Little is known about health care utilization among people experiencing homelessness (PEH) in rural areas, who are often unsheltered and face barriers from geographic isolation and resource shortages. We examined emergency department (ED) and acute hospitalization utilization in relation to weather patterns among PEH at a rural health care system in Northwest Michigan (2018-2022). Mental and behavioral health diagnoses accounted for 66.3% of ED visits and 84.4% of hospitalizations. Higher maximum daily temperature was associated with increased ED visits (β=0.017, 95% CI=0.01, 0.24), while total precipitation was associated with fewer visits (β=-0.053, 95% CI=-0.087, -0.021). Greater cumulative snow depth was linked to increased ED visits (β=0.022, 95% CI=0.008, 0.036) and hospitalizations (β=0.034, 95% CI=0.002, 0.065). Shelter availability was associated with lower monthly hospitalization rates (mean difference=-1.42, 95% CI=-2.46, -0.39). These findings underscore the need for targeted mental health services and weather-responsive care strategies for PEH in rural areas.
Community health centers (CHCs) have significantly expanded behavioral health (BH) and social service delivery in recent years. Using 2020 and 2024 Uniform Data System data and the 2023-2024 Commonwealth Fund CHC Survey data, this study describes trends and challenges in care provision. From 2020 to 2024, CHC BH and social services staffing, utilization, and patient volume increased markedly. Most CHCs offered onsite counseling for mental health (70.4% for long-term, 88.0% for short-term), while substance use disorder services were less common (66.1% onsite, 53.4% telehealth). The BH challenges most often cited by CHCs were provider shortages (66.0%) and BH needs outpacing capacity (64.0%). While over half reported routinely screening for patients' social needs, difficulty connecting patients to services was high-especially for housing (30.3% reported "Extremely difficult"). These findings underscore that CHCs are delivering comprehensive, community-anchored care, but rising behavioral and social needs call for targeted policy and financial support.
INTRODUCTION:People experiencing homelessness (PEH) face significant risks of early cancer-related mortality due to barriers of care for complex treatments. We describe our pilot study for PEH with advanced cancer undergoing treatment at a large safety-net hospital system. METHODS:We performed a retrospective case series of PEH with advanced cancer undergoing medical respite from 2020 to 2024. Descriptive statistics were used to describe patient characteristics and outcomes. RESULTS:Nineteen patients participated in medical respite program while undergoing cancer treatment. Patients were referred from hospitals, clinics, and prisons; 74% were men and 67% under age 65. The most common primary cancers involved the lung, colon or rectum, and oropharynx-53% with known metastatic disease. All patients were able to complete cancer-related treatment with 42% achieving treatment response and transitioning to long-term housing. CONCLUSION:We demonstrated that temporary housing and support facilitated cancer treatment, which is important as states adopt medical respite to address social needs.
Little is known about the civil legal needs (CLNs) of those experiencing intimate partner violence (IPV). In this convergent mixed-methods, cross-sectional study, we used quantitative and qualitative data from a national online survey linked to Veteran Affairs health records to describe and compare the CLNs of patients who have screened IPV-positive versus IPV-negative. Using chi-square tests, we found that those who screened positive were significantly more likely to have at least one CLN (70.9% vs. 53.7%, p<.01 for all) and to have three or more CLNs (29.1% vs. 11.9%) than those who screened negative. IPV-positive patients were also significantly more likely to have CLNs related to housing (23.6% vs. 8.9%), family (23.6% vs. 8.6%), protection orders (14.6% vs. 1.3%), and military discharge status (14.6% vs. 5.1%) than IPV-negative patients. These findings underscore the importance of raising provider awareness of the breadth of patient-survivors' CLNs and staffing medical-legal partnerships with legal professionals qualified to address a range of legal services.
Agricultural workers in the United States are crucial for food production yet face significant health challenges due to the conditions of their labor. Although these workers' use of U.S.-based health care services has been low historically, estimates from the first two decades of the 21st century show a sharp increase in incidence. We investigate the sources of this change by partitioning the increase into two components: one due to shifts in the composition of workers on 10 predictors of health care use, and one due to the changing impacts of these predictors on the use of U.S.-based health care. We find that 65-70% of the increase in use of health care services is accounted for by compositional shifts, especially with respect to sex, income, migrating for work, and having government-sponsored health insurance. The remaining 30-35% was due to changing impacts, particularly having access to an automobile and employer-sponsored health insurance.
BACKGROUND:Research on sexual and reproductive health (SRH) care among women and gender-diverse people in prisons in Canada demonstrates gaps in access to health information and institutional barriers to care. Women and gender-diverse people leaving prison often access community supports provided by non-governmental organizations (NGOs). The experiences, needs and skills of staff at these organizations with respect to supporting client SRH are under-researched. METHODS:This study followed a community-based design involving four qualitative focus groups at partner organization sites, for a total of 30 participants. Participants included directors of NGOs, case workers, peer support workers, and housing support workers. Data were analyzed using reflexive thematic analysis. RESULTS:Four key themes emerged from our analysis: (1) Pregnancy in transitional times; (2) Encouraging and accompanying clients to care; (3) Am I supposed to do this? Role conflict; (4) Being realistic: Navigating child welfare. CONCLUSION:In the transition from custody to community, SRH services are frequently required. Frontline staff working with people recently released from prison are motivated to enhance their ability to support client SRH.
Populations facing health care barriers often have limited access to genetic services addressing inherited disease risk. This report presents the implementation of a web tool to assess hereditary cancer risk in two safety-net primary care clinics. Our experience highlights real-world challenges and strategies to engage patients in hereditary cancer risk assessment.
Breast cancer, one of the most common cancers in America, exhibits health disparities disfavoring non-Hispanic Black women. The objective of this study is to assess the impact of COVID-19 on non-Hispanic Black women compared with non-Hispanic White women receiving mammograms. This study is a retrospective chart review conducted at a large health system in the South that included patients who were female, non-Hispanic Black or non-Hispanic White, between the ages of 18 to 74 years. The primary endpoint was time from previous mammogram prior to COVID-19 pandemic to first mammogram during the pandemic. The cohort included 385,419 patients with the majority identifying as non-Hispanic White. The time between mammogram pre-COVID and mammogram during COVID for Black women was 75.42 (56.00, 126.29) weeks compared with 79.57 (56.89, 136.14) weeks for White women (p <.0001). Black women were more likely to receive a mammogram sooner than White women during the COVID-19 pandemic.
OBJECTIVES:We assessed whether participation in a housing-based telehealth program was associated with increased vaccination uptake. METHODS:We compared vaccination rates between participants and non-participants of the Telehealth Intervention Programs for Seniors (TIPS) in two affordable housing complexes in Newark, NJ, and Detroit, MI. TIPS offered weekly telehealth sessions with health monitoring and social services delivered by trained staff and Resident Service Coordinators. Vaccination rates were compared between TIPS participants and non-participants using administrative data. RESULTS:Telehealth Intervention Programs for Seniors participants had significantly higher vaccination rates than non-participants across clinics and sites. In Newark, participant rates were 35%, 19%, and 20% across three periods, versus 9%, 8%, and 3% for non-participants (OR=5.4, 2.7, 8.5 respectively; all p <. 001). In Detroit, 86% of participants received vaccines versus 14% of non-participants (OR=34.5, p < .001). CONCLUSIONS:Housing-based telehealth programs are associated with increased preventive health behaviors among underserved populations.
OBJECTIVE:Many adults with a history of criminal legal involvement have a substance use disorder (SUD), however how this relationship changes with age is not well studied. We investigated the association between age and SUD among those with criminal legal involvement. METHODS:Using data from the National Survey of Drug Use and Health, we tested the association between age group and odds of having a SUD. Multivariate logistic regression analyses controlled for socio-demographic and clinical confounders. RESULTS:Compared with older adults, younger adults had increased odds of any substance use disorder (OR 2.2;95%CI:1.7,2.9). Middle aged adults similarly had higher odds of any substance use disorder (OR 1.7;95% CI: 1.3,2.2). CONCLUSIONS:Among adults with lifetime criminal legal involvement, younger adults experienced significantly higher odds of various SUDs compared with older adults. However, prevalence of SUD, particularly alcohol use disorder, remained high in older adults.
Primary care visits represent opportunities to engage patients in diabetic retinopathy screening through point-of-care retinal imaging. Using tele-retinal screening supported by a medical assistant-clinician dyad in a large urban community health center, we increased diabetic eye examination completion from 49% to 59% over six months, demonstrating feasibility in primary care.
Current health systems, particularly in Senegal, are struggling to ensure that the indigent population has access to health care. Although the recent situation has been well-studied, there remains a lack of historical research on the subject. When Senegal gained independence in 1960, did the country inherit a health care system that did not adequately meet the needs of indigent people and their access to care? This article shows that from 1852 to 1960, access to health care for the indigents was not a political and financial priority, that the colonial administration often confused the Indigenous people with the indigent people, and that the latter faced discrimination in accessing health care. The analysis shows that the current challenges in accessing health care for indigent people are a continuation of colonial history. There is an urgent need for change to achieve greater equity.
The impact of political competition on opioid-related mortality in the United States is examined in urban metropolitan counties (2001 to 2024). County groups were matched for 19 socio-demographic factors, and each county was categorized as having competitive, transitional, or monopoly mayoral governance based on duration of one-party control. There is higher opioid mortality in Black people versus White people from both prescription and non-prescription opioids in monopoly versus competitive counties. Rather than bringing health stability, mayoral political monopolies potentially harm vulnerable populations and strengthen structural racism based on political privilege. Interestingly, the political party itself is not the factor; duration of party control drives the observed disparate opioid mortality. We hypothesize a framework for understanding structural racism in opioid mortality based on political privilege and monopoly rather than racial privilege and political party affiliation. Analytic epidemiologic studies are needed to test the extent to which political control affects opioid outcomes.
PURPOSE:To detect rates of cataracts among underserved participants following community-based eye health screenings in Upper Manhattan. METHODS:A cluster-randomized controlled trial enrolled 708 participants aged 40 years or older for eye health screenings. Participants with visual acuity (VA) 20/40 or worse, intraocular pressure 23-29 mmHg, or unreadable fundus images in either eye were referred for examination by a study optometrist and subsequent referral for ophthalmologic exam, if warranted. RESULTS:Among 708 participants, 31.4% were diagnosed with cataracts (n=223). Logistic regression showed higher odds of visually significant cataracts with older age (adjusted odds ratio [aOR] = 1.121, 95% CI = 1.065-1.181), VA worse than 20/40 (aOR = 16.393, 95% CI = 3.268-83.333), or an unreadable fundus image (aOR = 333.333, 95% CI = 37.037-∞) (p < .001). CONCLUSION:Cataract detection in underserved individuals was associated with older age, poor visual acuity, and unreadable fundus images but cataract surgery rates were low.
Medical debt is prevalent in the U.S., and the relationship between medical debt and geographical health inequities remains underexplored. Using 2022 cross-sectional county-level data from the Urban Institute Debt in America project linked with County Health Rankings data, we assessed how having medical debt in collections is associated with six population morbidity and mortality outcomes by rural/urban location: fair/poor health, frequent mental or physical distress, life expectancy, and two premature mortality measures. A higher share of the population with medical debt was associated with worse population health across all six outcomes. Associations between increased medical debt and certain poorer health outcomes are somewhat more pronounced in urban counties than in rural counties, differences that remain for the three mortality outcomes even after adjusting for lower rural average household income. Our findings highlight the continuing need to reduce medical debt as a health equity issue across both rural and urban areas.
BACKGROUND:Community health events can be useful venues in hypertension control interventions, especially in low-income populations. This project performed blood pressure (BP) screenings at community health fairs in Nashville, Tennessee. METHODS:The project collected demographic characteristics and BP measures data from May 2025-September 2025. RESULTS:Of 272 participants screened, 126 (46.3%) occurred at public housing communities. Participants were often 65 years or older (43.4%) and female (51.8%). Men were more likely to be screened at health workshops (OR: 3.59, 95% CI: 1.92-6.71) and female attendees at churches (OR: 2.12, 95% CI: 1.15-3.90). Overall, 73 (26.8%) participants met the criteria for possible hypertension. CONCLUSIONS:This study provides insights into who attends community BP screenings. We found that people already diagnosed with hypertension, or those who deem themselves as high risk, attend BP screening events. Future research should tailor interventions based on demographic patterns to better engage underserved populations.
BACKGROUND:Atrial fibrillation (AF) is common and causes significant morbidity and mortality. However, U.S. data on socioeconomic status, rurality, and new diagnoses of AF (NDAF) have been limited and/or conflicting. METHODS:Retrospective analysis, adult encounters, 2021-2022, at a Midwest U.S. health system. Inclusion criteria intended to identify those likely to seek care at the health system. Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes represented socioeconomic status and rurality, respectively. New diagnoses of AF associations with RUCA and ADI were analyzed separately. RESULTS:Among 346,104 patients without identified prior AF diagnosis, unadjusted NDAF proportions and most AF risk factor prevalences were significantly greater in the higher ADI and RUCA groups in all analyses. Continuous ADI and RUCA remained significantly associated with NDAF in all adjusted analyses except one RUCA sensitivity analysis. CONCLUSIONS:In this study, patients in more socioeconomically disadvantaged or more rural areas were significantly more likely to have NDAF.
BACKGROUND:Asian Americans have higher rates of type 2 diabetes mellitus (T2DM) compared with non-Hispanic Whites, reflecting a health disparity influenced by diverse cultural health beliefs and practices. Data have aggregated Asian Americans into a single group, overlooking differences in tradition, religion, and migration history. Disaggregating data is critical for developing culturally appropriate interventions, as strategies effective for one subgroup may not yield the same results for another. METHODS:A literature review using PRISMA guidelines was conducted for studies on Asian American subgroups with T2DM, published between 1994-2024. The Common-Sense Model of Self-Regulation guided data extraction. RESULTS:Twenty-six studies met inclusion criteria. Key themes included family support, dietary challenges, and reliance on traditional medicine. Subgroup-specific differences emerged in beliefs about disease cause, severity, and management. CONCLUSIONS:Cultural beliefs significantly influence illness representation and diabetes self-management among subgroups. Tailoring interventions to these beliefs can improve care effectiveness and equity.
