Inadequate Access To Health Care Research Articles

Improving Health Equity for Women Involved in the Criminal Legal System.

Improving Health Equity for Women Involved in the Criminal Legal System.

Self-reported access to health care, communicable diseases, violence and perception of legal status among online transgender identifying sex workers in the UK

ObjectivesTransgender-identifying sex workers (TGISWs) are among the most vulnerable groups but are rarely the focus of health research. Here we evaluated perceived barriers to healthcare access, risky sexual behaviours and exposure to violence in the United Kingdom (UK), based on a survey of all workers on BirchPlace, the main transgender sex commerce website in the UK. Study designThe study design used in the study is an opt-in text-message 12-item questionnaire. MethodsTelephone contacts were harvested from BirchPlace's website (n = 592 unique and active numbers). The questionnaire was distributed with Qualtrics software, resulting in 53 responses. ResultsOur survey revealed significant reported barriers to healthcare access, exposure to risky sexual behaviours and to physical violence. Many transgender sex workers reportedly did not receive a sexual screening, and 28% engaged in condomless penetrative sex within the preceding six months, and 68% engaged in condomless oral sex. 17% responded that they felt unable to access health care they believed medically necessary. Half of the participants suggested their quality of life would be improved by law reform. ConclusionsTGISWs report experiencing a high level of risky sexual behaviour, physical violence and inadequate healthcare access. Despite a National Health System, additional outreach may be needed to ensure access to services by this population.

Telehealth in response to the COVID-19 pandemic: Implications for rural health disparities.

Telehealth programs have long held promise for addressing rural health disparities perpetuated by inadequate healthcare access. The COVID-19 (coronavirus disease 2019) pandemic and accompanying social distancing measures have hastened the implementation of telehealth programs in hospital systems around the globe. Here, we provide specific examples of telehealth efforts that have been implemented in a large rural healthcare system in response to the pandemic, and further describe how the massive shift to telehealth and reliance on virtual connections in these times of social isolation may impact rural health disparities for those without access to necessary broadband to deploy digital technologies. Finally, we provide recommendations for researchers and policymakers to ensure that telehealth initiatives do not amplify existing health disparities experienced by those living in rural communities.

LGBT friendly healthcare providers' tobacco treatment practices and recommendations.

This study aimed to describe lesbian, gay, bisexual, and transgender (LGBT) friendly providers' (1) smoking cessation recommendations to LGBT patients and (2) tobacco treatment practices for transgender patients. In-depth, semistructured phone interviews were conducted with 13 healthcare providers. Four overarching themes emerged: (1) providing tobacco treatment services for LGBT patients; (2) barriers to LGBT smoking cessation; (3) prescribing practices for transgender individuals taking estrogen hormone therapy; (4) provider community outreach to promote LGBT smoking cessation. Holistic tobacco treatment services are needed to address LGBT-specific barriers to tobacco cessation, such as stress, identity-related factors, and inadequate healthcare access.

Perceptions of opioid misuse and chronic pain: A qualitative assessment of Rhode Island commercial fishing captains.

To better understand how the contextual circumstances and lifestyle of commercial fishermen influence their access to healthcare and potentially contribute to the use and misuse of opioids. The authors conducted in-person, semistructured interviews with 15 full-time fishing captains in Rhode Island between the months of May and July of 2017. The authors identified five major themes: Recurrent patterns of addiction and opiate use among crewmembers; chronic pain and injury as common constructs of life in the fishing industry; insufficient pain management resources; practical barriers to obtaining primary healthcare; and perceived lack of support from state government. Rhode Island commercial fishing captains perceived opioid misuse among crewmembers, work-related chronic pain, and inadequate healthcare access as barriers to sustainability of their industry.

Highlights of This Issue

Alcohol consumption is associated with increased risk of numerous cancers, but existing evidence for an association with melanoma is equivocal. Rivera and colleagues used data from three large prospective cohort studies to investigate whether alcohol intake was associated with risk of melanoma. The authors report an association between higher alcohol intake and incidence of invasive melanoma. Among alcoholic beverages, white wine consumption was associated with an increased risk of melanoma. These findings further support American Cancer Society Guidelines for Cancer Prevention to limit alcohol intake.Vitamin D deficiency is associated with cancer and autoimmune diseases, but little is known about the association between vitamin D and antinuclear antibodies (ANA), a biomarker of immune dysfunction in healthy populations. Meier and colleagues examined if vitamin D deficiency is associated with ANA in middle-aged and older U.S. adults using data from the National Health and Nutrition Examination Survey 2001–2004. Greater vitamin D deficiency was associated with higher ANA prevalence in the unadjusted logistic regression model. Those with severe vitamin D deficiency had 2.99 times the odds of ANA compared to those having normal vitamin D levels.Higher cancer-related mortality has been observed among people with mental health disorders, possibly due to delay in diagnosis and/or inadequate health care access. Lin and colleagues used the U.S. Military Health System, where there are no or minimal barriers to health care access, to study this disparity. Patients with preexisting mental disorders did not present with more advanced disease at diagnosis, and there were no significant differences in receiving cancer treatments between the two groups. However, lung cancer patients with a mental health disorder did show higher mortality than those without.To understand breast cancer risk disparities in Asian American women, Wu and colleagues examined breast cancer risk factors in Filipina, Japanese, and Chinese Americans from the Los Angeles County Cancer Surveillance Program. In Filipina, Chinese, and Japanese Americans, breast cancer risk decreased significantly with increasing parity. Breast cancer risk increased with increasing quartiles of cumulative menstrual months in premenopausal and postmenopausal Filipina, and in in premenopausal but not postmenopausal Chinese. For postmenopausal Filipina and Japanese, greater weight gain since age 18, high current body mass index, and greater waist circumferences were all statistically significant.

An In-Depth and Updated Perspective on Determinants of Cervical Cancer Screening Among Central Appalachian Women

ABSTRACT Although cervical cancer rates in the U.S. have declined sharply, certain groups remain at elevated risk, including Appalachian women. To establish culturally-relevant cervical cancer prevention programs requires a comprehensive, current understanding of the factors which influence women's decisions to undergo Pap tests. Since most studies that found low rates of Pap test use in Appalachia were carried out decades ago, an in-depth update is warranted. Local, trained interviewers conducted interviews with rarely or never screened Appalachian women from Kentucky and West Virginia. Sessions were tape recorded, transcribed, and content analyzed. Participants (N = 25) suggested the following positive influences on obtaining screening: having an orientation toward the use of preventive health services; having health insurance and access to a good medical environment; and maintaining a flexible enough schedule to keep appointments. Screening barriers included: fear of subjecting oneself to medical scrutiny because of obesity or being a smoker; inadequate health care access such as clinician shortages, scarcity of specialty providers, long travel time to services, and clinic schedules that do not accommodate working women; and lack of providers' recommendations. Rarely mentioned were some previously reported factors including male relatives' refusal to permit Pap tests, concern over privacy, and lack of belief in Pap tests.