OMH Supplement and Emerging Adults, Clinical Care, and Minoritized Populations Virginia M. Brennan, PhD, MA This quarter, as classes resume at Meharry Medical College, we are publishing our regular issue and a supplemental issue sponsored by the Office of Minority Health (OMH). The open-access OMH supplement represents work supported by the office in the form of grants. Topics range from sickle cell disease to programs for Black and Latine youth to interpretation programs for people speaking minority languages. Papers were selected after blind peer review. (Initially, 90 abstracts were submitted and underwent review by OMH and JHCPU. Based on that review, we invited 56 authors to submit papers for peer review. The 18 published papers are the ones that did best in the blind peer review process.) The bulk of the regular issue concerns (1) emerging adults and pediatric patients, (2) clinical care, and (3) minoritized populations. There are also important papers on policy and politics, HIV, inadequate housing, and homelessness. Emerging adults and pediatric patients Most of the papers in this section focus on emerging adults, while two analyze pediatric data. Justice-involvement often collaterally affects adolescent and pediatric populations. Boch et al. investigated the intersection of parental justice involvement and child health by examining electronic health records in which parental justice involvement was attested. Achebe et al. conducted a qualitative study with justice-involved young adult (JIYA) men who identified as Black or Latino to understand their views of HIV risk and prevention. Kennedy et al. worked with transition-aged youth experiencing homelessness who were moving to transitional housing on a motivational interviewing program to reduce health risks. Jones et al. explored the prevalence of Multiracial/ethnic identity and its association with mental health among high school students, finding that over one out of five students in a large dataset identified as Multiracial/ethnic, and that Multiracial/ethnic identification predicted certain mental health concerns. Chase-Begay et al. looked at a large pediatric population by analyzing data from the National Survey of Children's Health (n = 145,226). They find that caregiver-perceived cultural sensitivity on the part of providers was associated with child health status. Clinical care In addition to Boch's study of clinician notes regarding parental justice involvement, several other papers in this issue concern clinical care. While sodicumglucose transporter-2-inhibitors (SGTL2i) are recommended by the American Diabetes Association guidelines, they are not always prescribed. Chu et al. investigated the prescription of SGTL2i to diabetic patients in a safety-net clinic and what clinical factors were associated with it. Wu et al. explored with health care and community partners the success of a population-based social determinants of health (SDOH) intervention [End Page vi] consisting of SDOH screening, a community health worker program, and a digital referral platform. Raber et al. also stayed in the community health care setting, looking at food is medicine programming in a federally qualified health center. Finally, Adu et al. describe the implementation of ophthalmology nights at a free clinic. Minoritized populations Four papers train their focus on one or more minoritized populations: racial and ethnic minority groups, transgender people in Jamaica, and Indigenous people in Taiwan. Wright et al. examined ethnoracial differences in SDOH and their associations with acute mental health symptoms among patients hospitalized after emergency care, using data from a multi-site study of 1,318 diverse adults admitted to inpatient units. The authors find complex associations. While Multiracial/Indigenous and Black adults had significantly higher discrimination and financial stress scores, both Black and Latine adults sustained greater mental health in adversity than non-Hispanic White adults. Jones et al. analyzed 2021 national Youth Risk Behavior Survey (N=17,232) data to explore Multiracial/ethnic identity and any association with mental health conditions. Most students identifying as Multiracial/ethnic also identify as American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or Hispanic or Latino. Multiracial/ethnic students who identify as American Indian or Alaska Native, Asian, Black, and White were disproportionately likely to suffer from persistent feelings of sadness or hopelessness, while Multiracial/ethnic Asian students were at increased risk for all four mental health indicators measured. Christie looks at another minoritized...

Money Matters Virginia M. Brennan, PhD, MA Two separate volumes make up our final issue of the year—the regular issue and a supplement titled Public-Private Partnerships and Health Equity. The latter, thanks to the financial support of the sponsor, CVS Health/Aetna, is entirely open access. The regular issue includes several interesting papers bringing to the fore the ways that money and socioeconomic status are inextricably linked to health. The first two explicitly concern money. Hubbard and Chen analyzed data from the National Financial Capability Study to examine household medical debt and delayed prescriptions. They found that American Indian/Alaska Native households were significantly more likely than non-Hispanic White households to bear medical debt and to skip filling prescriptions due to cost. As the authors note, this demonstrates inadequate insurance coverage for AI/ANs and suggests inadequacies in coverage by the Indian Health Service. Previous research has shown that temporary financial assistance (TFA) is associated with increased housing stability. Nelson and colleagues assessed the health effects of TFA on Veterans in the Supportive Services for Veteran Families (SSVF) program, which combines the efforts of the VA and non-profits to work with Veterans experiencing housing instability. Through this program, Veterans receive financial assistance for rent, utility payments, security deposits, and other housing-related expenses. Assessing the impact of the program in terms of cost savings, the authors found significant reductions in ED use, outpatient mental health, outpatient substance use disorder treatment, inpatient mental health, and residential behavioral health costs per quarter for Veterans in one component of SSVF. Two additional papers focus on socioeconomic status somewhat more broadly. Keneally and colleagues analyze knee arthroscopy data for patients organized by ZIP Codes, which are characterized in terms of median income. More specifically, they looked at the type of anesthesia used during the knee arthroscopy. As background, we should note that general anesthesia (GA) has worse outcomes in terms of recovery time and pain experienced than neuraxial anesthesia (NA) or regional anesthesia (RA). The result of their analysis is that patients from ZIP Codes with median incomes below $50,000 had significantly greater odds of undergoing GA rather than NA or RA in comparison with their counterparts from higher-income ZIP Codes. Finally, Hoskote and colleagues investigated the social and economic factors associated with health care delay during COVID-19. By means of a researcher-conducted survey of nearly 500 low-income parents of young children in California, the authors found that while delay in care for children related directly to such factors as lack of childcare and the child having preexisting conditions, for adults the associated risks of delayed care were more obviously structural: Delayed care for these low-income parents was associated with lack of childcare, but also with experiences of racism, government [End Page vi] mistrust, and perceptions of welfare stigma. The authors conclude, "These results suggest that health care access may be improved through a focus on supporting childcare systems and addressing structural racism." Qualitative techniques are employed in another paper to gain insight into obstetrical experiences in Trenton, New Jersey, and again the results point towards structural factors as the greatest barriers to care. This paper contributes to the ever-more-important literature on reproductive health in low-income communities. The last high-volume obstetrics unit in Trenton closed in 2011, creating a maternity care desert. McGregor and colleagues explored the experience of pregnancy and childbearing with women living in this environment. Most respondents were publicly insured and had no choices for prenatal care or delivery hospital. The authors found that structural impediments such as increased travel distance and institutional mistrust, together with added impediments to emotional support at the time of delivery, were the biggest barriers to entry into care and a quality care experience. Finally, provider motivation for their health care careers is the subject of a survey study by Gillette and colleagues. With a subject pool of 173 (health care providers [N=134] and physician assistant students [N=39]), the authors found that most study participants rated almost all the possible motivations as very important. However, the most important was a chance to make a difference in patient quality of life...

2022 Black History Month Theme:Black Health and Wellness throughout the African Diaspora Virginia M. Brennan, PhD, MA The Journal of Health Care for the Poor and Underserved is happy to join in the celebration of Black History Month 2022 with its theme of Black Health and Wellness throughout the African Diaspora. In this Note, I will highlight papers from the current issue fitting this theme. The distribution of physicians of color—specifically Black surgeons and international medical graduates (IMGs) from the seven countries on the Trump travel ban list—came under the spotlight of Imam Xierali and Mark Nivet. They employed withdrawal mapping in the theoretical foundation of spatial accessibility to identify what regions of the U.S. would be most affected if those physicians were withdrawn. For Black surgeons, the effect would be felt most in predominantly Black areas. As the authors write, "The spatial analysis results suggest that areas in the South with a higher percentage of Black residents, urban areas on the East Coast, and Midwestern states are more dependent than the rest of the nation on Black surgical specialists for spatial accessibility to surgical care." The region most affected by the withdrawal of the travel-ban IMGs would be the Midwest. Recognizing these patterns can help shape policy with respect to increasing the numbers of physicians of color. Turning to the larger diaspora, Eappen et al. report on interviews with providers for 126 survivors of the Boka Haram (Borno State, Nigeria) abductions and human trafficking. They detail the physical, mental, and social challenges the survivors faced when they were held captive, and how the providers employed a holistic model of care in treatment. Two other papers put a much wider lens on health in the African Diaspora. Oleribe et al. report the epidemiology of COVID-19 in Nigeria in the first year of the pandemic, employing the data from the Nigerian Center for Disease Control. The second paper examines the distribution of cholera worldwide analyzed into temporal fragments and spatial regions. The regions most affected by cholera over time were several regions in Africa, Haiti, and South Asia. Flint, Michigan became synonymous in 2014–2019 with drinking water contaminated by lead. In this issue, Wierda and Amini use survey data from 1,825 adults in Michigan and logistic regression to assess changes in consumption of soda, juice, and other sugar-sweetened drinks before and after the crisis. While consumption increased after the crisis, it increased much more among African Americans than Whites. The authors note that "the context of the FWC [Fline water crisis] made this a time when mistrust in local government messaging might have been a factor." Two papers concerning Black/White cancer disparities concern us next. Shabani and colleagues review the literature on head and neck squamous cell carcinomas. They summarize by saying the African American patients are diagnosed younger, present with a [End Page ix] higher tumor burden, are less likely to receive definitive treatment, and have increased mortality relative to Whites. Importantly, the authors note that all these conditions are reversible. Crittendon, LaNoue, and George compared the clinical care of Black and White men relating to prostate specific antigen (PSA) screening, using the large Behavioral Risk Factor Surveillance System data set. The found that perceived racism and its interaction with race was not significantly associated with any PSA outcomes. However, they also found that Black men were significantly less likely than White men to be advised of potential benefits and harms of PSA screening. The paper, "Positive Depression Screening at the First Prenatal Visit in a Low-Income Primarily Black Population," by Edwards et al. emerges from a larger effort to improve prenatal care in areas where there are wide infant mortality disparities. The depression screen administered to the 500 patients studied through chart review revealed an extremely high rate of depression among this primarily Black group of low-income mothers. The authors argue that decreasing the disproportionately high infant mortality rates in this population depends in part on incorporating mental health care as part of prenatal care. Finally, in the clinical area, we would like to mention the paper by Bransden, Hernandez, Mangels, and colleagues on echocardiograms of Haitian...

E-consults and Feminist Analyses of the Gig Economy Virginia M. Brennan, PhD, MA The papers in the present issue range in topic from the effects of Medicaid expansion on cardiovascular disease disparities all the way to the overlooked medical needs of siblings of children with special health care needs. Here, I will delve into just a few of the issue's papers, several with feminist analyses of the informal work sector and two concerning the growing practice of e-consults. Informal workers constitute a growing segment of the labor market in the U.S. Sometimes known as independent workers, contract workers, contingent workers, ondemand workers, or gig workers, the category includes domestic workers as well as sex workers, drug dealers, and episodic employees. In some of these sub-groups, women predominate. A major group of informal workers are non-migrant paid domestic workers (PDWs), among whom women are most numerous. The literature review by an international team led by Germán Guerra covers work on depressive symptoms among PDWs, both quantitative and qualitative. Quantitatively, the literature affirms a high level of depression among PDWs, ranging from 28% to 53%. Qualitatively, the structural conditions of poverty and intersectional discrimination are seen to drive women towards paid domestic work. Together, the quantitative and qualitative analyses in this paper point to psychosocial risks, working conditions, and workplace abuse as moderators of depressive symptoms among PDWs. Trout and colleagues explore the world of sex workers in Philadelphia through interviews with people from a drop-in support center for cis- and transgender individuals identifying as women. Among the health-related concerns affirmed in the 29 interviews and a follow-up focus group were homelessness, food insecurity, and personal safety. Participants laid special emphasis on a theme the researchers titled, "I am a person." Truck stops foster informal work of some variety, including sex work and drugdealing, but also "polishers who buff and polish the chrome on trucks, drug pushers, and runners who make drug deliveries and negotiate sales … and peripheral players [such as] people experiencing homelessness and migrant workers who also facilitate these transactions." Through interviews and a survey of an all-male group on health-related issues, Celeste-Villalvir and colleagues conducted research at a series of truck stops in Texas. The resulting themes were (1) substance use, (2) mental illness, (3) criminal justice involvement, (4) lack of access to health care, and (5) lack of access to transportation. Here, too, we find multiple and intersectional sources of vulnerability of an understudied group. Following the thread we have spun thus far, we come to "Discrimination Exposure Based on Race, Gender, and Sexual Orientation of Veterans Affairs Health Administration [End Page viii] Patients," which also emerges from a feminist, intersectional interpretive framework. Berke and colleagues find that, while relatively few veterans had either seen or experienced harassment at VHA facilities based on racial/ethnic identity, gender, transgender identity, or sexual orientation in the past 12 months, those rates were significantly different among sub-groups. Women experienced significantly greater health care-related discrimination than men, as did racially/ethnically minoritized people relative to non-Hispanic Whites. For observing such discriminatory behavior, significant differences were found between women vs. men, minoritized vs. non-Hispanic White, and lesbian/gay/bisexual vs. heterosexual. Digging deeper than overall rates unearths conditions in need of attention at the VA. In another vein, this issue includes two papers on e-consults, which seem especially relevant as remote health-related encounters take on a bigger share of the health care space, surging with COVID-19. Joseph and colleagues studied an e-consult program for primary care providers at 12 primary care sites within a public safety-net health system with hospital-based staff and trainee psychiatrists. Many of the consultations, which occurred both via video link and via phone, concerned medication, and the primary care providers widely expressed satisfaction with the service. The findings suggest this intervention facilitates primary care same-day treatment of psychiatry-related conditions in low-resource settings. A large multi-site federally qualified health center in Texas also implemented an e-consult program with the goal of improving uninsured patient connections with specialists. Comparing the year before the...