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Using data from a 1996/1997 survey of undocumented Latino immigrants in four sites, we examine reasons for coming to the United States, use of health care services, and participation in government programs. We find that undocumented Latinos come to this country primarily for jobs. Their ambulatory health care use is low compared with that of all Latinos and all persons nationally, and their rates of hospitalization are comparable except for hospitalization for childbirth. Almost half of married undocumented Latinos have a child who is a U.S. citizen. Excluding undocumented immigrants from receiving government-funded health care services is unlikely to reduce the level of immigration and likely to affect the well-being of children who are U.S. citizens living in immigrant households.

Objectives. We sought to determine the impact of comprehensive tobacco control measures in New York City. Methods. In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all workplaces, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking. Results. From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US born and foreign-born persons; and in all 5 boroughs, increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third. Conclusions. Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing. (Am J Public Health. 2005;95:1016-1023. doi:10.2105/AJPH.2004.058164)

HIV patients who live in rural areas are not receiving appropriate treatment, perhaps because they are treated by doctors who have little experience treating HIV patients. In a study of 367 HIV patients in rural areas and 2,806 HIV patients in urban areas, those in rural areas were less likely to take highly active antiretroviral therapy (HAART) or drugs to prevent Pneumocystis carinii pneumonia.

The treatment of HIV infection is not excessively expensive but many patients are poor and cannot afford health insurance. Based on a survey of 3,072 HIV patients, an estimated 231,400 HIV patients received care in the US in the first two months of 1996. Half were gay men and 46% had incomes less than $10,000 per year. Almost 70% had no insurance or were on Medicaid or Medicare. For the estimated 335,000 HIV patients who received care at least every six months, the total annual cost was $6.7 billion. This is less than 1% of the $700 billion that was spent on medical care in 1996.

Women appear much more likely than men to undergo surgery for treatment of temporomandibular joint disorders (TMD) but the reasons for this are unclear. TMD is characterized by pain and tenderness or popping and clicking sounds in the jaw. In a review of 46,293 people who had submitted an insurance claim for TMD treatment, 1,500 women and 166 men had at least one of 10 surgical procedures rather than a non-surgical treatment. Women were almost three times as likely to have surgical treatment as men. Surgical treatment of TMD is very controversial and can cause serious complications.

Judges, lawyers, and court employees of the US Courts of Appeals for the 2d Circuit were surveyed to determine whether and to what extent gender, race, and ethnicity affect the perceptions and experiences of those surveyed. The survey found that judges and court employees are less likely than lawyers to believe, based on disparaging remarks made in their presence, that the biases of participants undermined the fairness of proceedings in 2d Circuit courtrooms.

About 34 million Americans could be experiencing severe health problems because they can not get the medical treatments they need or can not pay for them. Researchers conducted telephone interviews with 3,993 Americans and asked them if they had recently been unable to get medical care or could not pay for it. Thirty-one percent reported being uninsured, unable to get medical care or unable to pay for care. Uninsured participants were more likely to have these problems, but 58% of those unable to pay their bills were insured. Up to 28 million insured Americans may be unable to afford adequate health care.

Many of the Cambodian refugees interviewed in a refugee camp in Thailand had psychological problems that may predict future difficulty in readjusting to life in Cambodia. More than half of the 993 Cambodian refugees who participated in the study had symptoms that correlated with a diagnosis of major depression. Many also had symptoms of post-traumatic stress disorder. Participants in the study were randomly selected from five regions in the Site 2 refugee camp on the Thailand-Cambodia border. Interviews were conducted in Khmer. From 1975 to 1979, under the Khmer Rouge regime, 83% of all participants lacked food or water. Many reported being forced into labor, separated from their families, unable to get needed medical treatment and subjected to brainwashing. More than 53% also reported the murder of a family member or friend. Social programs and health programs designed to aid the Cambodians after repatriation must take into account the very high levels of psychological and physical trauma endured by the refugees both during the time of the Khmer Rouge and during their stay at the refugee camp., Objective.--To assess the long-term impact of trauma and confinement on the functional health and mental health status of Cambodian displaced persons living on the Thailand-Cambodia border. Design.--Household survey of 993 adults randomly selected from household rosters. Household sample selection by multistage area probability sample. Setting.--Site 2, the largest Cambodian displaced-persons camp on the Thailand-Cambodia border. Participants.--Adults 18 years of age and older selected at random within households; 98% of eligible persons selected agreed to participate. Results.--From 1975 through 1975 (Khmer Rouge regime), more than 85% reported lack of food, water, shelter, and medical care, brainwashing, and forced labor; 54% reported murder of a family member or friend; 36% reported torture; 18% reported head injury; and 17% reported rape or sexual abuse. During the refugee period between 1980 and 1990, 56% reported lack of food or water, 44% reported lack of shelter, 28% reported lack of medical care, 24% reported brainwashing, and 8% reported torture. Since 1980, reports of murder of a family member, head injury, and rape/sexual abuse have decreased to 5%. Reports of experiencing combat situations and shelling attacks have remained consistent between the two time periods, approximately 44% and 30%, respectively. From 1989 to 1990, 25% reported experiencing lack of food or water, and 5% to 10% reported serious injury, combat, and shelling conditions. More than 80% said they were in fair or poor health, felt depressed, and had a number of somatic complaints despite good access to medical services. Fifty-five percent and 15% had symptom scores that correlate with Western criteria for depression and posttraumatic stress disorder respectively. Fifteen percent to 20% reported health impairments limiting activity, and moderate or severe bodily pain. Despite reported high levels of trauma and symptoms, social and work functioning were well preserved in the majority of respondents. Conclusions.--Reports of extensive trauma, poor health status, and depressive symptoms of this population are of concern in predicting future morbidity and mortality. The health and mental health needs of Cambodian displaced persons and their impact on social and economic behavior should be addressed now that the Cambodians have been repatriated.

The health care needs of uninsured individuals in Massachusetts may not be guaranteed by the Massachusetts Health Security Act of 1988. The Massachusetts law requires that hospitals that care for uninsured individuals be compensated by surcharges on services to insured individuals, and that all employers provide health insurance to their employees. A survey of 1,066 Massachusetts households found that 84% of uninsured residents live in a household with an employed adult. Most of the employed adults in uninsured households work for small to medium-sized companies. The uninsured were more likely to have a serious illness than the general population, and are more likely to be unaware of the health care law. Employers are concerned about the rising cost of health insurance premiums that result from hospital surcharges for uninsured individuals., Objectives.--The debate in Massachusetts over the repeal of the first state-based "pay or play" universal health plan is discussed using data from a survey of 1066 Massachusetts households. The survey attempted to measure the problems of the uninsured, to estimate the likelihood that they would buy insurance if offered, and to calculate the proportion of the uninsured who would be covered under an employer mandate. Design.--A survey conducted in person and by telephone in 1066 households, with an oversample of uninsured households, using stratification, clustering, disproportionate sampling, and poststatistical weighting. Participants.--Adults aged 18 years and older who were knowledgeable about the insurance status of persons in their household. Main Outcome Measures.--Insurance status, employment status, access to and use of health services, and willingness to purchase health insurance. Results.--First, the present system of hospital-based uncompensated care in Massachusetts is inadequate by itself to meet the needs of uninsured residents. Uninsured persons are less likely than insured ones to seek medical care for chronic health problems and serious symptoms requiring evaluation. Second, 83% of uninsured families and 24% of uninsured individual respondents would purchase one of several insurance options with 30% of the cost subsidized. Last, the employer mandate provisions of the legislation would cover 43% of the uninsured in Massachusetts. Conclusion.--In the current economic climate, the political viability of the universal health care plan and similar national initiatives is uncertain given the intractable conflict between perceptions of the financial stability of small businesses that do not offer insurance and the health care needs of uninsured individuals. (JAMA. 1992;267:1113-1117)