Search

A growing body of evidence has documented the effects of discrimination among Latinos. However, little is known about the impacts a noxious sociopolitical climate can have on their health and health care outcomes. The present study explored the associations between perceived anti-immigrant climate, health care discrimination, and satisfaction with care among US Latino adults. We used data from the 2015 Latino National Health and Immigration Survey (n = 1,284), a nationally representative sample of US Latino adults (ages 18 and older). Key predictors included living in a state whose policies are unfavorable towards immigrants, perceived anti-immigrant climate and/or anti-Hispanic climate, and health care discrimination. Ordered logistic regression models evaluated the associations between these predictors (adjusting for other relevant covariates) and satisfaction with care. Latinos living in state that is unfavorable towards immigrants were less likely to be satisfied with medical care they receive. Also, we found that Latinos living in anti-immigrant and anti-Hispanic climates were less likely to be satisfied with care. In both cases, experiencing health care discrimination significantly reduced the odds of satisfaction with care. Latinos’ perception of an anti-immigrant & anti-Hispanic climate and state policies can have detrimental effects on their health and health care outcomes. These results highlight the importance of addressing both community-wide and interpersonal discrimination specific to health care settings, which can have concurrent impacts on the health and well-being of Latino and other minoritized populations.

Much of the research regarding Latino men’s health tends to focus on specific health outcomes (e.g., HIV or diabetes). Few studies have examined how Latino men perceive factors that influence their health and/or health-related behaviors. This study explored rural Latino men’s experiences and attitudes toward health, using photovoice, in the context of a community-based participatory research partnership. We recruited nine Latino men living in a small town in Southeastern Iowa. Four to nine men attended four sessions and led a community forum. All the men were foreign-born, identified as Latino, aged between 34 and 67 years, and had lived in the United States for at least 7 years. Five themes were identified: (a) cultural conflict, (b) too much and discordant information, (c) lifestyles conflict, (d) sacrifice, and (e) family connectedness. An important implication of this study derives from familial and community connections and sacrifice. Feeling disconnected from family may impact physical and mental health and health-promoting behaviors. Future research should explore ways to inform community- and family-level interventions to connect rural Latino men more strongly to their family and local community and help them to take better control of their health.

Studies have shown that student engagement in undergraduate research experiences leads to considerable gains in a wide range of skills important for success in postsecondary education and career de...

The COVID‐19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC‐directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high‐quality HNC care.

Medical mistrust among racial/ethnic minorities has been associated with decreases in health care utilization, whereas religiosity has been separately linked with increases in this behavior. However, very few studies have examined the relationship between religiosity and medical mistrust among Latinos, a group with strong religious connections and potentially high mistrust. In-person, self-administered surveys were collected among 767 adult Latinos attending three Latino churches (one Catholic and two Pentecostal) in Long Beach, CA. Measures included a previously validated 12-item medical mistrust scale, religiosity (religious denomination, length and frequency of attendance, and number of groups or ministries involved in), health care access, and sociodemographic factors. Medical mistrust score was 2.47 (standard deviation [SD] = 0.77; range 1–5). Almost two-thirds of participants (62%) attended religious services frequently (once a week or more), and the majority attended a Catholic church (80%). About half of the participants had attended their church for ≥5 years (50%) and participated in one to two church groups or ministries (53%). Multivariable analyses show that Pentecostal church congregation and those identifying as Mexican/Chicano were negatively associated with medical mistrust. On the contrary, participating in church groups or ministries and having an immigrant parent were positively associated with medical mistrust. Our findings suggest that church-based health initiatives should consider church denomination, length of attendance, participation in groups or ministries, and ethnic differences to address medical mistrust issues among Latino congregants.

Although previous studies have examined the impact of medical mistrust on the health and health care seeking behaviors of diverse populations, including Latinos, limited research has explored cultural and structural factors that contribute to medical mistrust. The aim of the present study was to examine the associations between cultural and structural factors and perceived medical mistrust among a sample of young adult Latinos living in rural Oregon. We conducted in-person interviews with 499 young adult Latinos (ages 18-25). Medical mistrust was assessed using a modified version of the Group-Based Medical Mistrust Scale, which has been used with Latino populations. We included three cultural (acculturation, machismo, and familismo) and one structural (perceived everyday discrimination) variables, all measured using previously validated scales. Socio-demographic variables (eg, age, gender, income, educational level, employment) were also included in multivariable linear regression models. We found that everyday discrimination and traditional machismo values were associated with medical mistrust, the latter primarily among Latino women. It is possible that Latinos living in relatively new minority/immigrant settlement areas (such as rural Oregon) may be more vulnerable to experiencing discrimination, which in turn, may erode trust in health care providers. On the other hand, a strong ethnic identity, including the endorsement of machismo values, may serve as a protective mechanism for Latinos confronted by racial/ethnic discrimination. Culturally responsive, socio-cultural, and societal interventions are warranted to tackle the pervasive and ripple effects that racial/ethnic discrimination has on the health of Latinos and other minority populations.

A growing body of research has found that healthcare discrimination is a significant barrier in accessing healthcare among Latino patients. Despite evidence of the effects of perceived discrimination among Latinos, psychometric testing of scales used in previous research is limited. The present study explored the psychometric properties of a healthcare discrimination scale (HDS) among young-adult Latinos. We used data from a cross-sectional study of young-adult Latinos, primarily of Mexican heritage, living in rural Oregon. Bilingual, bicultural staff members conducted computer-assisted personal interviews matched by gender with 313 individuals who completed the interview in Spanish (n = 137) or English (n = 176). The interview guide included questions for the HDS and the experiences of discrimination (EOD) and acculturation scales, and satisfaction with healthcare services. Psychometric testing included exploratory factor analysis, internal consistency, split-half reliability, and convergent, discriminant, and predictive validity. The HDS scale had high internal consistency (Cronbach’s α = 0.92), was strongly correlated with the EOD scale (r = 0.70, p

OBJECTIVE Neuropsychological instruments are often developed in English and translated to other languages to facilitate the clinical evaluation of diverse populations or to utilize in research environments. However, the psychometric equivalence of these assessments across language must be demonstrated before populations can validly be compared. METHOD To test this equivalence, we applied measurement invariance procedures to a subsample (N = 1,708) of the Hispanic Community Health Survey/Study of Latinos (HCHS/SOL) across English and Spanish versions of a neurocognitive battery. Using cardinality matching, 854 English-speaking and 854 Spanish-speaking subsamples were matched on age, education, sex, immigration status (U.S. born, including territories, or foreign-born), and Hispanic/Latino heritage background. Neurocognitive measures included the Six-Item Screener (SIS), Brief-Spanish English Verbal Learning Test (B-SEVLT), Word Fluency (WF), and Digit Symbol Substitution (DSS). Confirmatory factor analysis was utilized to test item-level invariance of the SIS, B-SEVLT, and WF, as well as factor-level invariance of a higher-order neurocognitive functioning latent variable. RESULTS One item of both the SIS and WF were more difficult in Spanish than English, as was the DSS test. After accounting for partial invariance, Spanish-speakers performed worse on each of the subtests and the second-order neurocognitive functioning latent variable. CONCLUSIONS We found some evidence of bias at both item and factor levels, contributing to the poorer neurocognitive performance of Spanish test-takers. While these results explain the underperformance of Spanish-speakers to some extent, more work is needed to determine whether such bias is reflective of true cognitive differences or additional variables unaccounted for in this study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

This study analyzes the conditions and possibilities of sustainability of the Salud al Paso program of the Metropolitan Health Secretariat of the Municipality of Quito, Ecuador, as an example for similar initiatives, in the context of the changes made by the new administration in May 2019. The analysis of the implementation of this initiative, focused on the prevention of noncommunicable diseases (NCDs), was based on the program's user database, the information gathered on the perspectives of operational staff, knowledge of the program, and the opinion of local leaders and opinion leaders of the Quito Metropolitan District, as well as official information. Based on this data, the study identified factors that could have facilitated or hindered its sustainability and documented the rationale to suspend the on-demand activities included in the program and limit activities to the care of populations under municipal responsibility (day-care centers, schools and colleges, markets, elder care programs, and employees) and patients with identified cardiometabolic risk. The insufficient institutionalization of the program, conceived as a project with an insufficient vision of its sustainability in time, was mentioned as a possible obstacle by leaders and operational staff. The growing prevalence of NCDs requires initiatives for their prevention, which must be institutionalized to ensure their continuity and overcome eventual changes of government. In addition, future interventions similar to Salud al Paso should establish better sectoral coordination articulation, especially with the Ministry of Public Health and other service networks.El presente estudio analiza las condiciones y posibilidades de permanencia del programa Salud al Paso de la Secretaría Metropolitana de Salud del Municipio de Quito, Ecuador, como ejemplo para iniciativas similares, en el contexto de los cambios efectuados por la nueva administración en mayo del 2019. El análisis de esta implementación enfocada en la prevención de enfermedades no transmisibles se centró en la base de datos de usuarios del programa, la información recabada desde las perspectivas del personal operativo, el conocimiento del programa y el posicionamiento de líderes locales y de opinión del Distrito Metropolitano de Quito, así como información oficial. Con base en estos datos, el estudio identificó factores que podrían haber facilitado u obstaculizado su permanencia y documentó la fundamentación de las nuevas autoridades para suspender las actividades de libre demanda propias del programa y limitar la atención a las poblaciones bajo responsabilidad municipal (guarderías, escuelas y colegios, mercados, programas de atención a la tercera edad y empleados) y de pacientes con riesgo cardiometabólico identificado. La institucionalización insuficiente del programa, concebido más como proyecto y con una también insuficiente visión de permanencia en el tiempo, fue mencionada como un posible obstáculo por líderes y personal operativo. La prevalencia creciente de enfermedades no transmisibles demanda iniciativas para su prevención, que deben institucionalizarse para asegurar su continuidad y superar eventuales cambios de gobierno. Además, intervenciones futuras semejantes a Salud al Paso deberán establecer una mejor articulación sectorial, en especial con el Ministerio de Salud Pública y otras redes de servicios.

To examine the relationship between wealth and cardiovascular disease risk factors among Hispanic/Latinos of diverse backgrounds.This cross-sectional study used data from 4971 Hispanic/Latinos, 18-74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) baseline exam and the HCHS/SOL Sociocultural Ancillary Study. Three objectively measured cardiovascular disease risk factors (hypertension, hypercholesterolemia, and obesity) were included. Wealth was measured using an adapted version of the Home Affluence Scale, which included questions regarding the ownership of a home, cars, computers, and recent vacations.After adjusting for traditional socioeconomic indicators (income, employment, education), and other covariates, we found that wealth was not associated with hypertension, hypercholesterolemia or obesity. Analyses by sex showed that middle-wealth women were less likely to have hypercholesterolemia or obesity. Analyses by Hispanic/Latino background groups showed that while wealthier Central Americans were less likely to have obesity, wealthier Puerto Ricans were more likely to have obesity.This is the first study to explore the relationship between wealth and health among Hispanic/Latinos of diverse backgrounds, finding only partial evidence of this association. Future studies should utilize more robust measures of wealth, and address mechanisms by which wealth may impact health status among Hispanic/Latinos of diverse backgrounds in longitudinal designs.

Students were asked to (1) pre-record a three-minute lightning talk by capturing a voice narrative over a PowerPoint slide deck and (2) upload their talks, along with a written narrative, into a pre-made discussion board Because the Canvas site was open to the OSU community for two days, participants could watch the presentations, pose questions, and provide comments Many attendees noted benefits of hosting the symposium in a virtual environment, including an enhanced ability to devote personalized attention to presenters (e g , by providing links to relevant publications or websites), fewer distractions, more time to craft thoughtful responses, and an ability for students to keep track of shared resources and discussants' contact information that could be used for follow-up after the event [ ]the university's virtual, Canvas-based spring undergraduate research symposium was successful in bringing student researchers and participants onto a relatively dynamic platform, despite the many disruptions of the COVID-19 crisis on university programming

Purpose Cardiovascular diseases (CVDs) are a leading cause of death among Latinos in the United States. The present study examines the prevalence of four CVD risk factors (diabetes, hypertension, hypercholesterolemia, and obesity) in a large sample of Latino farmworkers in Oregon. Methods We pooled secondary, cross-sectional data from Latino vineyard and winery farmworkers (n = 3382), in the north Willamette valley, Oregon, between 2004 and 2012. Prevalence was estimated for the four CVD risk factors under study. Multivariable logistic regression analyses were conducted to examine the association between CVD risk factors, sex, and other sociodemographic factors. Results Hypercholesterolemia (21.6%) and obesity (22.8%) were the most prevalent CVD risk factors among Latino farmworker participants. In multivariable analyses, men and women, aged 45–64 years, were more likely to have all four CVD risk factors than those aged 18–44. Living in the United States for ten years or more was associated with higher odds of hypertension (OR = 1.72, 95% CI: 1.17–2.54), and obesity (OR = 2.08, 95% CI: 1.57–2.76) among Latino farmworker men. Among Latino farmworker women, living in the United States for ten years or more increased the odds of obesity (OR = 1.81, 95% CI: 1.07–3.06). Conclusions Our findings highlight the higher prevalence of CVD risk factors among Latino farmworkers and the need to address CVD risk factors in this population.

Health care discrimination is increasingly considered a significant barrier to accessing health services among minority populations, including Latinos. However, little is known about the role of immigration status. The purpose of this study was to examine the association between immigration status and perceived health care discrimination among Latinos living in rural areas. Interviews were conducted among 349 young-adult Latinos (ages 18 to 25) living in rural Oregon, as part of Proyecto de Salud para Latinos. Over a third of participants experienced health care discrimination (39.5 %). Discrimination was higher among foreign-born (44.9 %) rather than US-born Latinos (31.9 %). Multivariate results showed that foreign-born Latinos were significantly more likely to experience health care discrimination, even after controlling for other relevant factors (OR = 2.10, 95 % CI 1.16-3.82). This study provides evidence that health care discrimination is prevalent among young-adult Latinos living in rural areas, particularly the foreign-born. Effective approaches towards reducing discrimination in health care settings should take into consideration the need to reform our broken immigration system.

Objectivo El proposito del presente estudio es analizar las inequidades socioeconomicas en la utilizacion de servicios de salud en el Ecuador, las inequidades en la distribucion geografica de recursos humanos en salud, y reflexionar sobre los retos de equidad que el sistema de salud ecuatoriano enfrenta en la actualidad. Metodos Se utilizo la Encuesta Demografica y de Salud Materno-Infantil (ENDEMAIN 2004) como la principal fuente de datos, cuya muestra es representativa de la poblacion ecuatoriana. Para estimar los efectos en utilizacion de servicios de salud utilizamos analisis multivariado multinivel (usando el paquete estadistico MLWiN 2.02) y analisis espacial de recursos en salud (usando GeoDa 1.0.1 ). Resultados Nuestro analisis encontro que inequidades sociales, economicas y geograficas limitan el acceso a servicios de salud en el Ecuador. Hogares de bajos recursos, indigenas y aquellos que viven enareas rurales (muchos con las tres caracteristicas a la vez) tienen menos posibilidades de utilizar servicios de salud. A pesar de la marcada concentracion de proveedores de salud en zonas urbanas, encontramos que la presencia de personal de salud (excluyendo a medicos) en entidades publicas rurales incrementa la posibilidad de utilizacion de servicios preventivos y curativos. Conclusiones Los esfuerzos para transformar el sistema de salud deben reducir barreras sociales, culturales, financieras; y las desigualdades en la distribucion de recursos humanos en salud, particularmente en elarea rural. Consideramos que la orientacion comunitaria y familiar de los servicios, y el incremento de espacios de participacion ciudadana son necesarios para reducir dichas inequidades.

Background: Obesity is linked to food insecurity and generational status; however, little is known about how both impact obesity risk among Latino youth. Objective: To investigate the joint effect of generational status and food insecurity on obesity prevalence among Latino youth. Methods: We pooled data from the 2011 to 2017 waves of the National Health Interview Survey to derive a sample Latino youth aged 12 to 17 (N = 7532). Four generational categories were constructed: first generation (foreign-born children); second generation (US-born child; foreign-born parent[s]); 2.5 generation (US-born child; one foreign-born parent and one US-born parent); third generation (US-born child; U.S.-born parent[s]). Food insecurity was defined by monthly instances of food scarcity over the past year. Obesity was measured using age- and sex-specific body mass index percentile cut-offs. Log-binomial multivariable regression models estimated the association between generational status and food insecurity categories on obesity. Results: Obesity percentages among food-insecure households ranged from 12.8% in the first generation, 15.8% in the second, 24.3% in the 2.5, and 19.2% in the third. In fully adjusted models, 2.5 generation food secure youth had the highest prevalence of obesity (aPR: 1.53; 95% CI, 1.09-2.16) when compared with first generation food secure youth, followed by third generation food insecure youth (aPR: 1.49; 95% CI, 1.01-2.20). Conclusions: Food security status is associated with increased obesity prevalence among Latino youth across the generations. Given that obesity is a risk factor for top causes of mortality and morbidity, growing rates among this population is of public health and clinical importance.

Despite their increased vulnerability to disease and injury, farmworkers have limited access to health services. The purpose of this study was to analyze the influence of employment and family conditions on health care utilization among foreign-born farmworker men. Using the Hispanic Farmworker Health model as the theoretical framework, a secondary data analysis was conducted among 397 foreign-born vineyard and winery worker men who attended the ¡Salud! Services mobile health screenings during the summer of 2009. Working full time (odds ratio [OR] = 2.49), being employed directly by the vineyard or winery (OR = 1.96), and having immediate family members (children, spouse) living in Oregon (OR = 2.65) were positively associated with health care utilization. Findings suggest that despite the many barriers farmworker men face, supportive employment and family conditions may increase health care utilization for this population. Implications of these results are discussed in the context of health care reform.

OBJECTIVE: To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects. METHODS: Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status. RESULTS: Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services. CONCLUSIONS: Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.OBJETIVO: Examinar la relación entre la migración, las remesas de dinero y la utilización de los servicios de atención de la salud en el Ecuador y determinar los posibles efectos equilibradores. MÉTODOS: A partir de los datos de la Encuesta Demográfica y de Salud Materna e Infantil (ENDEMAIN) correspondientes al 2004, se efectuó un análisis multifactorial de varios niveles para evaluar la relación de dos factores predictivos de la migración (hogares con un migrante internacional; uso de remesas de dinero de migrantes) con el uso de los servicios de atención preventiva, el número de consultas para el tratamiento de enfermedades, la hospitalización y el uso de medicamentos antiparasitarios. Se incluyeron los factores predisponentes, mediadores y de necesidad percibida pertinentes según el Modelo de Andersen de Comportamientos de Utilización de los Servicios de Atención de la Salud. También se incluyeron términos de interacción para evaluar los posibles efectos equilibradores de la migración y las remesas por grupo étnico, área de residencia y nivel económico. RESULTADOS: Los factores predictivos de la migración se asociaron firmemente con el uso de medicamentos antiparasitarios y, en menor grado, con las consultas para el tratamiento de enfermedades, incluso después de ajustar los datos según diversos factores predisponentes, mediadores y de necesidad percibida. Los modelos de interacción demostraron que la presencia de un migrante internacional en el grupo familiar aumentaba el uso de estos servicios en los ecuatorianos de bajos ingresos (quintiles 1 y 2). No se encontró una relación significativa entre los factores predictivos de la migración y el uso de servicios preventivos. CONCLUSIONES: La migración y las remesas parecen tener un efecto equilibrador sobre el acceso a los medicamentos antiparasitarios y, en menor medida, sobre los servicios de atención de la salud relacionados con el tratamiento. Las actividades de reforma sanitaria deben tener en cuenta el alcance de este efecto en la elaboración de políticas públicas.

Although agricultural work is considered one of the most dangerous and physically demanding jobs, the majority of farmworkers remain vulnerable to disease and injury, while use of health services is limited. The present study analyzes the use of health care services among vineyard and winery workers in the North Willamette Valley, Oregon. Data from 513 foreign-born workers collected during the summer of 2009 by ¡Salud! Services, was used to test the influence of relevant predisposing and enabling factors of the Behavioral Model of Health Care Utilization among Vulnerable Populations. The majority of participants were males (87%) with an average age of 33 years. Over half of the workers were either married or living with a partner (54%) and had children living with them (58%). Very few spoke English (5%) and only a third had more than 6 years of formal education. Two-thirds of workers (65%) had a full time job and shared housing (67%). Only one of every five workers (19%) had health insurance. Multivariate analyses show that use of health services in the past 2 years is more likely among females, those who have children, have more than 6 years of education, work full time, are insured, and are currently attending school. This study provides further insight for health care provision initiatives to reduce the many barriers faced by farmworkers and their families.

The significant growth of the Latino population in the midst of an economic recession has invigorated anti-Latino, anti-immigrant sentiments in many US states. One common misconception is that Latino immigrants are a burden to safety net services. This may be particularly true in nontraditional immigrant states that have not historically served Latino immigrants. Oregon data suggest that despite a higher prevalence of poverty, use of safety net services among Latino immigrants in Oregon is lower than that among non-Latino Whites. Immigration status, costs, lack of insurance coverage, and discrimination are among the reasons for this group’s limited use of services. Nevertheless, policies designed to strengthen community and institutional support for Latino immigrant families should be considered in the context of current health care and immigration reform efforts.

Background: Studies show that wealth factors are associated with health status. Limited research has examined this association among Hispanic/Latinos of diverse backgrounds. The purpose of this study was to examine the associations between wealth factors, and subjective and objective health status. Methods: This cross-sectional study used data from 4,716 Hispanic/Latinos, 18 to 74 years, who participated in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study (SCAS). Participants provided information on wealth and “traditional” socioeconomic measures (i.e., education, occupation, income), and subjective health status (i.e., mental health [MCS] and physical health [PCS] scores of the SF-12®). Blood pressure, cholesterol, and weight and height were assessed and all medications were reviewed. Objective health status measures included: hypertension (blood pressure ≥140/90 or on antihypertensive medications); hypercholesterolemia (total cholesterol ≥240, HDL cholesterol < 40, LDL cholesterol ≥ 160, or receiving cholesterol-lowering medication); and obesity (Body Mass Index ≥30). Wealth was measured using a Home Affluence Scale (HASC: range 0 - 6); ability to maintain a standard of living greater than or equal to 6 months; and having accrued savings greater than or equal to $5,000. Other factors included sociodemographic (age, sex, marital status, family size, years in the US, Short Acculturation Scale for Hispanics score), health-related (physical activity, diet) and healthcare access variables (health insurance coverage). Data analyses consisted of weighted summary statistics and multivariable linear and logistic regression models using the svy commands in Stata IC 12.1. Results: The mean HASC score was 2.9 (95%CI: 2.8-3.0). Approximately 25% (95% CI: 23-27%) of participants reported they would be able to maintain their standard of living for 6 months or more. Almost a third (29%, 95%CI: 27- 32%) had $5,000 or more in savings. Multivariable analyses showed that wealth, as measured by HASC, was positively associated with PCS score (β= 0.54, SE= 0.13, p< 0.01), even after adjusting for “traditional” SES and other sociodemographic factors. In turn, wealth was not associated with MCS score or objective health status. Discussion: Results demonstrate that among Hispanic/Latinos of diverse backgrounds, a measure of wealth (HASC score) was associated with perceived physical health status (PCS score) but not other subjective (mental health status [MCS score]) or objective health status measures (i.e., hypertension, hypercholesterolemia, obesity). Future studies should address mechanisms via which wealth factors may impact health status in longitudinal designs.

Little research has analyzed mistrust and discrimination influencing receipt of health care services among Latinos, particularly those living in rural areas. This study examined the associations between medical mistrust, perceived discrimination, and satisfaction with health care among young-adult rural Latinos.This cross-sectional study analyzed data from 387 young-adult Latinos (ages 18-25) living in rural Oregon. The Behavioral Model of Vulnerable Populations was utilized as the theoretical framework. Correlations were run to assess bivariate associations among variables included in the study. Ordered logistic regression models evaluated the associations between medical mistrust, perceived discrimination, and satisfaction with health care.On average, participants used health services 4 times in the past year. Almost half of the participants had health insurance (46%). The majority reported that they were moderately (32%) or very satisfied (41%) with health care services used in the previous year. In multivariable models, medical mistrust and perceived discrimination were significantly associated with satisfaction with health care.Medical mistrust and perceived discrimination were significant contributors to lower satisfaction with health care among young-adult Latinos living in rural Oregon. Health care reform implementation, currently under way, provides a unique opportunity for developing evaluation systems and interventions toward monitoring and reducing rural Latino health care disparities.

This article describes the Latino Health Ambassadors Network ( Voceros de Salud ) project created to support and mobilize Latino community leaders to address health inequalities in a rural Oregon county. Voceros de Salud is discussed as a model that other rural communities may implement towards strengthening Latino civic engagement for health.

To examine the prevalence and identify correlates of food insecurity among students attending a rural university in Oregon.Cross-sectional nonprobability survey of 354 students attending a midsize rural university in Oregon during May, 2011. The main outcome was food insecurity measured using the US Department of Agriculture Household Food Security Survey Module: 6-Item Short Form. Socioeconomic and demographic variables were included in multivariate logistic regression models.Over half of students (59%) were food insecure at some point during the previous year. Having fair/poor health (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.07-4.63), being employed (OR, 1.73; 95% CI, 1.04-2.88), and having an income$15,000/y (OR, 2.23; 95% CI, 1.07-4.63) were associated with food insecurity. In turn, good academic performance (grade point average of ≥ 3.1) was inversely associated with food insecurity.Food insecurity seems to be a significant issue for college students. It is necessary to expand research on different campus settings and further strengthen support systems to increase access to nutritious foods for this population.

Importance Regular ocular care is critical to early detection and prevention of eye disease and associated morbidity and mortality; however, there have been relatively few studies of ocular health care utilization among Hispanics/Latinos of diverse backgrounds. Objective To examine factors associated with ocular health care utilization among Cuban, Central American, and South American Hispanics/Latinos in a cohort study. Design, Setting, and Participants An ancillary study to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) evaluating ocular health, knowledge, risk factors, and health care use was conducted with 1235 HCHS/SOL participants (aged ≥40 years) at the Miami, Florida, study site. Data were collected from October 17, 2011, to September 30, 2013, and analyses were conducted from May 28, 2014, to March 18, 2015. Descriptive and multivariable logistic regression analyses were performed for 3 ocular health care outcomes. Regression models were built sequentially with variables conceptually grouped according to Andersen’s Behavioral Model of Health Services Use. Main Outcomes and Measures Ever having an eye examination, having an eye examination performed within the past 2 years, and difficulty obtaining needed eye care in the past year. Results Of the 1235 participants, 478 were men and 757 were women, and they had a mean (SD) age of 53.6 (8.1) years. Those who never had insurance were less likely to have had an eye examination (with data reported as odds ratios [95% CIs]) ever, 0.19 (0.07-0.53) and in the past 2 years, 0.22 (0.15-0.33) and were more likely to have had difficulty obtaining needed eye care in the past year (3.72 [1.75-7.93]). Those with less than excellent or good self-rated eyesight were less likely to ever have had an eye examination (0.26 [0.12-0.56]) and more likely to have had difficulty obtaining care (3.00 [1.48-6.11]). Men were less likely to ever have had an eye examination (0.31 [0.18-0.53]). Older (55-64 years) Hispanics/Latinos (3.04 [1.47-6.31]) and those with a high school degree or general educational development certification (2.06 [1.02-4.13]) or higher levels of education (4.20 [2.12-8.30]) were more likely to ever have had an eye examination. Finally, those living in the United States for more than 15 years (0.42 [0.21-0.82]) were less likely to have had difficulty obtaining care. Conclusions and Relevance Our findings suggest that increasing insurance coverage, decreasing the costs of care, and increasing the availability of care for Hispanics/Latinos with poor self-rated eyesight are relevant issues to address to improve ocular health care use among Hispanics/Latinos of diverse backgrounds.

Background From an equity perspective, a health system needs to address social, political and economic inequalities that prevent people to achieve higher standards of living and exert their right to health [1,2]. The 2008 Ecuadorian Constitution guarantees the right to health, an important contributing factor to good living or Sumak Kawsay [3]. The purpose of this study was to analyze socioeconomic inequalities and its relationship to provision of health care services in Ecuador, and to discuss relevant policy alternatives.

OBJECTIVE: To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects. METHODS: Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status. RESULTS: Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services. CONCLUSIONS: Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.

Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.

This article examines socio-economic determinants and inequality of health care utilization in Ecuador. Despite health reform efforts in Latin America, drastic socio-economic inequalities persist across the region, including Ecuador. Almost a third of Ecuador's population lack regular access to health services, while more than two-thirds have no health insurance and insufficient resources to pay for health care services. Using Andersen's model of health care utilization behaviour, relevant variables were selected from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN) household survey. Four outcomes were assessed: use of preventive services, number of curative visits, hospitalization, and use of antiparasitic medicines. Adjusting for various predisposing, enabling and need factors, a significant negative relationship was found between household economic status (as measured by assets and consumption quintiles) and utilization of preventive and curative services. The same was true for use of antiparasitic medicines. Further, indigenous ethnicity was found to be a significant negative predictor of health care utilization, regardless of economic status. These socio-economic inequalities in the use of health care services suggest the need for health care reform in Ecuador to address these issues more systematically. It is necessary for public health authorities to move forward on a reform that will expand coverage, particularly to indigenous and low- and middle-income households.