Am Jrl of Public Health Highlights -- November 2008

Newswise — The articles below will be published online September 17, 2008, at 4 p.m. (ET) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shmtl, and they are currently scheduled to appear in the November 2008 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

Existing disparities in health care access persist along the U.S.-Mexican border

Researchers set out to examine the inequities in health care use among U.S.-Mexico border residents, with an effort to determine factors that may influence health care use in Mexico. They found that uninsurance increased between 2001 and 2005 by 7 percent for all previously insured participants younger than 65 years out of their population-based study of 1,048 Latino residents of selected Texas border counties. This insurance coverage decline reflects almost exclusively the loss of private insurance. Researchers suggest that these results indicate that health insurance coverage was an important predictor of seeking and receiving medical care in Mexico. High health care costs in the United States adversely affected health care insurance coverage in the border region. Therefore, the private health care system in Mexico has become a viable alternative for border residents.

The study's authors conclude, "Results from this study indicate that existing disparities in health care access will continue to undermine the health status of the region's population unless major health care policy reforms are initiated to promote greater accessibility to U.S. health care."

[From: "Persistent Disparities in the Use of Health Care Along the U.S.-Mexico Border: An Ecological Perspective" ].

U.S. Spanish-speaking population faces greater challenges in health care access

To assess the extent of language-associated disparities, researchers examined the self-reported health status, behaviors, access to care and use of preventive services of the U.S. Hispanic adult population. They did this by using 2003 to 2005 data from the Behavioral Risk Factor Surveillance System from 45,076 Hispanic adults in 23 states, representing as many as 90 percent of the U.S. Hispanic population, and compared 25 health indicators between Spanish-speaking Hispanics and English-speaking Hispanics. Results showed that Spanish-speaking Hispanics had significantly lower rates of chronic disease, obesity and smoking, and reported less physical activity and use of preventive services.

"The U.S. Spanish-speaking population represents a particularly vulnerable subset of U.S. Hispanics who have far lower income and educational attainment, poor perceived health status, and far worse access to the health care system." Therefore, the study's authors recommend, "Priority areas for improving the health status of Spanish speakers in the United States include maintenance of healthy behaviors related to tobacco and alcohol use, promotion of physical activity and healthy weight, improvement in immunization and cancer screening rates, and increasing access to affordable, timely and linguistically appropriate care."

[From: "Differences in Health Status, Access to Care, and Receipt of Preventive Services Among U.S. Hispanics, by Language Spoken." ].

Immigrant children increasingly uninsured

The "public charge" rule of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 initially required families to repay the U.S. government for public health benefits, including Medicaid, previously received at no cost. However, in 1999, the government specified that Medicaid benefits would be exempted from the public charge rule. The researchers' goal was to determine whether the reversal of the public charge rule led to immigrant children becoming increasingly reliant on public health insurance programs. They found that low-income U.S.-born children were just as likely as foreign-born children to have public insurance coverage and that, after 2000, foreign-born children were 1.59 times more likely than were U.S.-born children to be uninsured versus publicly insured.

"In the various discussions of proposals for universal child health coverage, policies designed to promote the healthy growth of this highly underserved population merit serious consideration, given their potential to ensure the future socioeconomic well-being of an increasingly diverse American population," the study's authors stated.

[From: "Immigrant Children's Reliance on Public Health Insurance in the Wake of Immigration Reform." ].

Neighborhood environment plays a role in weight status

This study examines the influence of neighborhood environment on the weight status of adults 55 years and older in the United States. Researchers based their study on the Health and Retirement Study (HRS), a nationally representative survey of persons 50 years and older, drawing primarily on 2002 data. After controlling for individual- and family-level confounders, the results showed that living in a neighborhood with a high level of economic advantage was associated with a lower likelihood of being obese for both men and women. Men living in areas with a high concentration of immigrants and women living in areas of high residential stability were more likely to be obese. Finally, women living in areas of high street connectivity were less likely to be overweight or obese. Of the total sample, 76 percent of men and 67 percent of women were either obese or overweight.

"Our study suggests that areas with few households of high socioeconomic status, high immigrant concentration, low street connectivity, and high residential stability and older adults living in these areas should be targeted for interventions," the study's authors said.

[From: "Neighborhoods and Obesity in Later Life." ].

The American Journal of Public Health is the monthly Journal of the American Public Health Association (APHA), the oldest and most diverse organization of public health professionals in the world. APHA is a leading publisher of books and periodicals promoting sound scientific standards, action programs and public policy to enhance health. More information is available at http://www.apha.org.

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