by bringing a pop-up style museum exhibit to local libraries and public events. As an artist with a science and education background and the graphic designer for this exhibit, this author will highlight the ways this project utilizes art and design to educate underserved populations in ocean and geosciences.

The Continuing Umbrella of Research Experiences (CURE): a model for training underserved scientists in cancer research.

PubMed

Franco, Idalid; Bailey, LeeAnn O; Bakos, Alexis D; Springfield, Sanya A

2011-03-01

Mentoring is a critical aspect of research and training; and the adoption of a successful mentoring model for guiding researchers through the educational pipeline is lacking. The Continuing Umbrella of Research Experiences (CURE) program was established in the Comprehensive Minority Biomedical Branch; which is part of the National Cancer Institute. This program offers unique training and career development opportunities to enhance diversity in cancer research. The CURE initiative focuses on broadening the cadre of underserved investigators engaging in cancer research. CURE begins with high school students and fosters scientific, academic and research excellence throughout the trainee's educational progression. The program supports students throughout the entirety of their training career. During this period, the trainee matures into a competitive early stage investigator; capable of securing advanced research project funding in academic and industry workforces. Thus, the CURE program provides a comprehensive vehicle for training and reinforces the critical mass of underserved investigators conducting cancer research.

International Comparisons in Underserved Health: Issues, Policies, Needs and Projections.

PubMed

Hutchinson, Paul; Morelli, Vincent

2017-03-01

Health care globally has made great strides; for example, there are lower rates of infant and maternal mortality. Increased incomes have led to lower rates of diseases accompanying poverty and hunger. There has been a shift away from the infectious diseases so deadly in developing nations toward first-world conditions. This article presents health care statistics across age groups and geographic areas to help the primary care physician understand these changes. There is a special focus on underserved populations. New technologies in health and health care spending internationally are addressed, emphasizing universal health care. The article concludes with recommendations for the future. Copyright © 2016 Elsevier Inc. All rights reserved.

Training future health providers to care for the underserved: a pilot interprofessional experience.

PubMed

Hasnain, Memoona; Koronkowski, Michael J; Kondratowicz, Diane M; Goliak, Kristen L

2012-01-01

Interprofessional teamwork is essential for effective delivery of health care to all patients, particularly the vulnerable and underserved. This brief communication describes a pilot interprofessional learning experience designed to introduce medicine and pharmacy students to critical health issues affecting at-risk, vulnerable patients and helping students learn the value of functioning effectively in interprofessional teams. With reflective practice as an overarching principle, readings, writing assignments, a community-based immersion experience, discussion seminars, and presentations were organized to cultivate students' insights into key issues impacting the health and well-being of vulnerable patients. A written program evaluation form was used to gather students' feedback about this learning experience. Participating students evaluated this learning experience positively. Both quantitative and qualitative input indicated the usefulness of this learning experience in stimulating learners' thinking and helping them learn to work collaboratively with peers from another discipline to understand and address health issues for at-risk, vulnerable patients within their community. This pilot educational activity helped medicine and pharmacy students learn the value of functioning effectively in interprofessional teams. Given the importance of interprofessional teamwork and the increasing need to respond to the health needs of underserved populations, integrating interprofessional learning experiences in health professions training is highly relevant, feasible, and critically needed.

Facilitating telemedicine project sustainability in medically underserved areas: a healthcare provider participant perspective.

PubMed

Paul, David L; McDaniel, Reuben R

2016-04-26

Very few telemedicine projects in medically underserved areas have been sustained over time. This research furthers understanding of telemedicine service sustainability by examining teleconsultation projects from the perspective of healthcare providers. Drivers influencing healthcare providers' continued participation in teleconsultation projects and how projects can be designed to effectively and efficiently address these drivers is examined. Case studies of fourteen teleconsultation projects that were part of two health sciences center (HSC) based telemedicine networks was utilized. Semi-structured interviews of 60 key informants (clinicians, administrators, and IT professionals) involved in teleconsultation projects were the primary data collection method. Two key drivers influenced providers' continued participation. First was severe time constraints. Second was remote site healthcare providers' (RSHCPs) sense of professional isolation. Two design steps to address these were identified. One involved implementing relatively simple technology and process solutions to make participation convenient. The more critical and difficult design step focused on designing teleconsultation projects for collaborative, active learning. This learning empowered participating RSHCPs by leveraging HSC specialists' expertise. In order to increase sustainability the fundamental purpose of teleconsultation projects needs to be re-conceptualized. Doing so requires HSC specialists and RSHCPs to assume new roles and highlights the importance of trust. By implementing these design steps, healthcare delivery in medically underserved areas can be positively impacted.

Understanding and Effectively Addressing Breast Cancer in African American Women: Unpacking the Social Context

PubMed Central

Williams, David R.; Mohammed, Selina A.; Shields, Alexandra E.

2017-01-01

Black women have higher incidence of breast cancer before the age of 40, more severe disease at all ages, and elevated mortality risk compared to white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse, and the complex ways that socioeconomic status and racism shape exposure to psychosocial, physical, chemical and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which Black women live is also needed to maximize the opportunities to prevent breast cancer among this underserved group. PMID:26930024

Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.

PubMed

Ganguli, Ishani; Souza, Jeffrey; McWilliams, J Michael; Mehrotra, Ateev

2018-02-01

In 2011 Medicare introduced the annual wellness visit to help address the health risks of aging adults. The visit also offers primary care practices an opportunity to generate revenue, and may allow practices in accountable care organizations to attract healthier patients while stabilizing patient-practitioner assignments. However, uptake of the visit has been uneven. Using national Medicare data for the period 2008-15, we assessed practices' ability and motivation to adopt the visit. In 2015, 51.2 percent of practices provided no annual wellness visits (nonadopters), while 23.1 percent provided visits to at least a quarter of their eligible beneficiaries (adopters). Adopters replaced problem-based visits with annual wellness visits and saw increases in primary care revenue. Compared to nonadopters, adopters had more stable patient assignment and a slightly healthier patient mix. At the same time, visit rates were lower among practices caring for underserved populations (for example, racial minorities and those dually enrolled in Medicaid), potentially worsening disparities. Policy makers should consider ways to encourage uptake of the visit or other mechanisms to promote preventive care in underserved populations and the practices that serve them.

Light at Night and Breast Cancer Risk Among California Teachers

PubMed Central

Hurley, Susan; Goldberg, Debbie; Nelson, David; Hertz, Andrew; Horn-Ross, Pamela L.; Bernstein, Leslie; Reynolds, Peggy

2014-01-01

Background There is convincing evidence that circadian disruption mediated by exposure to light at night promotes mammary carcinogenesis in rodents. The role that light at night plays in human breast cancer etiology remains unknown. We evaluated the relationship between estimates of indoor and outdoor light at night and the risk of breast cancer among members of the California Teachers Study. Methods Indoor light-at-night estimates were based on questionnaire data regarding sleep habits and use of night time lighting while sleeping. Estimates of outdoor light at night were derived from imagery data obtained from the U.S. Defense Meteorological Satellite Program assigned to geocoded addresses of study participants. Analyses were conducted among 106,731 California Teachers Study members who lived in California, had no prior history of breast cancer, and provided information on lighting while sleeping. 5,095 cases of invasive breast cancer diagnosed 1995–2010 were identified via linkage to the California Cancer Registry. We used age-stratified Cox proportional hazard models to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for breast cancer risk factors and neighborhood urbanization and socioeconomic class. Results An increased risk was found for women living in areas with the highest quintile of outdoor light at night exposure estimates (HR=1.12 [95% CI=1.00 – 1.26], test for trend, P=0.06). While more pronounced among premenopausal women (HR=1.34 [95% CI=1.07 – 1.69], test for trend, P=0.04), the associations did not differ statistically by menopausal status (test for interaction, P=0.34). Conclusions Women living in areas with high levels of ambient light at night may be at an increased risk of breast cancer. Future studies that integrate quantitative measurements of indoor and outdoor light at night are warranted. PMID:25061924

Addressing multilevel barriers to cervical cancer screening in Korean American women: A randomized trial of a community-based intervention.

PubMed

Fang, Carolyn Y; Ma, Grace X; Handorf, Elizabeth A; Feng, Ziding; Tan, Yin; Rhee, Joanne; Miller, Suzanne M; Kim, Charles; Koh, Han Seung

2017-05-15

Korean American women have among the lowest rates of cervical cancer screening in the United States. The authors evaluated a multicomponent intervention combining community education with navigation services to reduce access barriers and increase screening rates in this underserved population. It was hypothesized that cervical cancer screening rates would be higher among women who received the intervention program compared with those in the control program. Korean American women (N = 705) were recruited from 22 churches. In this matched-pair, group-randomized design, 347 women received the intervention, which consisted of a culturally relevant cancer education program combined with provision of navigation services. The control group (N = 358) received general health education, including information about cervical cancer risk and screening and where to obtain low-cost or no-cost screening. Screening behavior was assessed 12 months after the program. Screening behavior data were obtained from 588 women 12 months after the program. In both site-level and participant-level analyses, the intervention program contributed to significantly higher screening rates compared with the control program (odds ratio [OR], 25.9; 95% confidence interval [CI], 10.1-66.1; P < .001). In sensitivity analysis, the treatment effect remained highly significant (OR, 16.7; 95% CI, 8.1-34.4; P < .001). A multicomponent intervention combining community cancer education with navigation services yielded significant increases in cervical cancer screening rates among underscreened Korean American women. Community-accessible programs that incorporate cancer education with the delivery of key navigation services can be highly effective in increasing cervical cancer screening rates in this underserved population. Cancer 2017;123:1018-26. © 2016 American Cancer Society. © 2016 American Cancer Society.

The Women in Medicine and Health Science program: an innovative initiative to support female faculty at the University of California Davis School of Medicine.

PubMed

Bauman, Melissa D; Howell, Lydia P; Villablanca, Amparo C

2014-11-01

Although more female physicians and scientists are choosing careers in academic medicine, women continue to be underrepresented as medical school faculty, particularly at the level of full professor and in leadership positions. Effective interventions to support women in academic medicine exist, but the nature and content of such programs varies widely. Women in medicine programs can play a critical role in supporting women's careers and can improve recruitment and retention of women by providing opportunities for networking, sponsorship, mentorship, and career development. The University of California Davis School of Medicine established the Women in Medicine and Health Science (WIMHS) program in 2000 to ensure the full participation and success of women in all roles within academic medicine. The authors describe the components and evolution of the WIMHS program. A steady increase in the number and percentage of female faculty and department chairs, as well as a relatively low departure rate for female faculty, strong and growing internal partnerships, and enthusiastic support from faculty and the school of medicine leadership, suggest that the WIMHS program has had a positive influence on recruitment and retention, career satisfaction, and institutional climate to provide a more inclusive and supportive culture for women. Going forward, the WIMHS program will continue to advocate for broader institutional change to support female faculty, like creating an on-site child care program. Other institutions seeking to address the challenges facing female faculty may consider using the WIMHS program as a model to guide their efforts.

Coccidioidomycosis-associated hospitalizations, California, USA, 2000-2011.

PubMed

Sondermeyer, Gail; Lee, Lauren; Gilliss, Debra; Tabnak, Farzaneh; Vugia, Duc

2013-10-01

In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000-2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.

California Community College Trustees. Report Number One.

ERIC Educational Resources Information Center

Wilbur, Leslie; Sheldon, M. Stephen

As part of a larger study of the efficacy of the local boards of trustees for California's community colleges, the chief executive officer (CEO) of each community college district was surveyed to determine what proportion of the more than 400 board members in the state were women, what the current or recent vocations of the board members were, and…

Factors associated with female provider preference among African American women, and implications for breast cancer screening.

PubMed

Casciotti, Dana M; Klassen, Ann C

2011-07-01

Globally, breast cancer incidence is increasing. Early detection remains important for addressing disparities, including among U.S. minorities. Seeing a female physician increases screening, but the effects of unmet provider gender preference among underserved populations remain unexplored. Among 576 urban African American women age 45-93, we examined predictors of gender preference and how met and unmet preference influenced screening. We conclude that provider gender is a "double-edged sword." We saw a female provider screening benefit, but also that gender preference was associated with past disadvantage and attitudes inconsistent with health maintenance. Provider gender preference merits further consideration in women's health research.

Clinically determined and self-reported dental status during and after pregnancy among low-income Hispanic women.

PubMed

Weintraub, Jane A; Finlayson, Tracy L; Gansky, Stuart A; Santo, William; Ramos-Gomez, Francisco

2013-01-01

This analysis assessed, during and 1 year after pregnancy: a) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; and b) factors associated with high levels of professionally determined or self-reported oral disease. Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and 1-year postpartum (PP). During pregnancy and PP, 93 percent had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists' determinations were modest (ranging from 45-80 percent for sensitivity and 41-77 percent for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94 percent), but negative predictive values were low (<23 percent). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR = 0.44). There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate analyses

The Pathway Program: A Collaboration between 3 Universities to Deliver a Social Work Distance Education (DL) Program to Underserved Areas of California

ERIC Educational Resources Information Center

Morris, Teresa; Jones, Celeste A.; Sehrawats, Seema

2016-01-01

This paper describes the development of a partnership between three campuses to develop a (DL) education program-serving employees of county and tribal Health and Human Service Departments in remote rural areas of California. Specifically, the program supports the development of a career pathway for students living in isolated regions of Northern…

Temporal Trends and Predictors for Cancer Clinical Trial Availability for Medically Underserved Populations

PubMed Central

Lakoduk, Ashley M.; Priddy, Laurin L.; Yan, Jingsheng; Xie, Xian-Jin

2015-01-01

Background. Lack of access to available cancer clinical trials has been cited as a key factor limiting trial accrual, particularly among medically underserved populations. We examined the trends and factors in clinical trial availability within a major U.S. safety-net hospital system. Materials and Methods. We identified cancer clinical trials activated at the Harold C. Simmons Cancer from 1991 to 2014 and recorded the characteristics of the trials that were and were not activated at the Parkland Health and Hospital System satellite site. We used univariate and multivariate logistic regression to determine the association between trial characteristics and nonactivation status, and chi-square analysis to determine the association between the trial characteristics and the reasons for nonactivation. Results. A total of 773 trials were identified, of which 152 (20%) were not activated at Parkland. In multivariable analysis, nonactivation at Parkland was associated with trial year, sponsor, and phase. Compared with the 1991–2006 period, clinical trials in the 2007–2014 period were almost eightfold more likely not to be activated at Parkland. The most common reasons for nonactivation at Parkland were an inability to perform the study procedures (27%) and the startup costs (15%). Conclusion. Over time, in this single-center setting, a decreasing proportion of cancer clinical trials were available to underserved populations. Trial complexity and costs appeared to account for much of this trend. Efforts to overcome these barriers will be key to equitable access to clinical trials, efficient accrual, and the generalizability of the results. Implications for Practice: Despite numerous calls to increase and diversify cancer clinical trial accrual, the present study found that cancer clinical trial activation rates in a safety-net setting for medically underserved populations have decreased substantially in recent years. The principal reasons for study nonactivation were

Teaching the content in context: Preparing "highly qualified" and "high quality" teachers for instruction in underserved secondary science classrooms

NASA Astrophysics Data System (ADS)

Tolbert, Sara E.

2011-12-01

This dissertation research project presents the results of a longitudinal study that investigates the knowledge, beliefs, and practices of 13 preservice secondary science teachers participating in a science teacher credentialing/Masters program designed to integrate issues of equity and diversity throughout coursework and seminars. Results are presented in the form of three papers: The first paper describes changes in preservice teacher knowledge about contextualization in science instruction, where contextualization is defined as facilitating authentic connections between science learning and relevant personal, social, cultural, ecological, and political contexts of students in diverse secondary classrooms; the second paper relates changes in the self-efficacy and content-specific beliefs about science, science teaching, diversity, and diversity in science instruction; and the final paper communicates the experiences and abilities of four "social justice advocates" learning to contextualize science instruction in underserved secondary placement classrooms. Results indicate that secondary student teachers developed more sophisticated understandings of how to contextualize science instruction with a focus on promoting community engagement and social/environmental activism in underserved classrooms and how to integrate science content and diversity instruction through student-centered inquiry activities. Although most of the science teacher candidates developed more positive beliefs about teaching science in underrepresented classrooms, many teacher candidates still attributed their minority students' underperformance and a (perceived) lack of interest in school to family and cultural values. The "social justice advocates" in this study were able to successfully contextualize science instruction to varying degrees in underserved placement classrooms, though the most significant limitations on their practice were the contextual factors of their student teaching

Mapping a Strategic Plan for Health: Community-Based Participatory Research with Underserved, Low-Income, Urban Neighborhoods

ERIC Educational Resources Information Center

Zandee, Gail

2012-01-01

Since 2002, community-based participatory research methods have been used by the Calvin College Nursing Department to map out a strategic health plan for three urban, low-income, underserved neighborhoods. Nine focus groups and 449 door-to-door health surveys were completed across the three urban neighborhoods between 2002 and 2004. Neighborhood…

Abuse and mental health concerns among HIV-infected Haitian women living in the United States.

PubMed

Glémaud, Myriam; Illa, Lourdes; Echenique, Marisa; Bustamente-Avellaneda, Victoria; Gazabon, Shirley; Villar-Loubet, Olga; Rodriguez, Alan; Potter, JoNell; Messick, Barbara; Jayaweera, Dushyantha T; Boulanger, Catherine; Kolber, Michael A

2014-01-01

This study describes the prevalence of abuse and mental health issues among a cohort of HIV-infected Haitian women living in the United States. We present data on 96 women, ages 19-73 years (M = 47.6, SD = 11.1), who were screened for mental health concerns between 2009 and 2012. Results demonstrated that 12.5% of the women reported a history of abuse. However, posttraumatic stress disorder (PTSD) secondary to HIV was reported by approximately 34% of women. Depression and anxiety were also highly reported, with rates of 49% and 43%, respectively. Women who reported a history of abuse were more likely to report anxiety, PTSD, and PTSD related to HIV symptoms than those without. Our findings suggest that Haitian HIV-infected women may underreport abuse and experience significant depression and anxiety. These preliminary results could be used to develop future studies and to design and implement culturally sensitive interventions for this underserved population. Copyright © 2014 Association of Nurses in AIDS Care. All rights reserved.

Clinically Determined and Self-Reported Dental Caries Status During and After Pregnancy Among Low-Income Hispanic Women

PubMed Central

Weintraub, Jane A.; Gansky, Stuart A.; Santo, William; Ramos-Gomez, Francisco

2014-01-01

Objectives This analysis assessed, during and one-year after pregnancy: 1) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; 2) factors associated with high levels of professionally determined or self-reported oral disease. Methods Data are from a randomized clinical trial of 301 pregnant, low-income Hispanic women at the California-Mexico border to compare two interventions to prevent early childhood caries. Interviews and dental examinations were conducted at enrollment (second trimester) and one-year post-partum (PP). Results During pregnancy and PP, 93% had untreated caries and most had gingival inflammation. Sensitivity and specificity of self-reported measures compared to dentists’ determinations were modest (ranging from 45–80% for sensitivity and 41–77% for specificity at both time points); positive predictive values for women reporting current tooth decay or fair/poor oral health were high (>94%), but negative predictive values were low (<23%). In a bivariate GEE model, factors associated with fair/poor self-reported oral health during and after pregnancy included self-reported dental symptoms (current tooth decay, bleeding gums without brushing), dental behaviors (not flossing) and number of decayed tooth surfaces. In a logistic regression model, the only significant factor PP associated with less extensive untreated disease was if women ever had their teeth cleaned professionally (OR=0.44). Conclusions There is a great need for dental treatment in this underserved population both during pregnancy and PP. Women may not be able to accurately recognize or act on their treatment needs. At baseline and PP, few demographic or behavioral factors were associated with either self-reported or clinically-determined oral disease (e.g., being less educated or acculturated and not flossing) in the bivariate

Title VII funding is associated with more family physicians and more physicians serving the underserved.

PubMed

Meyers, D; Fryer, G E; Krol, D; Phillips, R L; Green, L A; Dovey, S M

2002-08-15

Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues.

Women and the Japanese American Camp Experience: Transforming the Women's Studies Curriculum.

ERIC Educational Resources Information Center

Hale, Sondra

1993-01-01

Discusses integrating information on the Japanese-American internment experience of World War II into the women's studies curriculum at the University of California Los Angeles (UCLA). Describes the author's experiences in using ideas and materials from a seminar on the internment issue. (SLD)

The Role of Motivation in Understanding Social Contextual Influences on Physical Activity in Underserved Adolescents in the ACT Trial: A Cross-Sectional Study

PubMed Central

Wilson, Dawn K.; Van Horn, M. Lee; Zarrett, Nicole

2012-01-01

Abstract Background Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Methods Baseline data (n=1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Results Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. Conclusions These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA. PMID:23181920

The role of motivation in understanding social contextual influences on physical activity in underserved adolescents in the ACT Trial: a cross-sectional study.

PubMed

Lawman, Hannah G; Wilson, Dawn K; Van Horn, M Lee; Zarrett, Nicole

2012-12-01

Previous research has shown that social contextual factors are important in understanding physical activity (PA) behavior, although little is known about how these factors may relate to PA, especially in underserved adolescents (low income, minorities). This study examined how motivation may differentially mediate the relationship of two social contextual variables (i.e., peer and parent social support) and moderate-to-vigorous PA (MVPA). Baseline data (n = 1421 sixth graders, 54% female, 72% African American) from the Active by Choice Today (ACT) trial in underserved adolescents were analyzed. Motivation was examined as a mediator of the relationships between peer social support, parent social support, and MVPA (measured by 7-day accelerometer estimates). Motivation and peer but not parent support were significantly related to MVPA overall. Significant mediation effects were found indicating motivation partially mediated the relation between peer social support and MVPA and to a lesser degree parent support and MVPA. These findings provide support for the importance of social contextual influences, especially peer social support, on underserved adolescents' PA and motivation for PA.

Disability and Preventive Cancer Screening: Results from the 2001 California Health Interview Survey

PubMed Central

Ramirez, Anthony; Farmer, Gail C.; Grant, David; Papachristou, Theodora

2005-01-01

Objective. We sought to evaluate preventive cancer screening compliance among adults with disability in California. Methods. We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. Results. Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. Conclusions.secondary to structural and/or clinical factors underpinning the differences found. PMID:16195509

Desired mental health resources for urban, ethnically diverse, impoverished women struggling with anxiety and depression.

PubMed

Doornbos, Mary Molewyk; Zandee, Gail Landheer; DeGroot, Joleen; Warpinski, Mary

2013-01-01

Depression and anxiety are mental health issues that disproportionately affect women-particularly when access to culturally sensitive care is limited. The purpose of this study was to identify mental health concerns in three urban, ethnically diverse, underserved, and impoverished neighborhoods using the ideological perspective of community-based participatory research. In the context of long-term partnerships between a department of nursing and these neighborhoods, we recruited 61 women aged 18 to 69 years and collected data via homogeneous focus groups comprised of Black, Hispanic, and White women, respectively. We conducted five of the focus groups in English and one in Spanish. The women perceived anxiety and depression as significant concerns for themselves, their families, and their communities. They used unique community resources to manage mental health issues and desired new resources, including support groups and education.

Colorectal cancer screening among the medically underserved.

PubMed

Wolf, Michael S; Satterlee, Melissa; Calhoun, Elizabeth A; Skripkauskas, Silvia; Fulwiler, Daniel; Diamond-Shapiro, Linda; Alvarez, Hugo; Eder, Mickey; Mukundan, Padmanabhan

2006-02-01

Prevalence of physician recommendation and patient completion of colorectal cancer screening was investigated among Federally Qualified Health Centers (FQHC) serving low-income neighborhoods in Chicago. Medical records of 3,416 patients receiving primary care services at 1 of 31 FQHCs were randomly chosen for review. In all, 642 patients were identified by age and family history as eligible for colorectal cancer screening and included in this study. Patient demographic information and colorectal cancer screening history were collected. The physician screening recommendation rate was 9.2% (n=59); 7.0% (n=45) of patients were determined to have been appropriately screened for colorectal cancer, primarily by Fecal Occult Blood Test (94.1%, n=43). Among patients who received a recommendation from their physician, 76.2% had completed a screening test. Older patients were more likely than their younger counterparts to have received a recommendation from their physician (p<.05) and to have been screened (p<.01). Organizational interventions are needed to support physicians in medically underserved areas and to promote recommended screening practices.

Family Foundations: A New Program for Pregnant and Parenting Women Offenders with Substance Abuse Histories

ERIC Educational Resources Information Center

Wiewel, Brenda; Mosley, Toni

2006-01-01

A new program in California partners the California Department of Corrections with a non-profit drug treatment agency on behalf of pregnant or parenting women who are drug offenders with substance abuse histories. The women are sentenced to the family foundations facility for one year and receive a range of special services to prepare for…

Using Concept Mapping to Develop a Strategy for Self-Management Support for Underserved Populations Living With Chronic Conditions, British Columbia, August 2013-June 2014.

PubMed

Mills, Susan L; Bergeron, Kim; Pérez, Guillermina

2015-10-08

Self-management support (SMS) is an essential component of public health approaches to chronic conditions. Given increasing concerns about health equity, the needs of diverse populations must be considered. This study examined potential solutions for addressing the gaps in self-management support initiatives for underserved populations. Stakeholders representing government, nongovernment organizations, Aboriginal communities, health authorities, medical practices, and research institutions generated, sorted, and rated ideas on what could be done to improve self-management support for underserved populations. Concept mapping was used to facilitate the collection and organization of the data and to generate conceptual maps. Participants generated 92 ideas that were sorted into 11 clusters (foster partnerships, promote integrated community care, enhance health care provider training, shift government policy, support community development, increase community education, enable client engagement, incorporate client support systems, recognize client capacity, tailor self-management support programs, and develop client skills, training, and tools) and grouped into system, community, and individual levels within a partnership framework. The strategy can stimulate public health dialogue and be a roadmap for developing SMS initiatives. It has the potential to address SMS and chronic condition inequities in underserved populations in several ways: 1) by targeting populations that have greater inequities, 2) by advocating for shifts in government policies that create and perpetuate inequities, 3) by promoting partnerships that may increase the number of SMS initiatives for underserved groups, and 4) by promoting training and engagement that increase the relevance, uptake, and overall effectiveness of SMS.

Perceived Barriers to and Facilitators of Hypertension Management among Underserved African American Older Adults.

PubMed

Rimando, Marylen

2015-08-07

To understand the perceived barriers to and facilitators of hypertension self-management among underserved African American older adults in a southeastern clinic. Qualitative descriptive. Urban cardiovascular health clinic in a southeastern state. 28 African Americans diagnosed with hypertension. Interview questions were focused on knowledge of hypertension management and barriers and facilitators to hypertension self-management. Thematic content analysis was applied. Patients reported increased hypertension knowledge after attending the clinic. All patients reported knowledge of the severe consequences of uncontrolled hypertension. Perceived barriers to hypertension management included lack of money, lack of motivation to exercise, and fear of injury from exercising. Perceived facilitators of hypertension management included weight loss, unexpected diagnosis of hypertension, family members with hypertension and diabetes, and social support. Findings suggest that perceived barriers and facilitators influence a patient's decision to manage hypertension. Findings suggest the importance of health literacy and patient-provider communication at this particular clinic. Possible factors in the social environment may influence hypertension management. This study adds to the literature by understanding the perceived barriers to and facilitators of hypertension management of an underserved sample in a southeastern clinic. The results suggest a need for the redesign and transformation of future hypertension education strategies aimed at this clinic sample.

Sexual Politics in the California Public K-12 Superintendency and District Office Personnel System

ERIC Educational Resources Information Center

Stuckey, Jennifer W.

2012-01-01

A review of literature suggests women superintendents face several disadvantages gaining access to positions as public school district superintendents. This study focused on (1) which characteristics applied to the prediction of women superintendents in California public K-12 system; (2) if the predecessor's sex predicted for the successor's sex;…

California-Baja California border master plan - plan maestro fronterizo California-Baja California.

DOT National Transportation Integrated Search

2008-09-01

Crossborder travel at the six land ports of entry (POEs) in the California-Baja California region has grown : significantly over the years. The San Diego County-Tijuana/Tecate region is home to the San Ysidro- : Puerta Mxico, the Otay Mesa-Mesa de ...

A study protocol: using demand-side financing to meet the birth spacing needs of the underserved in Punjab Province in Pakistan.

PubMed

Azmat, Syed Khurram; Ali, Moazzam; Hameed, Waqas; Mustafa, Ghulam; Abbas, Ghazanfer; Ishaque, Muhammad; Bilgrami, Mohsina; Temmerman, Marleen

2014-05-30

High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women's health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan. This study will use quasi-experimental design with control arm and be implemented in: six government clinics from the Population Welfare Department; 24 social franchise facilities branded as 'Suraj' (Sun), led by Marie Stopes Society (a local non-governmental organization); and 12 private sector clinics in Chakwal, Mianwali and Bhakkar districts. The study respondents will be interviewed at baseline and endline subject to voluntary acceptance and medical eligibility. In addition, health service data will record each client visit during the study period. The study will examine the impact of vouchers in terms of increasing the uptake of modern contraception by engaging private and public sector service providers (mid-level and medical doctors). If found effective, this approach can be a viable solution to satisfying the current demand and meeting the unmet need for contraception, particularly among the poorest socio-economic group.

Telepsychiatry in correctional facilities: using technology to improve access and decrease costs of mental health care in underserved populations.

PubMed

Deslich, Stacie Anne; Thistlethwaite, Timothy; Coustasse, Alberto

2013-01-01

It is unclear if telepsychiatry, a subset of telemedicine, increases access to mental health care for inmates in correctional facilities or decreases costs for clinicians or facility administrators. The purpose of this investigation was to determine how utilization of telepsychiatry affected access to care and costs of providing mental health care in correctional facilities. A literature review complemented by a semistructured interview with a telepsychiatry practitioner. Five electronic databases, the National Bureau of Justice, and the American Psychiatric Association Web sites were searched for this research, and 49 sources were referenced. The literature review examined implementation of telepsychiatry in correctional facilities in Arizona, California, Georgia, Kansas, Ohio, Texas, and West Virginia to determine the effect of telepsychiatry on inmate access to mental health services and the costs of providing mental health care in correctional facilities. Telepsychiatry provided improved access to mental health services for inmates, and this increase in access is through the continuum of mental health care, which has been instrumental in increasing quality of care for inmates. Use of telepsychiatry saved correctional facilities from $12,000 to more than $1 million. The semistructured interview with the telepsychiatry practitioner supported utilization of telepsychiatry to increase access and lower costs of providing mental health care in correctional facilities. Increasing access to mental health care for this underserved group through telepsychiatry may improve living conditions and safety inside correctional facilities. Providers, facilities, and state and federal governments can expect increased savings with utilization of telepsychiatry.

Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California.

PubMed

Froment, Marie-Anne; Gomez, Scarlett L; Roux, Audrey; DeRouen, Mindy C; Kidd, Elizabeth A

2014-06-01

This study aimed to evaluate the incidence of cervical cancer by nativity [United States (US) versus non-US], neighborhood socioeconomic status and ethnic enclave among Hispanics and Asians in California. Using data from the California Cancer Registry, information on all primary invasive cervical cancer (Cca) patients diagnosed in California from January 1, 1990 through December 31, 2004 was obtained. We analyzed the influence of enclave, socioeconomic status and nativity on Cca incidence. Among the 22,189 Cca cases diagnosed between 1990 and 2004, 50% were non-Hispanic white, 39% Hispanic and 11% Asian women, and 63% US-born. Seventy percent of the Cca cases were squamous cell carcinoma, 19% adenocarcinoma and 11% other histologies. Higher incidence of Cca was observed in high enclave (76%) and low socioeconomic status (70%) neighborhoods. By ethnic group, US-born women showed lower rates of squamous cell carcinoma compared to foreign-born women. Hispanics living in low socioeconomic and high enclave had 12.7 times higher rate of Cca than those living in high socioeconomic, low enclave neighborhoods. For Asian women incidence rates were 6 times higher in the low socioeconomic, high enclave neighborhoods compared to those living in high socioeconomic, low enclave neighborhoods. More targeted outreach to increase Pap smear screening and human papilloma virus vaccination for women living in high enclave neighborhoods can help decrease the incidence of Cca in these groups of women. Copyright © 2014 Elsevier Inc. All rights reserved.

Interdisciplinary Community-Based Oral Health Program for Women and Children at WIC.

PubMed

Gold, Jaana; Tomar, Scott L

2018-06-23

Objectives To evaluate the women, infants, and children (WIC) Oral Health Program in a county in Florida. Methods The non-traditional interdisciplinary program of the current study was designed to reach at-risk populations with untreated dental diseases and limited access to care; it provides oral health education, dental screenings, preventive dental services, and referrals for women, children, and families at WIC offices. We evaluated the health status of patients enrolled in the program and the services provided. Results From 2013 to 2016, the program provided dental screenings for 576 children and 180 women. Caries prevalence for 3-5 year olds was 46.0%. Only 6.6% (12/114) of pregnant women were eligible for comprehensive dental care under Medicaid (< 21 years). Further, 71.2% (47/66) of all pregnant women had unmet dental care needs. Conclusions for Practice Our results suggested that many children and women had untreated dental diseases and need preventive services and dental care. Also, many pregnant women were not covered by Medicaid. This program demonstrates that collaboration with the WIC program can improve access to oral health services for underserved populations.

Impact of a Plant-Based Diet and Support on Mitigating Type 2 Diabetes Mellitus in Latinos Living in Medically Underserved Areas.

PubMed

Ramal, Edelweiss; Champlin, Andrea; Bahjri, Khaled

2018-03-01

To determine the impact that a high-fiber, low-fat diet, derived from mostly plant-based sources, when coupled with support has upon self-management of type 2 diabetes mellitus in Latinos from medically underserved areas (MUAs). Experimental randomized controlled community pilot study. Three community clinics in MUAs located within San Bernardino County, California. Thirty-two randomly assigned Latinos with A1 C greater than 6.4: 15 control and 17 experimental. Participants completed a 5-week education program. Researchers provided follow-up support for 17 randomly assigned experimental group participants through focus groups held at participating clinics-1, 3, and 6 months posteducation. Changes in fat and fiber consumption were measured using a modified Dietary Screener for Mexican Americans. Self-management was measured through the Self-Efficacy for Exercise Scale and Diabetes Quality of Life Measure. Baseline characteristics for both groups were analyzed using independent t tests and χ 2 tests. A 2-way repeated-measures analysis of variance was used to analyze biometric data between baseline and 6 months for both groups. Mean A1 C levels decreased from baseline to 6 months for both groups: control, μ 1 = 9.57, μ 2 = 9.49; experimental, μ 1 = 8.53, μ 2 = 7.31. The experimental group demonstrated a statistically significant reduction in mean A1 C levels ( P = .002) when compared to the control group.

Latina Community College Leadership in California: Pathways to Executive Management

ERIC Educational Resources Information Center

Delgadillo, Monica D.

2017-01-01

Purpose: The purpose of this qualitative study was to examine the learned experiences, challenges, and leadership pathways of Latinas currently in California community college management positions. Latinas have been underrepresented in community college leadership positions. Currently, women constitute a majority of those attending college, and…

Adapting evidence-based strategies to increase physical activity among African Americans, Hispanics, Hmong, and Native Hawaiians: a social marketing approach.

PubMed

Van Duyn, Mary Ann S; McCrae, Tarsha; Wingrove, Barbara K; Henderson, Kimberly M; Boyd, Jamie K; Kagawa-Singer, Marjorie; Ramirez, Amelie G; Scarinci-Searles, Isabel; Wolff, Lisa S; Penalosa, Tricia L; Maibach, Edward W

2007-10-01

Using a social marketing approach, we studied how best to adapt proven, evidence-based strategies to increase physical activity for use with underserved racial or ethnic groups. We conducted focus groups with low-income Hispanic women in Texas, Hmong parents and their children in California, low-income African American women and men in the Mississippi Delta, and Native Hawaiian college students in Hawaii. We also interviewed key leaders of these communities. Topics of discussion were participants' perceptions about 1) the benefits of engaging in physical activity, 2) the proposed evidence-based strategies for increasing each community's level of physical activity, and 3) the benefits and barriers to following the proposed interventions for increasing physical activity. A total of 292 individuals participated in the study. All groups considered that being physically active was part of their culture, and participants found culturally relevant suggestions for physical activities appealing. Overwhelmingly, strategies that aimed to create or improve social support and increase access to physical activity venues received the most positive feedback from all groups. Barriers to physical activity were not culturally specific; they are common to all underserved people (lack of time, transportation, access, neighborhood safety, or economic resources). Results indicate that evidence-based strategies to increase physical activity need to be adapted for cultural relevance for each racial or ethnic group. Our research shows that members of four underserved populations are likely to respond to strategies that increase social support for physical activity and improve access to venues where they can be physically active. Further research is needed to test how to implement such strategies in ways that are embraced by community members.

Barriers to Cervical Cancer Screening among Middle-aged and Older Rural Appalachian Women

PubMed Central

Studts, Christina R.; Tarasenko, Yelena N.; Schoenberg, Nancy E.

2012-01-01

Although cervical cancer rates in the United States have declined sharply in recent decades, certain groups of women remain at elevated risk, including middle-aged and older women in central Appalachia. Cross-sectional baseline data from a community-based randomized controlled trial were examined to identify barriers to cervical cancer screening. Questionnaires assessing barriers were administered to 345 Appalachian women aged 40-64, years when Pap testing declines and cervical cancer rates increase. Consistent with the PRECEDE/PROCEED framework, participants identified barriers included predisposing, enabling, and reinforcing factors. Descriptive and bivariate analyses are reported, identifying (a) the most frequently endorsed barriers to screening, and (b) significant associations of barriers with sociodemographic characteristics in the sample. Recommendations are provided to decrease these barriers and, ultimately, improve rates of Pap tests among this traditionally underserved and disproportionately affected group. PMID:23179390

California WIC and Proposition 10: Made for Each Other. Building Community Systems for Young Children.

ERIC Educational Resources Information Center

Whaley, Shannon; True, Laurie

The federal government's WIC program, the Special Supplemental Nutrition Program for Women, Infants and Children, is designed to improve the health and development of low-income women and young children. California's passage of Proposition 10, the "Children and Families First Act," has created a climate that encourages collaborative…

Culturally adapting a physical activity intervention for Somali women: the need for theory and innovation to promote equity.

PubMed

Murray, Kate E; Ermias, Azieb; Lung, Amber; Mohamed, Amina Sheik; Ellis, B Heidi; Linke, Sarah; Kerr, Jacqueline; Bowen, Deborah J; Marcus, Bess H

2017-03-01

There is pressing need for innovation in clinical research to more effectively recruit, engage, retain, and promote health among diverse populations overburdened by health disparities. The purpose of this study is to provide a detailed illustration of the cultural adaptation of an evidence-based intervention to bolster translational research with currently underserved communities. The cultural adaptation heuristic framework described by Barrera and colleagues is applied to the adaptation of a physical activity evidence-based intervention with adult Somali women. Widespread changes were required to ensure program feasibility and acceptability, including the reduction of assessment protocols and changes discordant with current trends in physical activity research. The cultural adaptation of evidence-based interventions offers an important mechanism for reducing health disparities. Improved reporting standards, assessment of features relevant to underserved communities, and greater funding requirements to ensure better representation are needed to promote more widespread access for all people.

The Women in Medicine and Health Science Program: An Innovative Initiative to Support Female Faculty at the University of California Davis School of Medicine

PubMed Central

Bauman, Melissa D.; Howell, Lydia P.; Villablanca, Amparo C.

2014-01-01

Problem Although more female physicians and scientists are choosing careers in academic medicine, women continue to be underrepresented as medical school faculty, particularly at the level of full professor and in leadership positions. Effective interventions to support women in academic medicine exist, but the nature and content of such programs varies widely. Approach Women in medicine programs can play a critical role in supporting women’s careers and can improve recruitment and retention of women by providing opportunities for networking, sponsorship, mentorship, and career development. The University of California Davis School of Medicine established the Women in Medicine and Health Science (WIMHS) program in 2000 to ensure the full participation and success of women in all roles within academic medicine. The authors describe the components and evolution of the WIMHS program. Outcomes A steady increase in the number and percentage of female faculty and department chairs, as well as a relatively low departure rate for female faculty, strong and growing internal partnerships, and enthusiastic support from faculty and the school of medicine leadership, suggest that the WIMHS program has had a positive influence on recruitment and retention, career satisfaction, and institutional climate to provide a more inclusive and supportive culture for women. Next steps Going forward, the WIMHS program will continue to advocate for broader institutional change to support female faculty, like creating an onsite childcare program. Other institutions seeking to address the challenges facing female faculty may consider using the WIMHS program as a model to guide their efforts. PMID:25006704

Who Do You Think You Are? Medical Student Socioeconomic Status and Intention to Work in Underserved Areas

ERIC Educational Resources Information Center

Griffin, Barbara; Porfeli, Erik; Hu, Wendy

2017-01-01

A frequently cited rationale for increasing the participation of students from low socioeconomic status (SES) backgrounds is that it will create a workforce who will choose to work in low SES and medically underserviced communities. Two theoretical arguments, one that supports and one that contradicts this assumption, are proposed to explain the…

California-Baja California border master plan - plan maestro fronterizo California-Baja California : technical appendix.

DOT National Transportation Integrated Search

2008-09-01

Under the direction of the U.S. / Mexico Joint Working Committee, the California Department of : Transportation (Caltrans) and the State of Baja Californias Secretariat of Infrastructure and Urban : Development (SIDUE) hereby establish the Califor...

Who Gets Needed Mental Health Care? Use of Mental Health Services among Adults with Mental Health Need in California

PubMed Central

Ponce, Ninez A.

2017-01-01

Background Timely and appropriate treatment could help reduce the burden of mental illness. Purpose This study describes mental health services use among Californians with mental health need, highlights underserved populations, and discusses policy opportunities. Methods Four years of California Health Interview Survey data (2011, 2012, 2013, 2014) were pooled and weighted to the 2013 population to estimate mental health need and unmet need (n=82,706). Adults with mental health need had “unmet need” if they did not use prescription medication and did not have at least four or more mental health visits in the past year. Multivariable logistic regression analysis was performed to predict the probability adults with mental health need did not receive past-year treatment (n=5,315). Results Seventy-seven percent of Californians with mental health need received no or inadequate mental health treatment in 2013. Men, Latinos, Asians, young people, older adults, people with less education, uninsured adults, and individuals with limited English proficiency were significantly more likely to have unmet need. Cost of treatment and mental health stigma were common reasons for lack of care. Conclusion Unmet mental health need is predominant in California. Policy recommendations include continued expansion of mental health coverage, early identification, and ensuring that treatment is culturally and linguistically appropriate. PMID:28729814

Comparison of age at natural menopause in BRCA1/2 mutation carriers with a non-clinic-based sample of women in northern California.

PubMed

Lin, Wayne T; Beattie, Mary; Chen, Lee-May; Oktay, Kutluk; Crawford, Sybil L; Gold, Ellen B; Cedars, Marcelle; Rosen, Mitchell

2013-05-01

Germline mutations in BRCA1 and BRCA2 (BRCA1/2) are related to an increased lifetime risk of developing breast and ovarian cancer. Although risk-reducing salpingo-oophorectomy reduces the risk of both cancers, loss of fertility is a major concern. A recent study suggested an association between BRCA1 mutation and occult primary ovarian insufficiency. The objective of the current study was to determine whether BRCA1/2 mutation carriers have an earlier onset of natural menopause compared with unaffected women. White carriers of the BRCA1/2 gene (n = 382) were identified within the Breast Cancer Risk Program Registry at the University of California at San Francisco and compared with non-clinic-based white women in northern California (n = 765). The 2 groups were compared with regard to median age at the time of natural menopause before and after adjustment for known risk factors, and the role of smoking within each group was examined using the Kaplan-Meier approach for unadjusted analyses and Cox proportional hazards regression analyses for adjusted analyses. The median age at the time of natural menopause in the BRCA1/2 carriers was significantly younger than among the unaffected sample (50 years vs 53 years; P < .001). The unadjusted hazard ratio for natural menopause when comparing BRCA1/2 carriers with unaffected women was 4.06 (95% confidence interval, 3.03-5.45) and was 3.98 (95% confidence interval, 2.87-5.53) after adjusting for smoking, parity, and oral contraceptive use. For BRCA1/2 carriers who were current heavy smokers (smoking ≥ 20 cigarettes/day), the median age at natural menopause was 46 years versus 49 years for nonsmokers (P = .027). The BRCA1/2 mutation was associated with a significantly earlier age at natural menopause, and heavy smoking compounded this risk. Because the relationship between menopause and the end of natural fertility is considered to be fixed, these findings suggest the risk of earlier infertility among BRCA1/2 carriers

Biopsychosocial Challenges and Needs of Young African American Women with Triple-Negative Breast Cancer.

PubMed

Bollinger, Sarah

2018-05-01

Triple-negative breast cancer (TNBC) is a subtype of breast cancer known to have poorer prognoses and lower survival rates compared with other types of breast cancer. In addition, TNBC is overrepresented in premenopausal African American women. Using grounded theory as the qualitative methodological approach, the present article elucidates unique biopsychosocial challenges and needs of young African American women with TNBC. A study group of six women with TNBC and a comparison group of six women with estrogen receptor-positive breast cancer were interviewed longitudinally over three time points throughout the cancer treatment trajectory. Major themes that were unique to the study group of women with TNBC include (a) longer, more aggressive treatment trajectories; (b) more difficult struggles with feminine identity; (c) the presence of fertility and parenting issues; (d) higher burdens of care; (e) barriers to separation and individuation as a maturation milestone; and (f) feeling out of place compared with peers. These themes provide a foundation to inform how social workers care for this underserved group of women.

Coping strategies and behavioural changes following a genital herpes diagnosis among an urban sample of underserved Midwestern women.

PubMed

Davis, Alissa; Roth, Alexis; Brand, Juanita Ebert; Zimet, Gregory D; Van Der Pol, Barbara

2016-03-01

This study focused on understanding the coping strategies and related behavioural changes of women who were recently diagnosed with herpes simplex virus type 2. In particular, we were interested in how coping strategies, condom use, and acyclovir uptake evolve over time. Twenty-eight women screening positive for herpes simplex virus type 2 were recruited through a public health STD clinic and the Indianapolis Community Court. Participants completed three semi-structured interviews with a woman researcher over a six-month period. The interviews focused on coping strategies for dealing with a diagnosis, frequency of condom use, suppressive and episodic acyclovir use, and the utilisation of herpes simplex virus type 2 support groups. Interview data were analysed using content analysis to identify and interpret concepts and themes that emerged from the interviews. Women employed a variety of coping strategies following an herpes simplex virus type 2 diagnosis. Of the women, 32% reported an increase in religious activities, 20% of women reported an increase in substance use, and 56% of women reported engaging in other coping activities. A total of 80% of women reported abstaining from sex immediately following the diagnosis, but 76% of women reported engaging in sex again by the six-month interview. Condom and medication use did not increase and herpes simplex virus type 2 support groups were not utilised by participants. All participants reported engaging in at least one coping mechanism after receiving their diagnosis. A positive diagnosis did not seem to result in increased use of condoms for the majority of participants and the use of acyclovir was low overall. © The Author(s) 2015.

Distance traveled for Medicaid-covered abortion care in California.

PubMed

Johns, Nicole E; Foster, Diana Greene; Upadhyay, Ushma D

2017-04-19

Access to abortion care in the United States is limited by the availability of abortion providers and their geographic distribution. We aimed to assess how far women travel for Medicaid-funded abortion in California and identify disparities in access to abortion care. We obtained data on all abortions reimbursed by the fee-for-service California state Medicaid program (Medi-Cal) in 2011 and 2012 and examined distance traveled to obtain abortion care by several demographic and abortion-related factors. Mixed-effects multivariable logistic regression models were constructed to examine factors associated with traveling 50 miles or more. County-level t-tests and linear regressions were conducted to examine the effects of a Medi-Cal abortion provider in a county on overall and urban/rural differences in utilization. 11.9% (95% CI: 11.5-12.2%) of women traveled 50 miles or more. Women obtaining second trimester or later abortions (21.7%), women obtaining abortions at hospitals (19.9%), and rural women (51.0%) were most likely to travel 50 miles or more. Across the state, 28 counties, home to 10% of eligible women, did not have a facility routinely providing Medi-Cal-covered abortions. Efforts are needed to expand the number of abortion providers that accept Medi-Cal. This could be accomplished by increasing Medi-Cal reimbursement rates, increasing the types of providers who can provide abortions, and expanding the use of telemedicine. If national trends in declining unintended pregnancy and abortion rates continue, careful attention should be paid to ensure that reduced demand does not lead to greater disparities in geographic and financial access to abortion care by ensuring that providers accepting Medicaid payment are available and widely distributed.

Formative evaluation of a motivational intervention for increasing physical activity in underserved youth.

PubMed

Wilson, Dawn K; Griffin, Sarah; Saunders, Ruth P; Evans, Alexandra; Mixon, Gary; Wright, Marcie; Beasley, Amelia; Umstattd, M Renee; Lattimore, Diana; Watts, Ashley; Freelove, Julie

2006-08-01

The present study was designed to develop an innovative motivational intervention (based on Self-Determination Theory and Social Cognitive Theory) to increase physical activity (PA) in underserved adolescents. Sixty-four adolescents (35 females, 29 males; 50% minority; 65% on reduced lunch program; ages 11-13 yr) participated in either an 8-week motivational intervention after-school (n = 32) or a typical after-school program (n = 32). The conceptual framework for the intervention targeted the social environment (perceived autonomy, perceived social support, participation, fun), cognitive mediators (perceived choice, self-efficacy, and relatedness/belongingness), and motivational orientation (intrinsic motivation, commitment, positive self-concept). Formative evaluation data was collected by staff through daily forms throughout the 8-week program and through observational data completed by independent objective observers during 2 weeks of the program. The major themes that were identified addressed theoretical concepts regarding the intervention and logistical issues in delivering the intervention. The data revealed information regarding the importance of the cognitive appropriateness of the PA and motivational activities, the environmental climate for promoting nurturing relationships, developing specific strategies for increasing intrinsic rather than extrinsic reinforcement, and developing methods for preventing social "cliques" and gender conflicts to maintain an appropriate level of support in the social climate. Themes for training staff included focusing on team building, leadership, and nurturing. This formative evaluation is being used to formalize a randomized trial to test the effects of a student-centered motivational intervention on increasing PA in underserved 6th graders.

Assessing Underserved Students' Engagement in High-Impact Practices. With an Assessing Equity in High-Impact Practices Toolkit

ERIC Educational Resources Information Center

Finley, Ashley; McNair, Tia

2013-01-01

This publication presents findings from a national study conducted by AAC&U researchers to investigate the impact of engagement in high-impact practices on traditionally underserved populations (defined here as first-generation, minority, transfer, and low-income students).The mixed-method analysis includes student-level data on engaged…

Diet and Exercise Adherence and Practices among Medically Underserved Patients with Chronic Disease: Variation across Four Ethnic Groups

ERIC Educational Resources Information Center

Orzech, Kathryn M.; Vivian, James; Huebner Torres, Cristina; Armin, Julie; Shaw, Susan J.

2013-01-01

Many factors interact to create barriers to dietary and exercise plan adherence among medically underserved patients with chronic disease, but aspects related to culture and ethnicity are underexamined in the literature. Using both qualitative ("n" = 71) and quantitative ("n" = 297) data collected in a 4-year, multimethod study…

Hiring Processes in California of the PK-12 Superintendency

ERIC Educational Resources Information Center

Guthrie, Marcelline Marie

2013-01-01

In California women are underrepresented in the position of superintendent, yet are overrepresented in the field of education. The research questions for this study were (a) What are the processes used to hire superintendents? and (b) What are the processes when a woman is hired as superintendent? This research examined how organizational culture,…

Evaluation of Healthy Living Wellness Program With Minority Underserved Economically Disadvantaged Older Adults.

PubMed

Tallier, Peggy C; Reineke, Patricia R; Frederickson, Keville

2017-04-01

The purpose of this Roy adaptation model-guided study was to test the effectiveness of a student registered nurse intern-led nursing intervention entitled the Healthy Living Wellness Program. A one-group pretest/posttest preexperimental design was used. The intervention was imparted to minority, underserved, economically disadvantaged older adults ( N = 30). Significant findings pre- and postintervention were reported for body mass index, waist circumference, self-reported blood glucose, and weight. The findings supported the effectiveness of the nursing intervention, the Healthy Living Wellness Program, guided by the Roy adaptation model.

Randomized Trial of a Family-based, Automated, Conversational Obesity Treatment Program for Underserved Populations

PubMed Central

Wright, J. A.; Phillips, B.D.; Watson, B.L.; Newby, P.K.; Norman, G. J.; Adams, W.G.

2013-01-01

Objective To evaluate the acceptability and feasibility of a scalable obesity treatment program integrated with pediatric primary care and delivered using interactive voice technology (IVR) to families from underserved populations. Design and Methods Fifty parent-child dyads (child 9–12 yrs, BMI >95th percentile) were recruited from a pediatric primary care clinic and randomized to either an IVR or a wait-list control (WLC) group. The majority were lower-income, African-American (72%) families. Dyads received IVR calls for 12 weeks. Call content was informed by two evidenced-based interventions. Anthropometric and behavioral variables were assessed at baseline and 3 mo follow-up. Results Forty-three dyads completed the study. IVR parents ate 1 cup more fruit than WLC (p < .05). No other groups differences were found. Children classified as high users of the IVR decreased weight, BMI and BMI z-score compared to low users (p<.05). Mean number of calls for parents and children were 9.1 (5.2 SD) and 9.0 (5.7 SD), respectively. Of those who made calls, >75% agreed that the calls were useful, made for people like them, credible, and helped them eat healthy foods. Conclusion An obesity treatment program delivered via IVR may be an acceptable and feasible resource for families from underserved populations. PMID:23512915

A Mixed Methods Review of Education and Patient Navigation Interventions to Increase Breast and Cervical Cancer Screening for Rural Women.

PubMed

Falk, Derek

2018-01-01

Reviews have assessed studies of breast and cervical cancer screening access and utilization for rural women, but none analyze interventions to increase screening rates. A mixed methods literature search identified studies of breast and/or cervical cancer prevention education and patient navigation interventions for rural women. Rural areas need greater implementation and evaluation of screening interventions as these services address the challenges of delivering patient-centered cancer care to un-/underserved communities. The lack of intervention studies on breast and cervical cancer education and patient navigation programs compared to urban studies highlights the need for validation of these programs among diverse, rural populations.

Public Education and Targeted Outreach to Underserved Women Through the National Breast and Cervical Cancer Early Detection Program

PubMed Central

Levano, Whitney; Miller, Jacqueline W.; Leonard, Banning; Bellick, Linda; Crane, Barbara E.; Kennedy, Stephenie K.; Haslage, Natalie M.; Hammond, Whitney; Tharpe, Felicia S.

2015-01-01

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established to provide low-income, uninsured, and underinsured women access to cancer screening and diagnostic services with the goal of increasing the early detection and prevention of breast and cervical cancer. Although this is a valuable resource for women who might not have the means to get screened otherwise, providing services at no cost, by itself, does not guarantee uptake of screening services. Public education and targeted outreach facilitate the critical link between public service programs and the communities they serve. The purpose of public education and outreach in the NBCCEDP is to increase the number of women who use breast and cervical cancer screening services by raising awareness, providing education, addressing barriers, and motivating women to complete screening exams and follow-up. Effective strategies focus on helping to remove structural, physical, interpersonal, financial, and cultural barriers; educate women about the importance of screening and inform women about the services available to them. This article provides an overview of the importance of public education and targeted outreach activities for cancer screening through community-based programs including examples from NBCCEDP grantees that highlight successes, challenges, and solutions, encountered when conducting these types of interventions. PMID:25099902

Health and human rights of women imprisoned in Zambia

PubMed Central

2011-01-01

Background The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely studied and poorly understood. Methods A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners and 21 prison officers in four Zambian prisons to assess the health and human rights concerns of female detainees. Key informant interviews with 46 officials from government and non-governmental organizations and a legal and policy review were also conducted. Results Despite special protection under international and regional law, incarcerated women's health needs–including prenatal care, prevention of mother-to-child transmission of HIV, and nutritional support during pregnancy and breastfeeding–are not being adequately met in Zambian prisons. Women are underserved by general healthcare programs including those offering tuberculosis and HIV testing, and reported physical and sexual abuse conducted by police and prison officers that could amount to torture under international law. Conclusions There is an urgent need for women's healthcare services to be expanded, and for general prison health campaigns, including HIV and tuberculosis testing and treatment, to ensure the inclusion of female inmates. Abuses against women in Zambian police and prison custody, which violate their rights and compromise their health, must be halted immediately. PMID:21696625

Health and human rights of women imprisoned in Zambia.

PubMed

Todrys, Katherine W; Amon, Joseph J

2011-06-22

The healthcare needs and general experience of women in detention in sub-Saharan Africa are rarely studied and poorly understood. A mixed-methods study was conducted including in-depth interviews with 38 adult female prisoners and 21 prison officers in four Zambian prisons to assess the health and human rights concerns of female detainees. Key informant interviews with 46 officials from government and non-governmental organizations and a legal and policy review were also conducted. Despite special protection under international and regional law, incarcerated women's health needs-including prenatal care, prevention of mother-to-child transmission of HIV, and nutritional support during pregnancy and breastfeeding-are not being adequately met in Zambian prisons. Women are underserved by general healthcare programs including those offering tuberculosis and HIV testing, and reported physical and sexual abuse conducted by police and prison officers that could amount to torture under international law. There is an urgent need for women's healthcare services to be expanded, and for general prison health campaigns, including HIV and tuberculosis testing and treatment, to ensure the inclusion of female inmates. Abuses against women in Zambian police and prison custody, which violate their rights and compromise their health, must be halted immediately.

Developing a Community-Academic Partnership to Improve Recognition and Treatment of Depression in Underserved African American and White Elders

PubMed Central

Dobransky-Fasiska, Deborah; Brown, Charlotte; Pincus, Harold A.; Nowalk, Mary P.; Wieland, Melissa; Parker, Lisa S.; Cruz, Mario; McMurray, Michelle L.; Mulsant, Benoit; Reynolds, Charles F.

2011-01-01

Objective Reducing mental health disparities among underserved populations, particularly African American elders, is an important public health priority. The authors describe the process and challenges of developing a community/academic research partnership to address these disparities. Methods The authors are using a Community-Based Participatory Research approach to gain access to underserved populations in need of depression treatment. The authors identify six stages: 1) Collaborating to Secure Funding; 2) Building a Communications Platform and Research Infrastructure; 3) Fostering Enduring Relationships; 4) Assessing Needs/Educating about Research Process; 5) Initiating Specific Collaborative Projects (meeting mutual needs/interests); and 6) Maintaining a Sustainable and Productive Partnership. Data from a needs assessment developed collaboratively by researchers and community agencies facilitated agreement on mutual research goals, while strengthening the partnership. Results A community/academic-based partnership with a solid research infrastructure has been established and maintained for 3 years. Using the results of a needs assessment, the working partnership prioritized and launched several projects. Through interviews and questionnaires, community partners identified best practices for researchers working in the community. Future research and interventional projects have been developed, including plans for sustainability that will eventually shift more responsibility from the academic institution to the community agencies. Conclusions To reach underserved populations by developing and implementing models of more effective mental health treatment, it is vital to engage community agencies offering services to this population. A successful partnership requires “cultural humility,” collaborative efforts, and the development of flexible protocols to accommodate diverse communities. PMID:20104053

How underserviced rural communities approach physician recruitment: changes following the opening of a socially accountable medical school in northern Ontario.

PubMed

Mian, Oxana; Hogenbirk, John C; Warry, Wayne; Strasser, Roger P

2017-01-01

The Northern Ontario School of Medicine (NOSM) opened in 2005 with a social accountability mandate to address a long history of physician shortages in northern Ontario. The objective of this qualitative study was to understand the school's effect on recruitment of family physicians into medically underserviced rural communities of northern Ontario. We conducted a multiple case study of 8 small rural communities in northern Ontario that were considered medically underserviced by the provincial ministry of health and had successfully recruited NOSM-trained physicians. We interviewed 10 people responsible for physician recruitment in these communities. Interview transcripts were analyzed by means of an inductive and iterative thematic method. All 8 communities were NOSM medical education sites with populations of 1600-16 000. Positive changes, linked to collaboration with NOSM, included achieving a full complement of physicians in 5 communities with previous chronic shortages of 30%-50% of the physician supply, substantial reduction in recruitment expenditures, decreased reliance on locums and a shift from crisis management to long-term planning in recruitment activities. The magnitude of positive changes varied across communities, with individual leadership and communities' active engagement being key factors in successful physician recruitment. Locating medical education sites in underserviced rural communities in northern Ontario and engaging these communities in training rural physicians showed great potential to improve the ability of small rural communities to recruit family physicians and alleviate physician shortages in the region.

An Action Research Project on Preparing Teachers to Meet the Needs of Underserved Student Populations

NASA Astrophysics Data System (ADS)

Buck, Gayle A.; Cordes, Jeanene G.

2005-02-01

The focus of this action research study was on the initial stage in reforming our teacher preparation programs. We designed, conducted, evaluated, and revised the components of our teacher preparation programs that were aimed at providing preservice teachers with the confidence and knowledge needed to meet the needs of youth populations underserved in science education. The conceptual framework of this study predicted that providing preservice teachers with experiences in teaching science to at-risk youth in a nonformal educational setting and that exploring these experiences in a seminar setting will increase the teachers confidence and knowledge in regard to teaching science to children from underserved populations. The community-based experience allowed for an experience in which 20 preservice teachers taught in a situation in which at-risk youth were the majority, thus spotlighting their needs in a manner traditionally not experienced by these prospective teachers. A two-phase methodological design (J. Creswell, 1994) was utilized to answer the questions: (a) Did the plan lead to the desired outcomes? and (b) What strategies fostered or hindered progress toward the desired outcomes? The findings of this study were utilized to develop our next action step in preparing teachers to foster science literacy for All Americans.

Increasing hip fracture incidence in California Hispanics, 1983 to 2000.

PubMed

Zingmond, David S; Melton, L Joseph; Silverman, Stuart L

2004-08-01

Hip fracture incidence in non-Hispanic whites (NHW) has decreased nationwide for the past 20 years. Little is known regarding hip fracture incidence among Hispanics, the largest, fastest growing minority in the United States. To assess the change in standardized hip fracture incidence from 1983 through 2000 in California Hispanics relative to other racial groups. Hospitalizations for individuals older than 55 years with hip fracture requiring repair in acute care hospitals. Annual population estimates based on US Census Bureau estimates. Incidence standardized to national gender-age strata. Change in annual incidence calculated by weighted linear regression with robust variance estimates. 372,078 hip fractures were identified. Age-adjusted annual incidence of hip fractures declined by 0.74% per year among women (655 to 568 per 100,000), but was unchanged among men (247 to 238 per 100,000). Among NHW women, the standardized annual incidence fell by 0.6% (4.0 fractures per 100,000) per year. Annual incidence among Hispanic women increased 4.9% (11.1 fractures per 100,000) per year. Annual incidence among Hispanic men increased by 4.2% (4.5 fractures per 100,000) per year and among NHW men by 0.5% (1.2 fractures per 100,000) per year. No significant change occurred among black or Asian women or men. Among California women, hip fracture incidence has doubled among Hispanics since 1983, while remaining unchanged or declining in other groups. Greater attention should be given to identification of individuals at risk for hip fracture and initiation of preventive measures in Hispanic populations.

California-Baja California border master plan - plan maestro fronterizo California-Baja California : executive summary.

DOT National Transportation Integrated Search

2008-09-01

Crossborder travel at the six land ports of entry (POEs) in the California-Baja California region has grown : significantly over the years. The San Diego County-Tijuana/Tecate region is home to the San Ysidro- : Puerta Mxico, the Otay Mesa-Mesa de ...

Effects of Gender Discrimination and Reported Stress on Drug Use among Racially/Ethnically Diverse Women in Northern California

PubMed Central

Choi, Kyung -Hee

2010-01-01

Purpose Gender discrimination has been associated with worse health outcomes for U.S. women. Using the stress and coping process framework, we examined whether lifetime gender discrimination was associated with maladaptive coping behaviors: lifetime and recent hard drug use. We also considered if reported stress from gender discrimination mediated this relationship and if this process differed across racial/ethnic groups. Methods We used data from a racially/ethnically diverse convenience sample of 754 women attending family planning clinics in Northern California (11% African American,17% Latina, 10% Asian and 62% Caucasian). To test our hypotheses, we conducted logistic regression models, controlling for sociodemographic characteristics. Main Findings Gender discrimination was positively associated with both lifetime and recent hard drug use. We did not find support for the mediation hypothesis, as stress was not significantly associated with either lifetime or recent hard drug use. There was evidence of some race moderation for the Latina sample. Among these respondents, gender discrimination was associated with higher odds of lifetime drug use, while stress was associated with lower odds. Conclusions These results suggest that experiences of gender discrimination may still activate negative coping strategies involving drug use, regardless of the stress they cause. For Latina respondents, more research is needed to better understand the stress and coping process related to gender discrimination. PMID:20457409

English language proficiency and smoking prevalence among California's Asian Americans.

PubMed

Tang, Hao; Shimizu, Robin; Chen, Moon S

2005-12-15

The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females. Cancer 2005. (c) 2005 American Cancer Society.

Caregiver's depressive symptoms and asthma control in children from an underserved community.

PubMed

Rioseco, Andrea; Serrano, Carolina; Celedón, Juan C; Padilla, Oslando; Puschel, Klaus; Castro-Rodriguez, Jose A

2017-12-01

Caregiver's or maternal depression has been associated with increased asthma morbidity in children from prosperous nations, but little is known about this link in low and middle-income countries. To examine if caregiver's depressive symptoms are associated with poor asthma control and abnormal immune responses in school-aged children. Case-control study of 87 asthmatic children (aged 4-11 years) attending a primary care clinic in an underserved area of Santiago (Chile). Cases were children with poor asthma control (Child Asthma Control Test [cACT] <20 points) and controls were children with adequate asthma control (cACT ≥20 points). The Beck Depression Inventory-II (BDI) and a locally validated family health vulnerability test (SALUFAM) were used to assess caregivers' depression and family health vulnerability. Serum from participating children was assayed for IFN-γ, IL-4, IL-13, TGF-β, cortisol, and total IgE. The mean (SD) age of study participants was 8.23 (2.15 years), and 55.2% were females. Use of inhaled corticosteroids (ICS), family health vulnerability, and caregiver's depressive symptoms were significantly more common in cases than in controls (65.4% vs. 34.6%, p = 0.003; 41.3% vs. 24.8%, p = 0.07; and 39.1% vs. 19.5%, p = 0.04, respectively). There was no significant difference in the level of any serum biomarkers between groups. In a multivariate analysis, only ICS use was significantly associated with better asthma control (OR = 3.56 [1.34-9.48], p = 0.01). Presence of caregiver's depressive symptoms is associated with poor asthma control among children from an underserved community, but this association was no longer significant after accounting for ICS use.

The Importance of Location for Tobacco Cessation: Rural-Urban Disparities in Quit Success in Underserved West Virginia Counties

ERIC Educational Resources Information Center

Northridge, Mary E.; Vallone, Donna; Xiao, Haijun; Green, Molly; Blackwood, Julia Weikle; Kemper, Suzanne E.; Duke, Jennifer; Watson, Kimberly A.; Burrus, Barri; Treadwell, Henrie M.

2008-01-01

Context: Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. Purpose: To examine the end-of-class quit success of…

Factors influencing participation in worksite wellness programs among minority and underserved populations.

PubMed

Thompson, Sharon E; Smith, Brenda A; Bybee, Ronald F

2005-01-01

In the United States, employers and employees are increasingly paying a larger portion of the nation's healthcare bill. Preventive measures are being employed by businesses in an effort to contain the escalating costs of employee healthcare. The work site is an ideal setting for health promotion because 130 million Americans are employed and spend one third of their time at work. However, unhealthy workers tend to be the least likely to participate in health promotion activities. Worksite Wellness Programs must be designed to engage segments of the work force with the greatest health needs. Culturally sensitive and appropriate programs must be developed to engage economically challenged minority and other underserved populations.

Explaining and improving breast cancer information acquisition among African American women in the Deep South.

PubMed

Anderson-Lewis, Charkarra; Ross, Levi; Johnson, Jarrett; Hastrup, Janice L; Green, B Lee; Kohler, Connie L

2012-06-01

A major challenge facing contemporary cancer educators is how to optimize the dissemination of breast cancer prevention and control information to African American women in the Deep South who are believed to be cancer free. The purpose of this research was to provide insight into the breast cancer information-acquisition experiences of African American women in Alabama and Mississippi and to make recommendations on ways to better reach members of this high-risk, underserved population. Focus group methodology was used in a repeated, cross-sectional research design with 64 African American women, 35 years old or older who lived in one of four urban or rural counties in Alabama and Mississippi. Axial-coded themes emerged around sources of cancer information, patterns of information acquisition, characteristics of preferred sources, and characteristics of least-preferred sources. It is important to invest in lay health educators to optimize the dissemination of breast cancer information to African American women who are believed to be cancer free in the Deep South.

A Comparison of Health Information Needs between Patients at a Suburban Hospital-based Clinic and two Underserved Inner City Clinics

PubMed Central

Hong, Yi; Blackwelder, Mary; Gillis, Rick; Barnas, Gary; Early, Eileen; Jascur, Andrea

2003-01-01

A needs assessment was conducted and the results were analyzed to determine and compare the health information seeking habits and needs of outpatients at a suburban hospital-based clinic and at two clinics located in underserved areas of the inner city. PMID:14728370

Prevalence and Correlates of Intimate Partner Violence Among Young, Middle, and Older Women of Korean Descent in California

PubMed Central

Liles, Sandy; Usita, Paula; Irvin, Veronica L.; Hofstetter, C. Richard; Beeston, Tara; Hovell, Melbourne F.

2012-01-01

This research examined the prevalence and correlates of intimate partner violence (IPV) among younger, middle-aged, and older Korean American women. Data were drawn from telephone interviews of a population-based, representative probability sample (N = 592) of female adults of Korean descent residing in California, with a completion rate of 70%. Data were grouped by age. In each group, psychological aggression was the most common type of IPV in the past year, followed by a moderate form of sexual coercion, while physical assault and injury were infrequent. Immigration stress was associated with psychological aggression in all three groups, and partner alcohol use was associated in none. Other predictors varied by group. Results suggest that psychological abuse is a serious issue, and that women’s life stage is an important consideration in IPV among Korean Americans. Findings, which sometimes diverged from those of prior studies of this population, merit further investigation. PMID:23645971

Application of handheld devices to field research among underserved construction worker populations: a workplace health assessment pilot study.

PubMed

Caban-Martinez, Alberto J; Clarke, Tainya C; Davila, Evelyn P; Fleming, Lora E; Lee, David J

2011-04-01

Novel low-cost approaches for conducting rapid health assessments and health promotion interventions among underserved worker groups are needed. Recruitment and participation of construction workers is particularly challenging due to their often transient periods of work at any one construction site, and their limited time during work to participate in such studies. In the present methodology report, we discuss the experience, advantages and disadvantages of using touch screen handheld devices for the collection of field data from a largely underserved worker population. In March 2010, a workplace-centered pilot study to examine the feasibility of using a handheld personal device for the rapid health assessment of construction workers in two South Florida Construction sites was undertaken. A 45-item survey instrument, including health-related questions on tobacco exposure, workplace safety practices, musculoskeletal disorders and health symptoms, was programmed onto Apple iPod Touch® devices. Language sensitive (English and Spanish) recruitment scripts, verbal consent forms, and survey questions were all preloaded onto the handheld devices. The experience (time to survey administration and capital cost) of the handheld administration method was recorded and compared to approaches available in the extant literature. Construction workers were very receptive to the recruitment, interview and assessment processes conducted through the handheld devices. Some workers even welcomed the opportunity to complete the questionnaire themselves using the touch screen handheld device. A list of advantages and disadvantages emerged from this experience that may be useful in the rapid health assessment of underserved populations working in a variety of environmental and occupational health settings. Handheld devices, which are relatively inexpensive, minimize survey response error, and allow for easy storage of data. These technological research modalities are useful in the

Examining the Influence of Cost Concern and Awareness of Low-cost Health Care on Cancer Screening among the Medically Underserved.

PubMed

Best, Alicia L; Strane, Alcha; Christie, Omari; Bynum, Shalanda; Wiltshire, Jaqueline

2017-01-01

African Americans suffer a greater burden of mortality from breast, cervical, and colorectal cancers than other groups in the United States. Early detection through timely screening can improve survival outcomes; however, cost is frequently reported as a barrier to screening. Federally qualified health centers (FQHCs) provide preventive and primary care to underserved populations regardless of ability to pay, positioning them to improve cancer screening rates. The purpose of this study was to examine the influence of concern about health care cost (cost concern) and awareness of low-cost health care (awareness) on cancer screening among 236 African Americans within an FQHC service area using self-report surveys. Multiple logistic regression indicated that awareness was positively associated with cervical and colorectal cancer screening, while cost concern was negatively associated with mammography screening. Results indicate that improving awareness and understanding of low-cost health care could increase cancer screening among underserved African Americans.

Developing a culturally responsive breast cancer screening promotion with Native Hawaiian women in churches.

PubMed

Ka'opua, Lana Sue

2008-08-01

This article presents findings from research to develop the promotional component of a breast cancer screening program for Native Hawaiian women associated with historically Hawaiian churches in medically underserved communities.The literature on adherence to health recommendations and health promotions marketing guided inquiry on screening influences. Focus groups and individual interviews patterned on the culturally familiar practice of talk story were conducted with 60 Hawaiian women recruited through religious and social organizations.Text data were analyzed with an incremental process involving content analysis and Airhihenbuwa's PEN-3 model. Key informants and senior colleagues reviewed preliminary findings to ensure accuracy of interpretation. Findings reflect collectivist values at the intersection of indigenous Hawaiian culture and religiosity. Inclusion of messages that encourage holistic health across the intergenerational continuum of extended family and fictive kin, reinforcement from spiritual leaders, and testimonials of cancer survivors and family members may facilitate Hawaiian women's screening intent.

Physicians' perceptions on the impact of telemedicine on recruitment and retention in underserved areas: a descriptive study in Senegal.

PubMed

Ly, Birama Apho; Bourgeault, Ivy Lynn; Labonté, Ronald; Niang, Mbayang Ndiaye

2017-09-18

Similar to many places, physicians in Senegal are unevenly distributed. Telemedicine is considered a potential solution to this problem. This study investigated the perceptions of Senegal's physicians of the impact of telemedicine on their recruitment to and retention in underserved areas. We conducted individual interviews with a random sample of 60 physicians in Senegal, including 30 physicians working in public hospitals and 30 physicians working in district health centres between January and June 2014, as part of a mixed methods study. Data were collected using a semi-structured interview guide comprising both open- and close-ended questions. Interviews were recorded, transcribed and coded thematically using NVivo 10 software using a priori and emergent codes. Participants' characteristics were analyzed descriptively using SPSS 23. The impact of telemedicine on physicians' recruitment and retention in underserved areas was perceived with some variability. Among the physicians who were interviewed, most (36) thought that telemedicine could have a positive impact on their recruitment and retention but many (24) believed the opposite. The advantages noted by the first included telemedicine's ability to break their professional isolation and reduce the stress related to this, facilitate their distance learning and improve their working conditions. They did acknowledge that it is not sufficient in itself, an opinion also shared by physicians who did not believe that telemedicine could affect their recruitment and retention. Both identified contextual, economic, educational, family, individual, organizational and professional factors as influential. Based on these opinions of physicians, telemedicine promotion is one intervention that, alongside others, could be promoted to assist in addressing the multiple factors that influence physicians' recruitment and retention in underserved areas.

Motherhood: making it safer for Filipino women.

PubMed

Baylon, M C

1996-01-01

In November 1995, in the Philippines, the Department of Health implemented the Women's Health and Safe Motherhood Project. Its target audience is poor women in remote and underserved provinces. It addresses maternal health, reproductive tract infections (RTIs), sexually transmitted diseases (STDs), cervical cancer, domestic violence, and the desire to space births. It aims to improve the quality of women's health services through training of health providers, providing women with information to help them make informed choices, providing regular supplies and drugs, privacy and infection control at service delivery points, providing follow-up care, and improved cost-effective and technically-sound referral systems. The project also aims to ensure accessible service delivery points, well-equipped and maintained facilities, client and community feedback in managing service delivery, and information provision in order to increase acceptability of health services. The major components of the project include service delivery, institutional strengthening (via information, education, and communication; training of health providers; and improvement of the logistics system), community partnership for women's health development, and policy and operations research. The service delivery component will adopt a life-cycle approach to service delivery in Region 8 (urban and rural communities). It will pilot the syndromic approach in the management and detection of RTIs and STDs in 10 provinces. The biggest tasks of the project are upgrading referral networks from provincial and district hospitals to rural health units and barangay health stations and upgrading primary hospitals.

Recruiting Underserved Mothers to Medical Research: Findings from North Carolina

PubMed Central

Spears, Chaya R.; Sandberg, Joanne C.; O’Neill, Jenna L.; Grzywacz, Joseph G.; Howard, Timothy D.; Feldman, Steven R.; Arcury, Thomas A.

2014-01-01

Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies. PMID:24185171

Storytelling for promoting colorectal cancer screening among underserved Latina women: a randomized pilot study.

PubMed

Larkey, Linda K; Lopez, Ana Maria; Minnal, Archana; Gonzalez, Julie

2009-01-01

In a low socioeconomic-status population of Latina women, we evaluated the potential of storytelling (ST) as a culturally aligned narrative method to promote colorectal cancer (CRC) prevention and screening, compared to a risk tool (RT)-based intervention. Seventy-eight women were randomized in this pilot study to one of two brief interventions to communicate CRC risk reduction options: ST or an RT. Measures of behavioral intentions relative to CRC prevention and screening were obtained following the intervention. Mean scores for intent to obtain and recommend endoscopy to others were significantly better for participants receiving ST than RT (P = .038 and P = .011, respectively). All participants expressed intent to increase fruit and vegetable consumption and physical activity in response to interventions. Post-intervention perceptions of cancer risk and fear of CRC were not significantly different for participants receiving ST compared with RT. Pre- to post-intervention perceptions of risk increased in ST and decreased in RT, while decreases in fear were similar across both intervention groups. Storytelling may be an effective approach for changing CRC risk-related behavioral intentions among Latinas. Mediating factors (such as perceived risk or fear) often used to predict behavior change may not adequately explain the potential persuasive mechanisms of storytelling.

Exploring the Experiences of Women Adjunct Faculty: A Phenomenology

ERIC Educational Resources Information Center

Cross, Emily L.

2013-01-01

This qualitative phenomenological study was designed to give an in-depth understanding of the lived experiences of women adjunct faculty working at a mid-sized community college in California. A review of literature surrounding adjunct faculty, community colleges, and women in higher education found a gap in the exploration and discussion of…

Views of Low-Income Women of Color at Increased Risk for Breast Cancer.

PubMed

E Anderson, Emily; Tejada, Silvia; B Warnecke, Richard; Hoskins, Kent

2018-01-01

Individual risk assessment (IRA) for breast cancer may increase adherence to risk-appropriate screening and prevention measures. However, knowledge gaps exist regarding how best to communicate IRA results and support women at increased risk in future health care decisions, in part because patients conceptualize and make meaning of risk differently from the medical community. Better understanding the views of low-income women of color identified as being at increased risk for breast cancer can inform efforts to conduct IRA in an ethical and respectful manner. We conducted in-depth interviews with 13 low-income African American and Latina women who receive care at a federally qualified health center (FQHC) and had recently learned of their increased risk for breast cancer. These interviews explored their experience of the IRA process, their interpretation of what being at increased risk means, and their reactions to provider recommendations. Eight key themes were identified. We conclude with recommendations for the implementation of IRA for breast cancer in underserved primary care settings.

Project power: Adapting an evidence-based HIV/STI prevention intervention for incarcerated women.

PubMed

Fasula, Amy M; Fogel, Catherine I; Gelaude, Deborah; Carry, Monique; Gaiter, Juarlyn; Parker, Sharon

2013-06-01

Incarcerated women are a critical population for targeted HIV/STI prevention programming; however, there is a dearth of evidence-based, genderspecific behavioral interventions for this population. Systematically adapting existing evidence-based interventions (EBIs) can help fill this gap. We illustrate the adaptation of the HIV/STI prevention EBI, Project Safe, for use among incarcerated women and delivery in prisons. Project POWER, the final adapted intervention, was developed using formative research with prison staff and administration, incarcerated and previously incarcerated women, and input of community advisory boards. Intervention delivery adaptations included: shorter, more frequent intervention sessions; booster sessions prior to and just after release; facilitator experience in prisons and counseling; and new videos. Intervention content adaptations addressed issues of empowerment, substance use, gender and power inequity in relationships, interpersonal violence, mental health, reentry, and social support. This illustration of the adaption process provides information to inform additional efforts to adapt EBIs for this underserved population.

California State Waters Map Series: offshore of San Francisco, California

USGS Publications Warehouse

Cochrane, Guy R.; Johnson, Samuel Y.; Dartnell, Peter; Greene, H. Gary; Erdey, Mercedes D.; Golden, Nadine E.; Hartwell, Stephen R.; Endris, Charles A.; Manson, Michael W.; Sliter, Ray W.; Kvitek, Rikk G.; Watt, Janet Tilden; Ross, Stephanie L.; Bruns, Terry R.; Cochrane, Guy R.; Cochran, Susan A.

2015-01-01

Circulation over the continental shelf in the Offshore of San Francisco map area is dominated by the southward-flowing California Current, an eastern limb of the North Pacific Gyre that flows from Oregon to Baja California. At its midpoint offshore of central California, the California Current transports subarctic surface waters southeastward, about 150 to 1,300 km from shore. Seasonal northwesterly winds that are, in part, responsible for the California Current, generate coastal upwelling. Ocean temperatures offshore of central California have increased over the past 50 years, driving an ecosystem shift from the productive subarctic regime towards a depopulated subtropical environment.

Herb use, vitamin use, and diet in low-income, postpartum women.

PubMed

Gardiner, Paula; Jarrett, Kelli; Filippelli, Amanda; Pecci, Christine; Mauch, Maya; Jack, Brian

2013-01-01

Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with prenatal providers. We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal vitamin use, and diet. We asked women if they discussed use of herbs and vitamins with their prenatal care providers and asked about their satisfaction with these discussions. We reviewed inpatient chart medication lists for herb use. Of 160 women surveyed, 39% reported using herbs during pregnancy. Sixty-five percent of participants took a prenatal vitamin. Fifty-seven percent of herb users (n = 40) reported taking prenatal vitamins. Herb users were significantly more likely to report making any dietary change during their pregnancies than non-herb users (P = .03). Only 38% of herb users discussed it with their prenatal providers, and 82% were satisfied with the conversation. Of all 160 participants, 125 had prenatal vitamin use documented, and no women had herbal medicine use documented in the medical record during their birth hospitalization. We report a higher frequency of herb use during pregnancy than other studies. The fact that women of all backgrounds and economic statuses report using herbs during pregnancy makes it even more important for all women to be asked about their use of herbs. © 2013 by the American College of Nurse-Midwives.

Herb Use, Vitamin Use, and Diet in Low Income Postpartum Women

PubMed Central

Gardiner, Paula; Jarrett, Kelli; Filippelli, Amanda; Pecci, Christine; Mauch, Maya; Jack, Brian

2012-01-01

Introduction Little is known about herb use among underserved postpartum women and their patterns of communication about herb use with prenatal providers. Methods We interviewed women from the postpartum unit at an urban hospital about herb use during pregnancy, socioeconomic factors, prenatal vitamin use, and diet. We asked women if they discussed use of herbs and vitamins with their prenatal care provider, and their satisfaction with these discussions. We reviewed inpatient chart medication lists for herb use. Results Of 160 women surveyed, 39% reported using herbs during pregnancy. Sixty five percent of subjects took a prenatal vitamin. Fifty-seven percent of herb users (n=40) reported taking prenatal vitamins. Herb users were significantly more likely to report making any dietary change during their pregnancy than non-herb users (P=0.03). Only 38% of herb users discussed it with their prenatal provider and 82% were satisfied with the conversation. Of all 160 subjects, 125 had prenatal vitamin use documented and no women had herbal medicine use documented in the medical record during their delivery hospitalization. Discussion We report a higher frequency of herb use during pregnancy than other studies. The fact that women of all backgrounds and economic status report using herbs during pregnancy makes it even more important for all women to be asked about their use of herbs. PMID:23590486

Social and Environmental Barriers to Nutrition Therapy for Diabetes Management Among Underserved Pregnant Women: A Qualitative Analysis.

PubMed

Yee, Lynn M; McGuire, Jamie M; Taylor, Shaneah M; Niznik, Charlotte M; Simon, Melissa A

2016-03-01

To identify social and environmental barriers to nutrition therapy for diabetes management during pregnancy among a population of low-income, minority pregnant women. Prospective, in-depth, semi-structured interviews performed serially during pregnancy and continued until thematic saturation was reached. Urban academic medical center. Ten pregnant low-income, minority women with gestational diabetes and type 2 diabetes mellitus. Social and environmental barriers to nutrition therapy for diabetes management during pregnancy. Qualitative analysis of interview data using electronic coding software was performed using theme analysis. Participants perceived limited ability and self-efficacy to adopt nutrition recommendations. Specific themes identified as barriers included (1) feeling overwhelmed by the unfamiliar; (2) using and decoding nutrition labels; (3) managing nutrition choices and seeking control in the setting of food insecurity; (4) experiencing lack of control and motivation, and limited self-efficacy; (5) balancing recommendations with taste preferences and cultural food norms; (6) maintaining a healthy eating schedule; and (7) accommodating diabetes in family and social life. Pregnant women with diabetes encounter a number of knowledge-based, attitudinal, and resource-related barriers that reduce capacity for nutrition therapy adherence. Provision of culturally informed, practical nutrition support that addresses the needs of women in low-resource communities is an important component of comprehensive diabetes care during pregnancy. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Involving American Indians and medically underserved rural populations in cancer clinical trials.

PubMed

Guadagnolo, B Ashleigh; Petereit, Daniel G; Helbig, Petra; Koop, David; Kussman, Patricia; Fox Dunn, Emily; Patnaik, Asha

2009-12-01

To assess cancer clinical trial recruitment and reasons for nonaccrual among a rural, medically underserved population served by a community-based cancer care center. We prospectively tracked clinical trial enrollment incidence among all new patients presenting at the Rapid City Regional Cancer Care Institute. Evaluating physicians completed questionnaires for each patient regarding clinical trial enrollment status and primary reasons for nonenrollment. Patients who identified as American Indian were referred to a program where patients were assisted in navigating the medical system by trained, culturally competent staff. Between September 2006 and January 2008, 891 new cancer patients were evaluated. Seventy-eight patients (9%; 95% confidence intervals, 7-11%) were enrolled on a clinical treatment trial. For 73% (95% confidence intervals, 69-75%) of patients (646 of 891) lack of relevant protocol availability or protocol inclusion criteria restrictiveness was the reason for nonenrollment. Only 45 (5%; 95% confidence intervals, 4-7%) patients refused enrollment on a trial. Of the 78 enrolled on a trial, 6 (8%; 95% confidence intervals, 3-16%) were American Indian. Three additional American Indian patients were enrolled under a nontreatment cancer control trial, bringing the total percentage enrolled of the 94 American Indians who presented to the clinic to 10% (95% confidence intervals, 5-17%). Eligibility rates were unable to be calculated and cross validation of the number in the cohort via registries or ICD-9 codes was not performed. Clinical trial participation in this medically underserved population was low overall, but approximately 3-fold higher than reported national accrual rates. Lack of availability of protocols for common cancer sites as well as stringent protocol inclusion criteria were the primary obstacles to clinical trial enrollment. Targeted interventions using a Patient Navigation program were used to engage AI patients and may have resulted in

Syllabi Set on Women, Health and Healing: Fourteen Courses.

ERIC Educational Resources Information Center

Ruzek, Sheryl, Comp.; And Others

Compiled with the goal of developing social science perspectives on women's health and on topics at the intersection of social science and clinical issues, the syllabi included were developed by faculty teaching in the Women, Health and Healing Program at the University of California, San Francisco. The courses here are directed at upper division…

The Story of California = La Historia de California.

ERIC Educational Resources Information Center

Bartel, Nick

"The Story of California" is a history and geography of the state of California, intended for classroom use by limited-English-proficient, native Spanish-speaking students in California's urban middle schools. The book is designed with the left page in English and the right page in Spanish to facilitate student transition into…

The Effect of California's Breast Density Notification Legislation on Breast Cancer Screening.

PubMed

Chau, Stephanie Lynn; Alabaster, Amy; Luikart, Karin; Brenman, Leslie Manace; Habel, Laurel A

2017-04-01

Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California's 2013 BD notification legislation on breast cancer screening patterns. We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

A cancer screening intervention for underserved Latina women by lay educators.

PubMed

Larkey, Linda K; Herman, Patricia M; Roe, Denise J; Garcia, Francisco; Lopez, A M; Gonzalez, J; Perera, Prasadini N; Saboda, Kathylynn

2012-05-01

Inadequate screening adherence for breast, cervical, and colorectal cancer among Latinas places them at greater risk for poor survival rates, once diagnosed. The purpose of this study was to examine two delivery methods of lay health educators (promotoras de salud) to increase screening behavior and evaluate costs. This community-based group randomized trial assigned Latinas due for breast, cervical, or colorectal cancer screening (n=1006) to promotora-taught cancer screening/prevention classes delivered individually (IND) or in social support groups (SSG) over 8 weeks. Screening behaviors were assessed immediately after and 3 and 15 months after intervention. Intervention costs per study arm were compared. Screening and maintenance behaviors were not significantly different between SSG and IND for any one type of cancer screening, but with a study entry requirement that participants were either never screened or due for screening, postintervention screening rates (that is, completing a screening that was due) were notable (39.4% and 45.5%, respectively). The cost of achieving any one screening was much higher for IND participants. SSG vs. IND delivery did not significantly affect cancer screening behaviors, but both interventions produced robust achievement of screenings for previously nonadherent participants. Group-based promotora-led interventions supporting social involvement are recommended as a more cost-effective approach to achieving cancer screening among Latina women.

Factors Associated with the Involuntary Reassignment of Three Women Principals.

ERIC Educational Resources Information Center

Cohn, Kathleen C.

Careers of women in educational administration differ from those of their male counterparts. Women encounter career barriers in educational organizations. This paper presents case studies of three female principals, two from California and one from Pennsylvania. The first case describes a woman whose tenure was ended with a negotiated reassignment…

8 CFR 245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2011 CFR

2011-01-01

... period following Service approval of a second preference employment-based immigrant visa petition. (b) Do... with Form I-485. The medical examination report shall be submitted with the documentary evidence noting... Form I-140 with a national interest waiver based upon full-time clinical practice in an underserved...

8 CFR 245.18 - How can physicians (with approved Forms I-140) that are serving in medically underserved areas or...

Code of Federal Regulations, 2010 CFR

2010-01-01

... period following Service approval of a second preference employment-based immigrant visa petition. (b) Do... with Form I-485. The medical examination report shall be submitted with the documentary evidence noting... Form I-140 with a national interest waiver based upon full-time clinical practice in an underserved...

Joint breast and colorectal cancer screenings in medically underserved women

PubMed Central

Davis, Terry C; Arnold, Connie L; Wolf, Michael S; Bennett, Charles L; Liu, Dachao; Rademaker, Alfred

2016-01-01

Background Breast and colon cancer screening in rural community clinics is underused. Objective To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics. Methods A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualifed health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support). Results Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care. Limitations There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results. Conclusions Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was

Engaging with Underserved Urban Communities on Climate Resilience

NASA Astrophysics Data System (ADS)

Akerlof, K.; Moser, F. C.; Baja, K.; Dindinger, J. M.; Chanse, V.; Rowan, K. E.; Rohring, B.

2016-12-01

Meeting the needs of urban high-risk/low-resource communities is one of the most critical challenges in improving climate resilience nationally, but little tailored information exists to guide community engagement efforts specifically for these contexts. This case study describes a collaboration between universities, local governments, and community members working in underserved neighborhoods of the City of Baltimore and Prince George's County, Maryland. In service of current and developing community programs, the team surveyed residents door-to-door about their perceptions of the socio-environmental risks they face, their priorities for change, and the ways in which communication may build protective social capital. We highlight theoretical, applied, and pedagogical aspects of the study that inform both the promise and limitations of these collaborations. These include: 1) the role of citizen participation in climate adaptation decision-making; 2) the meaning, use, and potential impact of community data; 3) balancing differing organizational priorities, timelines, and cultures within community-based projects; and 4) research participation of undergraduate students. The results of the survey illuminate climate risk perceptions in neighborhoods facing complex stressors with lessons for communication and engagement in other urban areas facing similar adaptation challenges.

Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas.

PubMed

Boscardin, Christy K; Grbic, Douglas; Grumbach, Kevin; O'Sullivan, Patricia

2014-11-01

The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention). Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention. After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation. Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.

Innovative Educational Initiatives to Train Psychodynamic Psychiatrists in Underserved Areas of the World.

PubMed

Alfonso, César A; Michael, Marco Christian; Elvira, Sylvia Detri; Zakaria, Hazli; Kalayasiri, Rasmon; Adlan, Aida Syarinaz A; Moinalghorabaei, Mahdieh; Lukman, Petrin Redayani; San'ati, Mohammad; Duchonova, Katerina; Sullivan, Timothy B

2018-06-01

Psychodynamic psychiatry remains a challenging subject to teach in underserved areas, where enthusiasm to learn is substantial. Besides logistical and psychiatric workforce shortcomings, sensible cultural adaptations to make psychodynamic psychiatry relevant outside of high-income countries require creative effort. Innovative pedagogical methods that include carefully crafted mentoring and incorporate videoconferencing in combination with site visits can be implemented through international collaborations. Emphasis on mentoring is essential to adequately train future psychodynamic psychotherapy supervisors. Examples of World Psychiatric Association initiatives in countries such as Indonesia, Iran, Malaysia, and Thailand are presented as possible models to emulate elsewhere. Copyright © 2018 Elsevier Inc. All rights reserved.

Perceived Physician-informed Weight Status Predicts Accurate Weight Self-Perception and Weight Self-Regulation in Low-income, African American Women.

PubMed

Harris, Charlie L; Strayhorn, Gregory; Moore, Sandra; Goldman, Brian; Martin, Michelle Y

2016-01-01

Obese African American women under-appraise their body mass index (BMI) classification and report fewer weight loss attempts than women who accurately appraise their weight status. This cross-sectional study examined whether physician-informed weight status could predict weight self-perception and weight self-regulation strategies in obese women. A convenience sample of 118 low-income women completed a survey assessing demographic characteristics, comorbidities, weight self-perception, and weight self-regulation strategies. BMI was calculated during nurse triage. Binary logistic regression models were performed to test hypotheses. The odds of obese accurate appraisers having been informed about their weight status were six times greater than those of under-appraisers. The odds of those using an "approach" self-regulation strategy having been physician-informed were four times greater compared with those using an "avoidance" strategy. Physicians are uniquely positioned to influence accurate weight self-perception and adaptive weight self-regulation strategies in underserved women, reducing their risk for obesity-related morbidity.

Randomized, Controlled Trial to Examine the Impact of Providing Yogurt to Women Enrolled in WIC

ERIC Educational Resources Information Center

Fung, Ellen B.; Ritchie, Lorrene D.; Walker, Brent H.; Gildengorin, Ginny; Crawford, Patricia B.

2010-01-01

Objective: Examine the impact of providing yogurt to women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Design: Randomized, controlled intervention trial. Setting: Two California WIC local agency sites. Participants: 511 pregnant, breast-feeding, or postpartum women. Intervention: Substitution of…

Pilot Testing of a Parent-Directed Intervention (Project ASPIRE) for Underserved Children Who Are Deaf or Hard of Hearing

ERIC Educational Resources Information Center

Sacks, Chana; Shay, Sophie; Repplinger, Lyra; Leffel, Kristin R.; Sapolich, Shannon G.; Suskind, Elizabeth; Tannenbaum, Sally; Suskind, Dana

2014-01-01

This pilot study explored the potential for Project ASPIRE to effect behavior change in a sample of 11 parents of children with hearing loss who were from typically underserved populations, such as families from backgrounds of low socioeconomic status or families who speak English as a second language. The study consisted of one education session,…

Pertussis epidemic--California, 2014.

PubMed

Winter, Kathleen; Glaser, Carol; Watt, James; Harriman, Kathleen

2014-12-05

On June 13, 2014, the California Department of Public Health (CDPH) declared that a pertussis epidemic was occurring in the state when reported incidence was more than five times greater than baseline levels. The incidence of pertussis in the United States is cyclical, with peaks every 3-5 years, as the number of susceptible persons in the population increases. The last pertussis epidemic in California occurred in 2010, when approximately 9,000 cases were reported, including 808 hospitalizations and 10 infant deaths, for a statewide incidence of 24.6 cases per 100,000 population. During January 1-November 26, 2014, a total of 9,935 cases of pertussis with onset in 2014 were reported to CDPH, for a statewide incidence of 26.0 cases per 100,000. CDPH is working closely with local health departments to prioritize public health activities, with the primary goal of preventing severe cases of pertussis, which typically occurs in infants. All prenatal care providers are being encouraged to provide tetanus, diphtheria, and acellular pertussis vaccine (Tdap) to pregnant women during each pregnancy, ideally at 27-36 weeks' gestation, as is recommended by the Advisory Committee on Immunization Practices (ACIP), or refer patients to an alternative provider, such as a pharmacy or local public health department, to receive Tdap.

Trends in Rural and Urban Deliveries and Vaginal Births: California 1998-2002

ERIC Educational Resources Information Center

Hughes, Susan; Zweifler, John A.; Garza, Alvaro; Stanich, Matthew A.

2008-01-01

Context: Pregnant women in rural areas may give birth in either rural or urban hospitals. Differences in outcomes between rural and urban hospitals may influence patient decision making. Purpose: Trends in rural and urban obstetric deliveries and neonatal and maternal mortality in California were compared to inform policy development and patient…

Did Intraprofessional Training with Dental Therapists Affect Dental Students' Attitudes Toward Caring for the Underserved?

PubMed

Flynn, Priscilla M; Luthra, Makshita; Blue, Christine M

2017-02-01

Dental therapy was recently introduced as a new oral health care workforce model to increase care for vulnerable populations in Minnesota. Nine dental therapy and 98 dental students began intraprofessional training at the University of Minnesota in 2009. The aim of this longitudinal study was to determine whether intraprofessional education with the dental therapy students would affect the dental students' attitudes toward caring for underserved populations. One class of dental students was surveyed annually between 2009 and 2013 using the Attitudes Toward Health Care survey to measure attitudinal changes about treating vulnerable patients across their four years of dental school. Participation ranged from 68% to 99% in each year. The results showed that the dental students had positive attitudes toward treating vulnerable patients on entering dental school, but their attitudes became less positive over the four years. While the composite survey results were similar to other studies using the same instrument, variations were seen by domain. These students' attitudes about societal expectations and personal efficacy remained stable, while their dentist/student responsibility and access to care attitudes showed statistically significant declines. Their positive attitudes toward treating the underserved declined over four years regardless of intraprofessional training with dental therapy students. As attitudes toward caring for vulnerable patients are shaped by both personal attitudes and societal norms, additional research is needed to determine whether the addition of an intentional curricular thread may alter results over time compared to intraprofessional training alone.

Comparison of Same-Sex Couples Who Were Married in Massachusetts, Had Domestic Partnerships in California, or Had Civil Unions in Vermont

ERIC Educational Resources Information Center

Rothblum, Esther D.; Balsam, Kimberly F.; Solomon, Sondra E.

2008-01-01

This study compared 55 men and 78 women who had same-sex marriages in Massachusetts, 101 men and 120 women who had domestic partnerships in California, and 35 men and 86 women who had civil unions in Vermont, all in 2004. Couples were surveyed on demographic and relationship information, conflict, contact with family of origin, social support,…

The Effects of Proposition 209 on California: Higher Education, Public Employment, and Contracting

ERIC Educational Resources Information Center

Geshekter, Charles L.

2008-01-01

In 1996, Californians overwhelmingly approved Proposition 209, which prohibited all state agencies from discriminating on the basis of race, ethnicity, or gender in university admissions, public employment, or competition for a state contract. Opponents of Proposition 209 predicted dire consequences for California's ethnic minorities and women if…

"A Woman's World": The University of California, Berkeley, during the Second World War

ERIC Educational Resources Information Center

Dorn, Charles

2008-01-01

During World War II, female students at the University of California, Berkeley--then the most populous undergraduate campus in American higher education--made significant advances in collegiate life. In growing numbers, women enrolled in male-dominated academic programs, including mathematics, chemistry, and engineering, as they prepared for…

Evaluating associations between sources of information, knowledge of the human papillomavirus, and human papillomavirus vaccine uptake for adult women in California.

PubMed

Almeida, Cristina M; Tiro, Jasmin A; Rodriguez, Michael A; Diamant, Allison L

2012-04-19

Vaccines have the potential to reduce morbidity from HPV infections if age-eligible patients receive and parents know about them. Content analyses have demonstrated significant range in the quality of HPV information obtained from different sources. The purpose of this study was to determine the pattern of associations between information source and level of knowledge about HPV and vaccine receipt/intention. We analyzed the 2007 California Health Interview Survey, a population-based, statewide random digit dial survey, using data on adult females ages 18-65 who had heard about HPV (n=16,806). One-way ANOVA and multivariate logistic regression assessed the associations between source of information (advertisement only, advertisement plus other sources, and non-advertisement sources) and knowledge of HPV (3 or greater correct on a 4-point scale). Multivariate logistic regressions were conducted on a subsample of vaccine-eligible women and parents to assess vaccine uptake or intention. Less than half of respondents (43%) correctly answered 3 or more of the HPV knowledge questions. Mean knowledge scores were significantly different when comparing women who reported advertisement only, non-advertisement, and advertisement plus other sources of information (p<0.001). In multivariate analysis, women who reported non-advertisement sources (OR 2.44, 95% CI 2.07-2.87) and advertisements plus other sources (OR 3.03, 95% CI 2.57-3.58) were more likely to have knowledge scores above the 75% level than women who relied on advertisements alone. In the subsample of vaccine-eligible women and parents, those who reported advertisements plus other sources (OR 1.85, 95% CI 1.30-2.62) were more likely to have received or intend to receive the vaccine than those who reported advertisements as their sole information source. Advertisements are the most commonly reported source of information about HPV, and while they inform women of the existence of the vaccine, they do not contribute to

Estimating dietary costs of low-income women in California: a comparison of 2 approaches.

PubMed

Aaron, Grant J; Keim, Nancy L; Drewnowski, Adam; Townsend, Marilyn S

2013-04-01

Currently, no simplified approach to estimating food costs exists for a large, nationally representative sample. The objective was to compare 2 approaches for estimating individual daily diet costs in a population of low-income women in California. Cost estimates based on time-intensive method 1 (three 24-h recalls and associated food prices on receipts) were compared with estimates made by using less intensive method 2 [a food-frequency questionnaire (FFQ) and store prices]. Low-income participants (n = 121) of USDA nutrition programs were recruited. Mean daily diet costs, both unadjusted and adjusted for energy, were compared by using Pearson correlation coefficients and the Bland-Altman 95% limits of agreement between methods. Energy and nutrient intakes derived by the 2 methods were comparable; where differences occurred, the FFQ (method 2) provided higher nutrient values than did the 24-h recall (method 1). The crude daily diet cost was $6.32 by the 24-h recall method and $5.93 by the FFQ method (P = 0.221). The energy-adjusted diet cost was $6.65 by the 24-h recall method and $5.98 by the FFQ method (P < 0.001). Although the agreement between methods was weaker than expected, both approaches may be useful. Additional research is needed to further refine a large national survey approach (method 2) to estimate daily dietary costs with the use of this minimal time-intensive method for the participant and moderate time-intensive method for the researcher.

Lack of a close confidant: prevalence and correlates in a medically underserved primary care sample.

PubMed

Newton, Tamara; Buckley, Amy; Zurlage, Megan; Mitchell, Charlene; Shaw, Ann; Woodruff-Borden, Janet

2008-03-01

The present study examined prevalence of lack of a close confidant in a medically underserved primary care sample, and evaluated demographic, medical, and psychological correlates of patients' deficits in close, personal contact. Adult patients (n = 413) reported on confidant status and symptoms of depression and anxiety. Sociodemographic and medical information were obtained through chart review. One-quarter of patients endorsed lack of a close confidant. Past month anxiety and depression symptoms, but not medical status, were associated with unmet socioemotional needs. Implications for primary healthcare interventions are discussed.

Improving the Health of Cambodian Americans: Grassroots Approaches and Root Causes.

PubMed

Lee, Juliet P; Kirkpatrick, Sean; Rojas-Cheatham, Ann; Sin, Talaya; Moore, Roland S; Tan, Sotheavy; Godoy, Shadia; Ercia, Angelo

2016-01-01

Cambodian Americans experience great disparities in health compared to other Americans, yet may be underserved by conventional healthcare systems. Community-based participatory research (CBPR) is a means to engage underserved communities in health research and programming. We describe results of our efforts to engage the Cambodian grassroots members as well as formal leaders in Oakland, California. In addition to a community advisory group, we convened a Community Work Group (CWG), composed of 10 grassroots community women of varying ages and backgrounds. The project aimed to leverage the lived experiences of these women and their understandings of health and wellness in identifying specific health issues and developing culturally resonant strategies. The CWG met weekly with staff facilitators using methods for collective analysis including theater, body mapping, and other expressive arts. The approach proved logistically challenging, but resulted in novel analyses and strategies. The group identified trauma, along with poor access to education, unemployment and underemployment, social isolation, and generation gap, together with community violence, as root causes of key behavioral health issues, namely, alcohol abuse, gambling, prescription drug misuse, and domestic violence. Strategies proposed and implemented by the group and project staff were a community garden, Cambodian New Year's celebrations, and a museum exhibit on the Cambodian refugee experiences. Grassroots community engagement can support projects in identifying social determinants of health and developing the capacities of community members to conduct research and actions to improve health.

Epidemiology and consequences of women's revictimization.

PubMed

Kimerling, Rachel; Alvarez, Jennifer; Pavao, Joanne; Kaminski, Amy; Baumrind, Nikki

2007-01-01

This study uses Kraemer's approach for nonrandom comorbidity to identify the parameters of revictimization among women, using a diverse, population-based sample. Participants (n = 11,056) are from the California Women's Health Survey. Women were asked about childhood and adult violence and current symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety. Logistic regressions adjusted for age, ethnicity, education, and poverty indicate that women who experienced childhood physical or sexual abuse were 5.8 (95% confidence interval, 5.2-6.4) times more likely to experience adult physical or sexual victimization. Revictimization affected 12% of women, and these women were substantially more likely to report current symptoms of anxiety, depression, and PTSD than women exposed to violence only in childhood or only as an adult. Revictimization is a methodologically distinct concept and is a potent risk factor for adult mental health problems. Prevention should target women exposed to both physical and sexual assault.

Explaining and Improving Breast Cancer Information Acquisition among African American Women in the Deep South

PubMed Central

Anderson-Lewis, Charkarra; Ross, Levi; Johnson, Jarrett; Hastrup, Janice L.; Green, B. Lee; Kohler, Connie L.

2012-01-01

Objectives A major challenge facing contemporary cancer educators is how to optimize the dissemination of breast cancer prevention and control information to African American women in the Deep South who are believed to be cancer free. The purpose of this research was to provide insight into the breast cancer information-acquisition experiences of African American women in Alabama and Mississippi and to make recommendations on ways to better reach members of this high-risk, underserved population. Methods Focus group methodology was used in a repeated, cross-sectional research design with 64 African American women, 35 years old or older who lived in one of four urban or rural counties in Alabama and Mississippi. Results Axial-coded themes emerged around sources of cancer information, patterns of information acquisition, characteristics of preferred sources, and characteristics of least-preferred sources. Conclusions It is important to invest in lay health educators to optimize the dissemination of breast cancer information to African American women who are believed to be cancer free in the Deep South. PMID:22665151

California.

DOT National Transportation Integrated Search

1991-08-01

On January 1, 1990 California lowered the allowable blood alcohol concentration (BAC) at which it is illegal to drive from 0.10 to 0.08. On July 1, 1990 California also implemented an Administrative Per Be (also known as Administrative License . Revo...

A Multidimensional View of Personal Health Systems for Underserved Populations

PubMed Central

Botts, Nathan E; Burkhard, Richard J

2010-01-01

The advent of electronic personal health records (PHR) provides a major opportunity to encourage positive health management practices, such as chronic disease management. Yet, to date there has been little attention toward the use of PHRs where advanced health information services are perhaps most needed, namely, in underserved communities. Drawing upon research conducted with safety net providers and patients, the authors propose a multi-level analytical framework for guiding actions aimed at fostering PHR adoption and utilization. The authors first outline distinctive user and technical requirements that need to be considered. Next, they assess organizational requirements necessary to implement PHRs within health systems bound by limited resources. Finally, the authors analyze the overriding health care policy context that can facilitate or thwart such efforts. The conclusion notes that heightened national attention toward health information technology and reform provides a significant opportunity for initiatives whose goal is to increase widepread access to PHRs. PMID:20685644

FACCCTS: Journal of the Faculty Association of California Community Colleges, 2000-2001.

ERIC Educational Resources Information Center

Martinez, Katherine, Ed.

2001-01-01

This document contains the four issues of the 2000-2001 FACCCTs, the journal of the Faculty Association of California Community Colleges. The September 2000 issue includes a collection of observations on academic integrity and cheating, an article describing a history of opportunities for women in higher education, and editorial comments on a…

Reassessing Unintended Pregnancy: Toward a Patient-centered Approach to Family Planning.

PubMed

Morse, Jessica E; Ramesh, Shanthi; Jackson, Andrea

2017-03-01

Underserved women, especially those with low incomes and from racial and ethnic minorities, experience a disproportionate share of unintended pregnancies in the United States. Although unintended pregnancy rates are general markers of women's health and status, they may not accurately capture women's experiences of these pregnancies or their social circumstances. A patient-centered approach to family planning optimizes women's reproductive preferences, is cognizant of historical harms and current disparities, and may more comprehensively address the issue of unintended pregnancy. Clinicians, researchers, and policy makers can all adopt a patient-centered approach to help underserved women regain their reproductive autonomy. Copyright © 2016 Elsevier Inc. All rights reserved.

California Geothermal Forum: A Path to Increasing Geothermal Development in California

DOE Office of Scientific and Technical Information (OSTI.GOV)

Young, Katherine R.

The genesis of this report was a 2016 forum in Sacramento, California, titled 'California Geothermal Forum: A Path to Increasing Geothermal Development in California.' The forum was held at the California Energy Commission's (CEC) headquarters in Sacramento, California with the primary goal being to advance the dialogues for the U.S. Department of Energy's Geothermal Technologies Office (GTO) and CEC technical research and development (R&D) focuses for future consideration. The forum convened a diverse group of stakeholders from government, industry, and research to lay out pathways for new geothermal development in California while remaining consistent with critical Federal and State conservationmore » planning efforts, particularly at the Salton Sea.« less

[Prenatal care and hospital maternal mortality in Tijuana, Baja California, Mexico].

PubMed

Gonzaga-Soriano, María Rode; Zonana-Nacach, Abraham; Anzaldo-Campos, María Cecilia; Olazarán-Gutiérrez, Asbeidi

2014-01-01

To describe the prenatal care (PC) received in women with maternal hospital deaths from 2005 to 2011 in Tijuana, Baja California, Mexico. Were reviewed the medical chars and registrations of the maternal deaths by the local Committees of Maternal Mortality. There were 44 maternal hospital deaths. Thirty (68%) women assisted to PC appointments during pregnancy, the average number of PC visits was 3.8 and 18 (41%) had an adequate PC (≥ 5 visits). Six (14%) women didn't know they were pregnant; 19 (43%), 21 (48%) y 4 (9%) maternal deaths were due to direct, indirect obstetric cause or non-obstetric causes. Eighteen (18%), 2 (4 %) and 34 (77%) of the maternal deaths occurred during pregnancy, delivery or puerperium. It is necessary pregnancy women have an early, periodic and systematic PC to identify opportunely risk factors associated with pregnancy complications.

The Incidence and Prevalence of Systemic Lupus Erythematosus in San Francisco County, California: The California Lupus Surveillance Project.

PubMed

Dall'Era, Maria; Cisternas, Miriam G; Snipes, Kurt; Herrinton, Lisa J; Gordon, Caroline; Helmick, Charles G

2017-10-01

Estimates of the incidence and prevalence of systemic lupus erythematosus (SLE) in the US have varied widely. The purpose of this study was to conduct the California Lupus Surveillance Project (CLSP) to determine credible estimates of SLE incidence and prevalence, with a special focus on Hispanics and Asians. The CLSP, which is funded by the Centers for Disease Control and Prevention, is a population-based registry of individuals with SLE residing in San Francisco County, CA, from January 1, 2007 through December 31, 2009. Data sources included hospitals, rheumatologists, nephrologists, commercial laboratories, and a state hospital discharge database. We abstracted medical records to ascertain SLE cases, which we defined as patients who met ≥4 of the 11 American College of Rheumatology classification criteria for SLE. We estimated crude and age-standardized incidence and prevalence, which were stratified by sex and race/ethnicity. The overall age-standardized annual incidence rate was 4.6 per 100,000 person-years. The average annual period prevalence was 84.8 per 100,000 persons. The age-standardized incidence rate in women and men was 8.6 and 0.7 per 100,000 person-years, respectively. This rate was highest among black women (30.5), followed by Hispanic women (8.9), Asian women (7.2), and white women (5.3). The age-standardized prevalence in women per 100,000 persons was 458.1 in blacks, 177.9 in Hispanics, 149.7 in Asians, and 109.8 in whites. Capture-recapture modeling estimated 33 additional incident cases and 147 additional prevalent cases. Comprehensive methods that include intensive case-finding provide more credible estimates of SLE in Hispanics and Asians, and confirm racial and ethnic disparities in SLE. The disease burden of SLE is highest in black women, followed by Hispanic women, Asian women, and white women. © 2017, American College of Rheumatology.

Understanding the Experience of Women in Undergraduate Engineering Programs at Public Universities

ERIC Educational Resources Information Center

Perez, Jessica Ohanian

2017-01-01

Women earn bachelor's degrees in engineering at a rate of less than 17% at public universities in California. The purpose of this study was to understand how women experience undergraduate engineering programs at public universities. To understand this lack of attainment, a qualitative methodology and Feminist Poststructuralist perspective were…

Lack of knowledge about mother-to-child HIV transmission prevention in pregnant women at Tijuana General Hospital, Baja California, Mexico.

PubMed

Becka, Chandra M; Chacón-Cruz, Enrique; Araneta, Maria Rosario; Viani, Rolando M

2015-01-01

The objective of this study was to identify determinants of human immunodeficiency virus (HIV) knowledge regarding mother-to-child transmission (MTCT) among pregnant women at Tijuana General Hospital, Baja California, Mexico. Between March and November 2003, patients from the prenatal care (n = 1294) and labor and delivery (L&D) units (n = 495) participated in a cross-sectional study to measure HIV knowledge. Less than one-third (30%) knew that HIV could be transmitted to a child during delivery, and 36% knew that HIV could be transmitted by breast-feeding. Only 27% knew that an MTCT could be prevented. Prenatal patients were more likely to know that MTCT was preventable (prenatal: 31% versus L&D 25%; P = .02). Logistic regression indicated that prenatal patients (odds ratio = 1.49, confidence interval 1.07-2.07) were more likely to know that HIV could be transmitted through breast-feeding. Overall, both groups had poor knowledge regarding MTCT of HIV. © The Author(s) 2014.

Involving American Indians and medically underserved rural populations in cancer clinical trials

PubMed Central

Guadagnolo, B Ashleigh; Petereit, Daniel G; Helbig, Petra; Koop, David; Kussman, Patricia; Dunn, Emily Fox; Patnaik, Asha

2010-01-01

Purpose To assess cancer clinical trial recruitment and reasons for nonaccrual among a rural, medically underserved population served by a community-based cancer care center. Methods We prospectively tracked clinical trial enrollment incidence among all new patients presenting at the Rapid City Regional Cancer Care Institute. Evaluating physicians completed questionnaires for each patient regarding clinical trial enrollment status and primary reasons for nonenrollment. Patients who identified as American Indian were referred to a program where patients were assisted in navigating the medical system by trained, culturally competent staff. Results Between September 2006 and January 2008, 891 new cancer patients were evaluated. Seventy-eight patients (9%; 95% confidence intervals, 7–11%) were enrolled on a clinical treatment trial. For 73% (95% confidence intervals, 69–75%) of patients (646 of 891) lack of relevant protocol availability or protocol inclusion criteria restrictiveness was the reason for nonenrollment. Only 45 (5%; 95% confidence intervals, 4–7%) patients refused enrollment on a trial. Of the 78 enrolled on a trial, 6 (8%; 95% confidence intervals, 3–16%) were American Indian. Three additional American Indian patients were enrolled under a nontreatment cancer control trial, bringing the total percentage enrolled of the 94 American Indians who presented to the clinic to 10% (95% confidence intervals, 5–17%). Limitations Eligibility rates were unable to be calculated and cross validation of the number in the cohort via registries or ICD-9 codes was not performed. Conclusion Clinical trial participation in this medically underserved population was low overall, but approximately 3-fold higher than reported national accrual rates. Lack of availability of protocols for common cancer sites as well as stringent protocol inclusion criteria were the primary obstacles to clinical trial enrollment. Targeted interventions using a Patient Navigation program

The use of herbs by california midwives.

PubMed

Dennehy, Cathi; Tsourounis, Candy; Bui, Lindsey; King, Tekoa L

2010-01-01

To characterize herbal product use (prevalence, types, indications) among Certified Nurse Midwives/Certified Midwives (CNMs/CMs) and Licensed Midwives (LMs) practicing in the state of California and to describe formal education related to herbal products received by midwives during midwifery education. Cross-sectional survey/California/Practicing midwives. A list of LMs and CNMs/CMs practicing in California was obtained through the California Medical Board (CMB) and the American College of Nurse Midwives (ACNM), respectively. The survey was mailed to 343 CNMs/CMs (one third of the ACNM mailing list) and 157 LMs (the complete CMB mailing list). Of the 500 surveys mailed, 40 were undeliverable, 146 were returned, and 7 were excluded (30% response rate). Of the 139 completed surveys, 58/102 (57%) of CNMs/CMs and 35/37 (95%) of LMs used herbs, and LMs were more comfortable than CNMs/CMs in recommending herbs to their patients. A majority of LMs had >20 hours of midwifery education on herbs whereas a majority of CNMs/CMs received 0 to 5 hours. Some CNMs/CMs indicated that their practice site limited their ability to use herbs. Common conditions in which LMs and CNMs/CMs used herbs were nausea/vomiting (86% vs. 83%), labor induction (89% vs. 58%), and lactation (86% vs. 65%). Specific herbs for all indications are described. Licensed midwives were more likely than CNMs/CMs to use herbs in clinical practice. This trend was likely a reflection of the amount of education devoted to herbs as well as herbal use limitations that may be encountered in institutional facilities. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Temperature and Term Low Birth Weight in California.

PubMed

Basu, Rupa; Rau, Reina; Pearson, Dharshani; Malig, Brian

2018-06-12

Few investigations have explored temperature and birth outcomes. In a retrospective cohort study, we examined apparent temperature, a combination of temperature and relative humidity, and term low birth weight (LBW) among 43,629 full-term LBW infants and 2,032,601 normal weight infants in California from 1999 to 2013. The California Department of Public Health provided birth certificate data, while meteorologic data came from the California Irrigation Management Information System, US Environmental Protection Agency, and National Centers for Environmental Information. After considering several temperature metrics, we observed the best model fit for term LBW over the full gestation (13.0% change, 95% confidence interval: 4.1, 22.7 per 10 degrees Fahrenheit (°F) increase in apparent temperature) above 55°F and the greatest association for third trimester exposure above 60°F (15.8%, 95% confidence interval: 5.0, 27.6). Apparent temperature during the first month of pregnancy exhibited no significant risk, while the first trimester had a significantly negative association, and second trimester, last month and last two weeks had slightly increased risks. Mothers who were Black, older, delivered male infants, or gave birth during the warm season conferred the highest risks. This study provides further evidence for adverse birth outcomes from heat exposure for vulnerable subgroups of pregnant women.

Exploring the Influence of Efficacy Beliefs and Homework Help in Predicting Reading Achievement among Underserved Children in an Afterschool Program

ERIC Educational Resources Information Center

Lee, Diane Sookyoung; Dang, Tina G.; Ulibas-Pascual, Jennifer; Gordon Biddle, Kimberly A.; Heller de Leon, Brian; Elliott, Deborah; Gorter, Josiah

2017-01-01

The purpose of this study was to determine the effectiveness of a local afterschool program in helping underserved elementary school students improve their reading achievement. The study followed a cohort of students with 28 participants who were low-income, ethnic minority children in the 1st-6th grades between the ages of 6 and 12. Data on…

Report on a seminar on financing and service delivery issues in caring for the medically underserved.

PubMed Central

Tavani, C

1991-01-01

Current national activities directed toward improving access to health care and assessing the potential effectiveness of various financing and service delivery strategies were reviewed by an invited group of 39 public and private sector health policy experts. Health care access problems of the medically underserved population were defined and a range of strategies for addressing them were presented. The seminar was held at Columbia, MD, July 6-7, 1988, sponsored jointly by the Robert Wood Johnson Foundation and the Health Resources and Services Administration, PHS. PMID:1899935

How to Start Your Own Business. Women Entrepreneurs Project. Instructional Materials.

ERIC Educational Resources Information Center

McCaslin, Barbara S.; McNamara, Patricia P.

This text consisting of eight learning activities packages (LAP's) was developed during the California Women Entrepreneurs Project for use in a course designed to help women entrepreneurs learn how to start their own small business. The LAP's included here are self-paced, student-centered modules which take the learner step by step through the…

How to Start Your Own Business. [Women Entrepreneurs Project.] Instructor's Guide.

ERIC Educational Resources Information Center

McNamara, Patricia P.

This guide was developed to help instructors teach the course for women entrepreneurs as presented in the text, "How to Start Your Own Business." (This small business management course, a product of the California Women Entrepreneurs Project, and the final project report are contained in two related documents--CE 017 320 and 322.) The…

The Perceived Benefits of Paid Employment to Women in Working Class Jobs.

ERIC Educational Resources Information Center

Walshok, Mary Lindenstein

A two-year longitudinal study of 200 working women in California urban areas represents an effort to understand the processes by which specific interests and commitments to paid employment develop. Data from intensive personal interviews with women in traditional and nontraditional occupations should indicate factors which facilitate the entry of…

Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population.

PubMed

Raich, Peter C; Whitley, Elizabeth M; Thorland, William; Valverde, Patricia; Fairclough, Diane

2012-10-01

Barriers to timely resolution of abnormal cancer screening tests add to cancer health disparities among low-income, uninsured, and minority populations. We conducted a randomized trial to evaluate the impact of lay patient navigators on time to resolution and completion of follow-up testing among patients with abnormal screening tests in a medically underserved patient population. Denver Health, the safety-net health care system serving Denver, is one of 10 performance sites participating in the Patient Navigation Research Program. Of 993 eligible subjects with abnormal screening tests randomized to navigation and no-navigation (control) arms and analyzed, 628 had abnormal breast screens (66 abnormal clinical breast examinations, 304 BIRADS 0, 200 BIRADS 3, 58 BIRADS 4 or 5) whereas 235 had abnormal colorectal and 130 had abnormal prostate screens. Time to resolution was significantly shorter in the navigated group (stratified log rank test, P < 0.001). Patient navigation improved diagnostic resolution for patients presenting with mammographic BIRADS 3 (P = 0.0003) and BIRADS 0 (P = 0.09), but not BIRADS 4/5 or abnormal breast examinations. Navigation shortened the time for both colorectal (P = 0.0017) and prostate screening resolution (P = 0.06). Participant demographics included 72% minority, 49% with annual household income less than $10,000, and 36% uninsured. Patient navigation positively impacts time to resolution of abnormal screening tests for breast, colorectal, and prostate cancers in a medically underserved population. By shortening the time to and increasing the proportion of patients with diagnostic resolution patient navigation could reduce disparities in stage at diagnosis and improve cancer outcomes. 2012 AACR

Complementary and Alternative Medicine Use in Minority and Medically Underserved Oncology Patients: Assessment and Implications.

PubMed

Jones, Desiree; Cohen, Lorenzo; Rieber, Alyssa G; Urbauer, Diana; Fellman, Bryan; Fisch, Michael J; Nazario, Arlene

2018-06-01

Complementary and alternative medicine (CAM) use in minority and medically underserved oncology patients is not well documented. We assessed knowledge and utilization of CAM in a sample of these patients receiving treatment at an urban community hospital. Patients with cancer were interviewed using an electronic application that depicted specific CAM therapies. Patients were questioned on their knowledge and utilization of therapies, deterrents to use, and interest in using these therapies if they were made available. Patients (n = 165) reported a high awareness and use of CAM therapies. CAM use was highest for prayer (85%), relaxation (54%), special diet (29%), meditation (19%), and massage (18%). Patients' interest in using CAM was high for nearly all therapies. Lack of adequate knowledge and cost of use were reported as deterrents to use. Female patients reported higher use of aromatherapy relative to males (37.1% vs 19.4%, P = .02); those with higher education reported greater use of relaxation (60.8% vs 28.6%, P = .02); non-Hispanics reported higher use of relaxation relative to Hispanics (63.5% vs 44.2%, P = .03), and African American patients reported higher use of relaxation relative to White patients (69.2% vs 50%, P = .03). CAM use in minority and medically underserved cancer patients is common, but not professionally guided; thus, concerns remain regarding its safe use. Our data underscore the importance of patient-physician dialogue regarding CAM use in this patient population, and interest in access to the medically guided integration of evidence-based CAM therapies.

Teledermatology in Tijuana, Mexico.

PubMed

Brown, Megan

2016-12-01

The Health Frontiers in Tijuana (HFiT) clinic is a binational partnership between the University of California, San Diego School of Medicine (San Diego, California); the Universidad Autónoma de Baja California School of Medicine (Tijuana, Mexico); and Desayunador Salesiano Padre Chava, a community grassroots organization in Tijuana, Mexico. Health Frontiers in Tijuana provides accessible quality health care for the underserved in Tijuana's Zona Norte. This article is a narrative meant to share my clinical experience as a dermatology resident who worked with HFiT to establish teledermatology services at this clinic.

Changing practice: implications of the World Report on Disability for responding to communication disability in under-served populations.

PubMed

Wylie, Karen; McAllister, Lindy; Davidson, Bronwyn; Marshall, Julie

2013-02-01

The World Report on Disability provides a major challenge to the conceptualization and delivery of services for people with communication disabilities around the world. Many people, in both Majority and Minority World countries, receive limited or no support in relation to their communication disability. In this paper the prevalence of communication disability across the world (and the challenges to obtaining these data) are discussed, particularly in relation to disability more broadly. Populations that are under-served by speech-language pathology services in both Majority and Minority World countries are described. The paper describes organizational change theory and the potential it has, together with a biopsychosocial model of disability, to assist in understanding and influencing development of relevant services for people with communication disabilities (PWCD), particularly those who are under-served. Aspects of, and influences on, service delivery for PWCD are described. The need for novel ways of conceptualizing development of services, including population-based approaches, is highlighted. Finally, the challenges and opportunities for PWCD and for speech-language pathologists which arise from the nine recommendations of the World Report on Disability are considered and readers are encouraged to consider new and novel ways of developing equitable services for people with communication disabilities, in both majority and minority world settings.

Assessing predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan: results of a cross-sectional baseline survey.

PubMed

Azmat, Syed Khurram; Ali, Moazzam; Ishaque, Muhammad; Mustafa, Ghulam; Hameed, Waqas; Khan, Omar Farooq; Abbas, Ghazunfer; Temmerman, Marleen; Munroe, Erik

2015-03-28

Although Pakistan was one of the first countries in Asia to launch national family planning programs, current modern contraceptive use stands at only 26% with a method mix skewed toward short-acting and permanent methods. As part of a multiyear operational research study, a baseline survey was conducted to understand the predictors of contraceptive use and demand for family planning services in underserved areas of Punjab province in Pakistan. This paper presents the baseline survey results; the outcomes of the intervention will be presented in a separate paper after the study has been completed. A cross-sectional baseline household survey was conducted with randomly selected 3,998 married women of reproductive age (MWRA) in the Chakwal, Mianwali, and Bhakkar districts of Punjab. The data were analyzed on SPSS 17.0 using simple descriptive and logistic regression. Most of the women had low socio-economic status and were younger than 30 years of age. Four-fifths of the women consulted private sector health facilities for reproductive health services; proximity, availability of services, and good reputation of the provider were the main predicators for choosing the facilities. Husbands were reported as the key decision maker regarding health-seeking and family planning uptake. Overall, the current contraceptive use ranged from 17% to 21% across the districts: condoms and female sterilization were widely used methods. Woman's age, husband's education, wealth quintiles, spousal communication, location of last delivery, and favorable attitude toward contraception have an association with current contraceptive use. Unmet need for contraception was 40.6%, 36.6%, and 31.9% in Chakwal, Mianwali, and Bhakkar, respectively. Notably, more than one fifth of the women across the districts expressed willingness to use quality, affordable long-term family planning services in the future. The baseline results highlight the need for quality, affordable long-term family planning

Disaggregating data on Asian American and Pacific Islander women to provide new insights on potential exposures to hazardous air pollutants in California.

PubMed

Quach, Thu; Liu, Ruiling; Nelson, David O; Hurley, Susan; Von Behren, Julie; Hertz, Andrew; Reynolds, Peggy

2014-11-01

The Asian American and Pacific Islander (AAPI) population is heterogeneous and rapidly growing in the United States, with a high proportion concentrated in California. Although traditionally assumed to have lower rates of breast cancer than non-Hispanic white women, recent studies have suggested considerable variation in incidence by AAPI ethnic group, with rates in some exceeding those in non-Hispanic whites. The potential role of environmental toxicants has not been well explored and may provide insights into these patterns. We created an exposure potential index (EPI) score for 24 hazardous air pollutants modeled by the U.S. Environmental Protection Agency National-Scale Air Toxics Assessment considered to be mammary gland carcinogens, and compared values at the census tract level for "geographically concentrated" AAPI groups throughout the State. "Geographically concentrated" populations were defined as census tracts with at least 100 individuals from a specified racial/ethnic population as enumerated by the 2000 Census. Although EPI scores differed little between census tracts with aggregated AAPI (mean EPI = 0.53) and non-Hispanic white women (mean EPI = 0.63), there was substantial variation between tracts for disaggregated AAPI groups, with notably higher EPI scores for tracts enumerated for Korean or Japanese women (mean EPI of 0.78 and 0.77, respectively) compared with other AAPI groups. Our findings underscore the importance of disaggregating data for the heterogeneous AAPI population to identify differences in potential environmental exposures across groups. Future cancer etiology studies should examine environmental exposure differences within and across groups for the diverse AAPI population. ©2014 American Association for Cancer Research.

Gender, race + geography = jeopardy: marginalized women, human rights and HIV in the United States.

PubMed

Fried, Susana T; Kelly, Brook

2011-11-01

Across the United States, laws, policies, and practices put women living with HIV in jeopardy. In particular, the dignity, health, and well-being of women living with and at risk for HIV as well as the health and well-being of their families and communities is hampered by punitive laws and policies. Laws and policies that do not meet, or worse, criminalize women's sexual and reproductive rights result in the economic, social and political deprivation of marginalized women and girls-and especially those living with and at risk of HIV. These laws and policies exacerbate an already outsized HIV epidemic in underserved communities, and communities of color in the United States. This article draws from and builds on a human rights workshop that took place as part of the forum "Bringing Gender Home: Implementing Gender Responsive HIV/AIDS Programming for US Women and Girls," sponsored by the Office of Women's Health. It focuses on the damaging impact of laws, policies, and practices that criminalize women's sexuality. These laws significantly impact the well-being of women living with and at risk for HIV, and have an impact on the capacity of poor women of color in the United States to fully exercise their rights. When laws that purport to protect public health have the result of limiting women's reproductive choices, or have a disproportionate impact on marginalized groups such as sex workers, fundamental breaches of women's rights occur. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

California Burn Scars

Atmospheric Science Data Center

2014-05-15

article title:  Burn Scars Across Southern California     ... California between October 21 and November 18, 2003. Burn scars and vegetation changes wrought by the fires are illustrated in these ... and Nov 18, 2003 Images:  California Burn Scars location:  United States region:  ...

Psychosocial Intervention for Rural Women with Breast Cancer

PubMed Central

Angell, Karyn L; Kreshka, Mary Anne; McCoy, Rebecca; Donnelly, Patricia; Turner-Cobb, Julie M; Graddy, Kathy; Kraemer, Helena C; Koopman, Cheryl

2003-01-01

OBJECTIVE This study was initiated by breast cancer survivors living in a rural community in California. They formed a partnership with academic researchers to develop and evaluate a low-cost, community-based Workbook-Journal (WBJ) for improving psychosocial functioning in geographically and economically isolated women with primary breast cancer. DESIGN A randomized controlled trial was used to compare the WBJ intervention plus educational materials to educational materials alone (usual care). SETTING One rural cancer center and several private medical, surgical, and radiation oncology practices in 7 rural counties in the Sierra Nevada Foothills of California. PARTICIPANTS One hundred women with primary breast cancer who were either within 3 months of diagnosis or within 3 months of completing treatment. INTERVENTION A community-initiated, theoretically-based Workbook-Journal, designed by rural breast cancer survivors and providers as a support group alternative. It included compelling personal stories, local rural resources, coping strategies, and messages of hope. RESULTS Community recruiters enrolled 83% of the women referred to the study. Retention at 3-month follow-up was 98%. There were no main effects for the WBJ. However, 3 significant interactions suggested that women who were treated in rural practices reported decreased fighting spirit and increased emotional venting and posttraumatic stress disorder symptoms if they did not receive the WBJ. Among women who receive the WBJ, 74% felt emotionally supported. CONCLUSIONS This community-based Workbook-Journal may be an effective psychosocial intervention for rural, isolated, and low-income women with breast cancer. Community involvement was essential to the success of this project. PMID:12848832

Healthcare provider perceptions of the role of interprofessional care in access to and outcomes of primary care in an underserved area.

PubMed

Wan, Shaowei; Teichman, Peter G; Latif, David; Boyd, Jennifer; Gupta, Rahul

2018-03-01

To meet the needs of an aging population who often have multiple chronic conditions, interprofessional care is increasingly adopted by patient-centred medical homes and Accountable Care Organisations to improve patient care coordination and decrease costs in the United States, especially in underserved areas with primary care workforce shortages. In this cross-sectional survey across multiple clinical settings in an underserved area, healthcare providers perceived overall outcomes associated with interprofessional care teams as positive. This included healthcare providers' beliefs that interprofessional care teams improved patient outcomes, increased clinic efficiency, and enhanced care coordination and patient follow-up. Teams with primary care physician available each day were perceived as better able to coordinate care and follow up with patients (p = .031), while teams that included clinical pharmacists were perceived as preventing medication-associated problems (p < .0001). Healthcare providers perceived the interprofessional care model as a useful strategy to improve various outcomes across different clinical settings in the context of a shortage of primary care physicians.

Pediatric dentistry for the general practitioner: satisfying the need for additional education and training opportunities.

PubMed

Stewart, Ray E; Sanger, Roger G

2014-11-01

The Pediatric Oral Health Access Program is a joint project of the California Dental Association and the California Society of Pediatric Dentistry. The results have been remarkable in terms of the number of underserved children who have received oral health services. What is less certain is the number of general dentists who, as a result of the training, have been able and willing to provide comprehensive care to more and younger children.

California Federal Savings and Loan Association v. Guerra, 13 January 1987.

PubMed

1987-01-01

The plaintiff employer and other similar employers challenged the constitutionality of a California law that required employers to provide female employees with up to four months unpaid pregnancy leave with reinstatement in the same or a substantially similar job. They claimed that the law was preempted by Title VII of the Civil Rights Act of 1964 because the 1964 Act, as amended by the Pregnancy Discrimination Act of 1978, required absolute neutrality in the treatment of pregnant employees with respect to other employees. Their position was that the California law discriminated in favor of pregnant employees. The Court rejected their claim. It held that the Pregnancy Discrimination Act was "a floor beneath which pregnancy disability benefits may not drop--not a ceiling above which they may not rise," and that the California law shared a common goal with the federal law of providing women with full rights in the workforce without denying them the right to full participation in family life. It ruled that there was nothing in the law that prevented employers from complying with the law and Title VII. full text

Efficient Identification of Low-Income Asian American Women at High Risk for Hepatitis B

PubMed Central

Joseph, Galen; Nguyen, Kim; Nguyen, Tung; Stewart, Susan; Davis, Sharon; Kevany, Sebastian; Marquez, Titas; Pasick, Rena

2015-01-01

Hepatitis B disproportionately affects Asian Americans. Because outreach to promote testing and vaccination can be intensive and costly, we assessed the feasibility of an efficient strategy to identify Asian Americans at risk. Prior research with California’s statewide toll-free phone service where low-income women call for free cancer screening found 50% of English- and Spanish-speaking callers were willing to participate in a study on health topics other than cancer screening. The current study ascertained whether Asian Americans could be recruited. Among 200 eligible callers, 50% agreed to take part (95% confidence interval 43%–57%), a rate comparable to our previous study. Subsequent qualitative interviews revealed that receptivity to recruitment was due to trust in the phone service and women’s need for health services and information. This was a relatively low-intensity intervention in that, on average, only five minutes additional call time was required to identify women at risk and provide a brief educational message. Underserved women from diverse backgrounds may be reached in large numbers through existing communication channels. PMID:24185165

The Reality of Sustaining Community-Based Sport and Physical Activity Programs to Enhance the Development of Underserved Youth: Challenges and Potential Strategies

ERIC Educational Resources Information Center