Background. Rurality may influence racial/ethnic disparities in access to healthcare. This study sought to: (1) compare and contrast measures used to assess rurality and urbanicity; (2) determine if racial/ethnic disparities in access to healthcare differ for rural vs. urban areas; and, (3) determine if residential segregation and access to healthcare differ for rural vs. urban areas.

Sample. The sample was adult respondents to the 2005-2010 Medical Expenditure Panel Survey (MEPS), a nationally representative sample of U.S. households. Each aim had five samples; sample size ranged from 49,839 to 112,125.

Measures. Aim 1 involved five measures used to identify rurality relative to urbanicity. Aim 2 and aim 3 involved five self-reported MEPS outcomes indicating whether respondents had (1) a usual source of healthcare, (2) unmet need for healthcare, (3) cholesterol screenings, (4) cervical cancer screenings, or (5) dental visits. The main explanatory factors, which were based on respondents’ residential location, were rurality and residential segregation, which were examined separately for blacks and Hispanics using the isolation index. Respondents’ residential areas were characterized by using geographic identifiers to link the MEPS data with census tract and county information available via the American Community Survey (2005-2010), the Area Health Resource File (2010), and five publically available rurality indicators.

Analysis. The descriptive analysis explored variable characteristics and bivariate associations. The main analysis involved multi-level, random intercept logistic regression to estimate disparities in each access to healthcare outcome while controlling for confounders.

Results. One outcome, unmet healthcare need, changed depending on the measure used to assess rurality. With respect to disparities, relatively more blacks than whites had preventive screenings in the fully adjusted models; this difference was smaller in rural than urban areas. Rural blacks and Hispanics had fewer screenings than urban ones did. Across rural and urban areas, blacks and Hispanics in segregated areas had lower levels of unmet need.

Discussion. Unadjusted estimates suggest disadvantaged rates for certain measures of access to healthcare by rurality and segregation, while adjusted models attenuated some of these disparities.

Conclusion. Place-based factors (rurality, segregation) and racial factors may jointly affect access to healthcare among diverse U.S. populations.

INTRODUCTION:

Engaging multicultural perspectives in community-based participatory research (CBPR) can inform the functioning of culturally diverse collaborations. This study examines the extent to which group diversity influences the practices and collective functioning of CBPR partnerships.

METHODS:

Population and Setting: This study used data from Research for Improved Health: A National Study of Community-Academic Partnerships (RIH), which examined the promoters and barriers to CBPR partnerships. The eligible sample included N=294 partnerships that were federally funded in 2009.

Sample and Sampling: The qualitative sample consisted of stakeholder interviews (N=55) of seven case study partnerships from the RIH dataset (N=81) using purposive sampling. The quantitative sample comprised partnership-level surveys (N=200) and partner-level surveys (N=448) from the RIH partnership-level (N=200) and partner-level (N=450) datasets using criterion sampling.

Analysis: This study used a nested mixed methods design involving two stages: 1) qualitative, inductive, thematic analysis of the interviews to identify perceived characteristics of group diversity, benefits and challenges of group diversity, and diversity engagement practices (DEP) 2) quantitative, deductive, logistic survey analysis to test whether demographic entropy is associated with structural elements and with collective functioning of the partnerships.

RESULTS:

Inductive, Qualitative Findings: Partnerships benefited from functional differences and from sociocultural similarities among members. Partnership faced challenges primarily from sociocultural differences among members. DEP included practices of promoting partnership functional capacities and esteem, and transcultural and interpersonal bridging practices.

Deductive, Quantitative Findings: Analysis detected few associations between partnership demographic entropy and approval structures. Location entropy was associated with increased odds of having a community governance structure (OR=11.3, 95% C.I.: 3.1, 41.1). However, demographic entropy was not associated participatory decision-making after adjusting for control factors.

DISCUSSION: DEP could enhance the benefits of members’ functional differences and mitigate the challenges of members’ sociocultural differences. Major limitations include the sample selection process of RIH, which limited generalizability of the findings, and the inadequacy of several measures, which limited measurement of the focal association.

CONCLUSION: CBPR partnerships can benefit from practices that promote functional capacities and practices that promote cultural and interpersonal bridging among members. Further research is needed to examine the long-term implications of group diversity and DEP.

BACKGROUNDDespite medical and technological advances, the preterm birth rate among Black American women is 55% higher than white women. Prior evidence identifies various forms of racialized spatial inequality, especially residential segregation, that contribute to the persistent racial disparities in preterm birth. However, less is known about how dynamic processes of spatial inequality such as gentrification and Black migration impact preterm birth. PURPOSE The purpose of this project is to understand the relationship between two indicators of racial resegregation (gentrification and residential mobility) and preterm birth among Black women in Northern California. The specific aims are (1) to determine if gentrification stage is associated with preterm delivery among Black women; (2) to explore residential mobility patterns relative to racial resegregation and preterm birth among Black women and (3) Identify potential mechanisms linking regional inequality to preterm birth risk among Black women. METHODS Design: For Aim 1, I used a non-experimental cross-sectional design to explore the association between gentrification and preterm birth. For Aim 2, I used a retrospective cohort, matched sibling design to explore the relationship between inter-pregnancy residential mobility and preterm birth. For Aim 3, I used a grounded theory approach. Sampling and Sample: The quantitative component (Aims 1 and 2) drew samples from the San Diego Study of Outcomes in Mothers and Infants (SOMI) database. SOMI contains vital statistics records from all births in California from the years 2011-2017. The inclusion criteria were singleton births to Black individuals in the San Francisco Bay Area. The sample for Aim 1 is N=18,327. The sample for Aim 2 is N=4,910. The qualitative component involved primary data collection using semi-structured interviews with Black women (N=12), birth workers (N=2), maternal and child health experts (N=6), and urban scholars (N=4). Analysis: This study used multi-level logistic regression to examine the association between gentrification and preterm birth (Aim 1) and conditional logistic regression to analyze the relationship between residential mobility and preterm birth (Aim 2). The qualitative analysis was completed using realist ground theory. RESULTS Quantitative Findings: Residence in low-income neighborhoods with advanced gentrification was associated with lower odds of preterm birth (aOR= 0.818, 95% CI: 0.642,1.042). Housing insecurity partially suppressed the association. The relationship between residential mobility trajectory and preterm birth is conditional on WIC participation. Out-migration was only associated with preterm birth among non-WIC participants (aOR=1.548; 95% CI: 0.875,2.736). While moving between cities losing Black population was associated with higher odds of preterm birth for WIC participants (aOR= 3.481; 95% CI: 1.363,8.889). Qualitative Findings: Several processes linked regional inequality to preterm birth risk: Wealth and resource hoarding at different scales leaves Black birthing people with insecure access to health-promoting resources. Black women’s willingness and ability to engage in health and support services is hindered by the fragmentation of the social safety net and the policing of Black mothers in “care” settings. Landlord discrimination and exploitation geographically sorts and; and community-driven resistance and advocacy. DISCUSSION AND CONCLUSION The findings demonstrate that gentrification and residential mobility can influence preterm birth among Black individuals in the San Francisco Bay Area in unexpected ways. Major limitations include selection bias, the inability to measure housing tenure or mobility intention, and inadequacy of several measures including housing insecurity and social class. The findings in this study suggest that greater attention should be given to the forces that sort people into places and the policies that provide people with more control in their residential environments. Policies that maximize poor and working people’s ability to remain in or move to places that are supportive and safe may reduce chronic stress, and preterm birth among Black women in the Bay Area.

Background

People living with HIV/AIDS (PLWHA) in rural Anhui, China face tremendous challenges, which may influence access to healthcare. This two-part study explored these issues. First, a quantitative study examined whether (a) two dimensions of HIV-related stigma (i.e., perceived stigma and internalized shame) or (b) three dimensions of social support (i.e., emotional support, tangible support, and affectionate support) are associated with access to care among HIV-positive men and women in rural Anhui, China. Second, a critical performance written and performed by the author applies ethnodrama strategies to explore HIV stigma and social support in Anhui Province.

Methods

The conceptual model integrates theoretical concepts of stigma and social support into Andersen’s Behavioral Model of Health Services Use. This was a secondary analysis of baseline data from participants (N = 522 PLWHA) in the Together for Empowerment Activities (TEA) study, a randomized controlled intervention trial among HIV-affected families in rural Anhui, China. The data were collected between October 2011 and March 2013 via computer-assisted personal interviewing. The analyses involved mixed-effects, multiple linear regression with village-level random effects to control for variance clustering by the village. Conquergood and ethnodrama strategies informed the elements included in the performance: movement, original text, quotes from PLWHA, and spectacle such as photographs, set, and props.

Results

Higher levels of perceived stigma were associated with poorer access to care (estimated difference = – 0.08, p = 0.015). With respect to social support, only higher levels of affectionate support were associated with greater access to care (estimated difference = 0.43, p < 0.0001). Tangible support was inversely associated with access to care (estimated difference = – 0.17, p = 0.003). Neither internalized shame nor emotional support was associated with access to care (p > 0.05).

Discussion

This study underscores complexities between HIV-related stigma, social support and access to care in rural Anhui, China. Future research should explore whether adverse effects exist for managing HIV disease in this region. Performance represents a potentially powerful, non-traditional approach to discussing these issues and disseminating some findings; future work should explore whether this holds in Anhui Province.

At least one in four U.S. women experiences intimate partner violence (IPV) in her lifetime regardless of personal demographic factors. Every year, 5.3 million IPV victimizations occur among women aged 18 and older, many which require medical attention. Additionally, the U.S. is a main source, destination, and transportation hub for individuals forced into human trafficking, especially women and girls. Healthcare providers could be critical in the process of screening and identifying IPV and human trafficking victims, but they may experience personal and institutionalized barriers that prevent them from doing so. A cross-sectional study was conducted on a convenience sample of healthcare providers in California (n = 148), which assessed whether healthcare providers' demographics, training, knowledge, patient characteristics, and practice setting were associated with frequency of screening, quality of screening question, and identifying victims. Findings indicate that healthcare provider characteristics are not predictive of how often a provider screens for IPV or how many women are identified as victims; however, serving low-income patients and receiving recent training are. Lastly, the specificity and depth of a screening question is unimportant; simply asking any "screening" question may open conversations in ways that enable intervention for IPV victims.

Background: The first community health centers (CHCs) were created to address the lack of health care services in segregated Black communities, but little research has empirically investigated the relationship between CHC access, medical underservice, and racial residential segregation.Objective: Using Black feminist thought, Critical Race Theory, and the Public Health Critical Race Praxis, this study examined how the residential segregation of Black Americans was associated with medical underservice and CHC expansion between fiscal years 2011 and 2019 among 3 populations: 1) US metropolitan counties; 2) Cook County, IL municipalities; and 3) Chicago census tracts (i.e., neighborhoods). Data: I linked CHC and medically underserved area/population (MUA/P) data from the Health Resources and Services Administration (2010-2019) to demographic, population health, and housing data from multiple sources including the: American Community Survey (2011-2015), Home Mortgage Disclosure Act (2010) and Home Owners’ Loan Corporation (HOLC) (1940). Measures: CHC expansion was first measured as a binary indicator of whether an area had at least 1 new CHC between FYs 2011 and 2019, and then as the number of new CHCs an area gained. MUA/P designation was a binary indicator of whether an area had at least 1 MUA/P designation between FYs 2011 and 2019. Segregation was measured using the dissimilarity and isolation indices for US counties and the index of concentration at the extremes for Cook County municipalities. For Chicago census tracts I measured contemporary redlining using racialized neighborhood credit refusal (an indication of whether a tract has a high proportion of denied mortgage loans and a majority Black population) and historical redlining using perceived mortgage foreclosure risk (a grade from A to D assigned by the HOLC). Analysis: The descriptive analysis compared the characteristics of CHC expansion and nonexpansion areas and geographic variation CHC expansion, MUA/P designations, and segregation. I estimated multivariate logistic and negative binomial models and compared estimates from the national and local samples. Results: Between FYs 2010 and 2019, the number of CHCs among US metropolitan counties in the sample increased from 3,687 to 10,305. Counties with higher Black-White dissimilarity and Black isolation were more likely to gain a new CHC and had a larger number of new CHCs. MUA/P designation only mediated the association between CHC expansion and isolation. At the local level, among Cook County municipalities, the concentration of Black and White residents was not significantly associated with CHC expansion or MUA/P designation between FYs 2011 and 2019. Among Chicago neighborhoods, there was a positive association between MUA/P eligibility and MUA/P designation and the association was moderated by contemporary redlining. Conclusion: The Patient Protection and Affordable Care Act of 2010 created the Community Health Center Fund, a multibillion-dollar investment in CHC expansion. Although the number of CHCs increased drastically, the results from this study suggest racialized geographic inequities in CHC expansion and MUA/P designations existed during the first 9 years of the fund.