Low-income Immigrants Research Articles

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

(JAMA. 2023;330(3):238–246) While physicians and professional medical organizations advocate for routine postpartum care for adults, some states impose restrictions on public insurance coverage for undocumented immigrants and immigrants granted legal documentation status within the past 5 years. The aim of this study was to investigate the relationship between public insurance coverage and postpartum care among low-income immigrants and to determine the difference in postpartum care receipt between immigrants and nonimmigrants.

Diagnosis of Perinatal Mental Health Conditions Following Medicaid Expansion to Include Low-Income Immigrants

For some low-income people, access to care during pregnancy is not guaranteed through Medicaid, based on their immigration status. While states have the option to extend Emergency Medicaid coverage for prenatal and postpartum care, many states have not expanded coverage. To determine whether receipt of first prenatal care services and subsequently receipt of postpartum care through extensions of Emergency Medicaid coverage were associated with increases in diagnosis and treatment of perinatal mental health conditions. This cohort study used linked Medicaid claims and birth certificate data from 2010 to 2020 with a difference-in-difference design to compare the rollout of first prenatal care coverage in 2013 and then postpartum services in Oregon in 2018 with a comparison state, South Carolina, which did not cover prenatal or postpartum care as part of Emergency Medicaid and only covered emergent conditions and obstetric hospital admissions. Medicaid claims and birth certificate data were linked by Medicaid identification number prior to receipt by the study team. Participants included recipients of Emergency Medicaid who gave birth in Oregon or South Carolina. Data were analyzed from April 1 to October 15, 2023. Medicaid coverage of prenatal care and Medicaid coverage of postpartum care. The main outcome was the diagnosis of a perinatal mental health condition within 60 days postpartum. Secondary outcomes included treatment of a mood disorder with medication or talk therapy. The study sample included 43 889 births to Emergency Medicaid recipients who were mainly aged 20 to 34 years (32 895 individuals [75.0%]), multiparous (33 887 individuals [77.2%]), and living in metropolitan areas (32 464 individuals [74.0%]). Following Oregon's policy change to offer prenatal coverage to pregnant individuals through Emergency Medicaid, there was a significant increase in diagnosis frequency (4.1 [95% CI, 1.7-6.5] percentage points) and a significant difference between states in treatment for perinatal mental health conditions (27.3 [95% CI, 13.2-41.4] percentage points). Postpartum Medicaid coverage (in addition to prenatal Medicaid coverage) was associated with an increase of 2.6 (95% CI, 0.6-4.6) percentage points in any mental health condition being diagnosed, but there was no statistically significant difference in receipt of mental health treatment. These findings suggest that changing Emergency Medicaid policy to include coverage for prenatal and 60 days of postpartum care for immigrants is foundational to improving maternal mental health. Expanded postpartum coverage length, or culturally competent interventions, may be needed to optimize receipt of postpartum treatment.

Medicaid Expansion Through the Affordable Care Act and Interstate Mobility of Low-Income Immigrants: Welfare Magnet or Myth?

Medicaid Expansion Through the Affordable Care Act and Interstate Mobility of Low-Income Immigrants: Welfare Magnet or Myth?

State Public Insurance Coverage Policies and Postpartum Care Among Immigrants

Professional medical organizations recommend that adults receive routine postpartum care. Yet, some states restrict public insurance coverage for undocumented immigrants and recently documented immigrants (those who received legal documentation status within the past 5 years). To examine the association between public insurance coverage and postpartum care among low-income immigrants and the difference in receipt of postpartum care among immigrants relative to nonimmigrants. A pooled, cross-sectional analysis was conducted using data from the Pregnancy Risk Assessment Monitoring System for 19 states and New York City including low-income adults with a live birth between 2012 and 2019. Giving birth in a state that offered public insurance coverage for postpartum care to recently documented or undocumented immigrants. Self-reported receipt of postpartum care by the category of coverage offered (full coverage: states that offered publicly funded postpartum care regardless of immigration status; moderate coverage: states that offered publicly funded postpartum care to lawfully residing immigrants without a 5-year waiting period, but did not offer postpartum care to undocumented immigrants; no coverage: states that did not offer publicly funded postpartum care to lawfully present immigrants before 5 years of legal residence or to undocumented immigrants). The study included 72 981 low-income adults (20 971 immigrants [29%] and 52 010 nonimmigrants [71%]). Of the 19 included states and New York City, 6 offered full coverage, 9 offered moderate coverage, and 4 offered no coverage; 1 state (Oregon) switched from offering moderate coverage to offering full coverage. Compared with the states that offered full coverage, receipt of postpartum care among immigrants was 7.0-percentage-points lower (95% CI, -10.6 to -3.4 percentage points) in the states that offered moderate coverage and 11.3-percentage-points lower (95% CI, -13.9 to -8.8 percentage points) in the states that offered no coverage. The differences in the receipt of postpartum care among immigrants relative to nonimmigrants were also associated with the coverage categories. Compared with the states that offered full coverage, there was a 3.3-percentage-point larger difference (95% CI, -5.3 to -1.4 percentage points) in the states that offered moderate coverage and a 7.7-percentage-point larger difference (95% CI, -10.3 to -5.0 percentage points) in the states that offered no coverage. Compared with states without insurance restrictions, immigrants living in states with public insurance restrictions were less likely to receive postpartum care. Restricting public insurance coverage may be an important policy-driven barrier to receipt of recommended pregnancy care and improved maternal health among immigrants.

Immigration, Income, and Public Transit Perceptions: Findings from an Intercept Survey

Although a significant fraction of public transit riders in the United States are immigrants, relatively little research explores whether immigrants have unique transit experiences. This paper analyzes intercept survey data from 1,247 transit riders in the San Francisco Bay Area to explore how mode choices and travel experiences differ for low-income immigrants compared to higher-income immigrants and US-born residents. We find that some public transit experiences are similar across all immigrant status and income groups, while in other ways low-income immigrants differ from their higher-income counterparts or from US-born respondents. In particular, low-income immigrants were less likely to have a bus pass or bicycle access. They were far more likely to substitute driving for taking public transit than all other immigrant and income groups. The results underscore the importance of collecting data on country of origin together with travel behavior data, because many experiences are more burdensome for low-income immigrants.

Charitable Legal Immigration Programs and the US Undocumented Population: A Study in Access to Justice in an Era of Political Dysfunction

This study examines the legal capacity available to low-income immigrants on national, state and sub-state levels. Legal professionals working in charitable immigration service programs serve as the study's rough proxy for legal capacity, and undocumented immigrants its proxy for legal need. The Center for Migration Studies of New York (CMS) compiled data on charitable immigration programs and their legal professionals from the: US Department of Justice's (DOJ's) “Recognized Organizations and Accredited Representatives Roster by State and City,” which is maintained by the Executive Office for Immigration Review's (EOIR's) Office of Legal Access Programs (OLAP). Directories of two leading, legal support agencies for charitable immigration legal programs, the Catholic Legal Immigration Network, Inc. (CLINIC) and the Immigrant Advocates Network (IAN). CMS supplemented and updated these sources with information from the websites of charitable immigration programs. It also added legal programs to its dataset that did not appear in any of these lists. It counted as legal professionals, attorneys, federally accredited non-attorneys, paralegals and legal assistants. The paper finds that there are 1,413 undocumented persons in the United States for every charitable legal professional, and far less capacity than the national average in: States such as Alabama (6,656 undocumented per legal professional), Hawaii (4,506), Kansas (3,010), Georgia (2,853), New Jersey (2,687), Florida (2,681), North Carolina (2,671), Virginia (2,634) and Arizona (2,561). Metropolitan areas (MAs) such as Riverside-San Bernardino-Ontario (5,307), Dallas-Fort Worth-Arlington (4,436), Phoenix-Mesa-Scottsdale (3,439) and Houston-The Woodlands-Sugar Land (3,099). San Bernardino County (6,178), Clark County (4,747), Riverside County (4,625), Tarrant County (3,955) and Dallas County (3,939). The study's introduction summarizes its top-line findings. Its first section describes the importance of charitable immigration legal programs to immigrants, families and communities. Its second details the study's findings on charitable legal capacity and immigrant need. Its third compares the legal capacity of 1,803 charitable legal programs and their 7,322 legal professionals, with the US undocumented population by state and for the 15 largest MAs and counties. Its fourth describes CMS's research methodology and data sources. The paper ends with policy recommendations on how to expand legal capacity for low-income immigrants and better assess legal capacity and need moving forward.

327-OR: Preliminary Outcomes of a Social Media–Based Diabetes Intervention among Low-Income Chinese Immigrants

Purpose: Mobile health holds strong promise to increase access to diabetes self-management education (DSME) programs in underserved communities. In this report, we examined the preliminary outcomes of a social media-based DSME intervention in low-income Chinese immigrants with type 2 diabetes (T2D) . Methods: We conducted a single-group pilot study in 30 Chinese immigrants with T2D living in NYC in 2020. Over 12 weeks, participants received 2 brief culturally and linguistically tailored DSME videos each week via WeChat, a free and popular social media app among Chinese immigrants. Participants completed baseline and 6-month surveys with self-efficacy, diabetes self-care behaviors, dietary intake, and physical activity measures. Paired t-tests were used to examine changes over time. Results: Of the 30 participants, mean (SD) age was 61.2 (6.7) years, 70.0% were women, 63.3% reported high school education, 84.0% reported annual family income of < $25,000, 63.3% were married, and 86.7% had limited English proficiency. Compared to baseline, there were significant improvements in participants’ self-efficacy, diabetes self-care behaviors, dietary intake and physical activity at 6 months (see Table 1) . Conclusions: Our social media-based DSME intervention demonstrated promising results in improving psychosocial and behavioral outcomes in low-income older Chinese immigrants with T2D. Disclosure L.Hu: None. N.Islam: None. N.Jiang: None. K.Tamura: None. R.Jagannathan: None. A.Y.Kharmats: None. O.Bubu: None. M.Sevick: None. Funding NIH K99MD0128 (PI Dr. Lu Hu) ; NIH R00MD0128 (PI Dr. Lu Hu) , Dr. Anna Kharmats was supported by a postdoctoral training grant from the National Institutes of Health (5T32HL129953-04)

Responding to the Disproportionate Impact of COVID-19 Among Latinx Patients in Baltimore: The JHM Latinx Anchor Strategy.

Latinx immigrants have been profoundly impacted by COVID-19. As the Johns Hopkins Health System faced a surge in admissions of limited English proficiency patients with COVID-19, it became evident that an institutional strategy to address the needs of this patient population was needed. The Johns Hopkins Medicine (JHM) Latinx Anchor Strategy was established in April 2020 with diverse stakeholder engagement to identify the most urgent community needs and develop timely solutions. The JHM Latinx Anchor Strategy provided a platform for information sharing to promote equitable access to resources for Latinxs with limited English proficiency who were impacted by COVID-19. Leveraging institutional, community, and government resources and expertise, the JHM Latinx Anchor Strategy helped establish interventions to improve access to COVID-19 testing and care for low-income immigrants without a primary care doctor and helped mitigate economic vulnerability through the distribution of food for 2,677 individuals and cash to 446 families and 95 individuals (May to August 2020). Expanded linguistic and culturally competent communication through webinars and livestream events reached more than 10,000 community members and partners. Over 7,500 limited English proficiency patients received linguistically congruent direct patient services through the Esperanza Center bilingual hotline, community testing resulting efforts, and inpatient consultations. The first stage of the JHM Latinx Anchor Strategy relied heavily on volunteer efforts. Funding for a sustainable response will be required to address ongoing COVID-19 needs, including expansion of the bilingual/bicultural healthcare workforce, expanded access to primary care, and investments in population health strategies addressing social determinants of health.

Expanded Access to Postabortion Contraception under Oregon's Reproductive Health Equity Act.

We describe the first 24months of expanded family planning services for low-income immigrants under Oregon's Reproductive Health Equity Act. We examined postabortion contraceptive use in rural versus urban locations. We conducted a historical cohort study of abortion services reimbursed under the Reproductive Health Equity Act in the first 2years after its implementation (2018 and 2019). Our primary outcome was shift in contraceptive tier from a less effective method before an abortion to a more effective contraceptive method after an abortion. Our key independent variable was residence in a metropolitan or nonmetropolitan area. We tested the association of nonmetropolitan residence and shift to a tier 1 or tier 2 method after the abortion, controlling for other factors, using logistic regression. Our analysis included 625 abortions from across the state. After an abortion, 68% of women transitioned to a more effective form of contraception. Nonmetropolitan residence was not significantly associated with a shift from no method or a tier 3 method to tier 1 or tier 2 method (adjusted odds ratio, 1.28; 95% confidence interval, 0.81-2.02) compared with metropolitan residence. The program was successful in helping women not wishing pregnancy to transition to a more effective contraceptive method postabortion, regardless of metropolitan location of residence.

Disparities in postpartum contraceptive use among immigrant women with restricted Medicaid benefits

BACKGROUNDThe Emergency Medicaid program offers restricted Medicaid benefits for people who meet the same financial eligibility criteria as Traditional Medicaid recipients but do not meet the citizenship requirements for enrollment in Traditional Medicaid. By federal law, Emergency Medicaid covers care for life-threatening emergencies or a hospital admission for childbirth. No prenatal or postpartum care is covered. Most of the women enrolled in Emergency Medicaid are Latina.OBJECTIVEWe assessed postpartum visits and receipt of postpartum contraception and compared the outcomes for Emergency (restricted benefit) Medicaid recipients with those of Traditional (full-benefit) Medicaid recipients in Oregon and South Carolina, 2 states with similar-sized immigrant populations.STUDY DESIGNWe conducted a retrospective cohort study using linked Medicaid claims and birth certificate data of live births covered by Medicaid (Traditional and Emergency) between January 1, 2010 and September 30, 2017, in Oregon and South Carolina. Our analysis was at the individual level. Primary outcomes were postpartum visit attendance and receipt of postpartum contraception within 2 months. We examined differences in demographic and delivery characteristics by Medicaid type. If women received postpartum contraception, we compared the timing of receipt (immediate postpartum, ≤1 month, 1–2 months, and 2–6 months after delivery) by the type of Medicaid. Among women using contraception, we described the type of contraceptive received at each time point, stratified by Medicaid type. Associations between Medicaid type (Traditional vs Emergency) and postpartum visit attendance and contraception use were assessed using adjusted absolute predicted probabilities from logistic regression models. We ran models for the entire cohort and conducted a subanalysis restricted to only Latina women.RESULTSOur study included 375,544 live births to 288,234 women, with 12.7% of births among Emergency Medicaid recipients. Women enrolled in Emergency Medicaid tended to be older (age >35 years; 18.1% vs 7.2%; P<.001) and were more likely to be multiparous (76.8% vs 60.8%; P<.001) and Latina (80.3% vs 9.5%; P<.001) than their Traditional Medicaid peers. Among women enrolled in Emergency Medicaid, the probability of having a postpartum visit was 6.1% (95% confidence interval, 5.9–6.4) compared with 58.8% (95% confidence interval, 58.6–58.9) for women covered by Traditional Medicaid. After 6 months following delivery, 97.6% of Emergency Medicaid recipients had no evidence of contraceptive use compared with 55.6% of Traditional Medicaid enrollees (P<.001). In our adjusted model, Emergency Medicaid recipients were also significantly less likely to receive postpartum contraception than Traditional Medicaid enrollees (1.9% vs 35.5%; 95% confidence interval, [1.8–2.1] vs [35.4–35.7]). We examined the role that race may play in postpartum contraceptive use by conducting a subanalysis restricted to Latina women only.Latinas with births covered by Emergency Medicaid had a 1.9% (95% confidence interval, 1.8–2.0) adjusted probability of postpartum contraception use within 2 months compared with 39.8% (95% confidence interval, 38.7–39.9) among Latinas enrolled in Traditional Medicaid.CONCLUSIONWomen enrolled in Emergency Medicaid experience large disparities in postpartum care and contraceptive use. Policies that restrict Medicaid coverage following delivery exacerbate inequities in postpartum care, potentially leading to worse health outcomes for low-income immigrants and their children.

Incorporating children's views and perceptions about urban mobility: Implementation of the “philosophy with children” inquiry approach with young children

There is an increasing concern among scholars and practitioners to incorporate children's views and perceptions about their daily mobility, followed by the search for structured approaches for data collection and analysis. This paper draws on academic research conducted with 5 to 6-year old children and their caregivers (N = 317) in three public preschools in São Paulo (Brazil) with a high prevalence of low-income immigrants, using the “Philosophy with Children” (PwC) inquiry approach. Once the PwC sessions were transcribed and associated to the questionnaires to caregivers (73% response rate), it was possible to adopt a set of qualitative analysis tools to extract children's views and perceptions about urban mobility, namely topic modelling (Latent Dirichlet Allocation) and sentiment analysis (AFINN and Bing sentiment lexicons). These allowed the identification of variables affecting the opinions shared by young children about urban mobility, including more negative perceptions among boys, non-native children, and those in high social vulnerability. Beyond revealing a potential of the PwC approach to enquire children about their established travel behavior, the implementation of the proposed inquiry sessions covered an age group that is commonly disregarded in most of transport-related studies involving children and youth while encompassing a context of public schools in a developing country, with a high prevalence of low-income and immigrant families.

Putting out the ‘unwelcome mat:’ The Announced Public Charge Rule reduced safety net enrollment among exempt noncitizens

Government action shapes the perceived and actual costs of citizens’ interactions with the state. By manipulating these costs, policymakers can affect citizens’ willingness to engage with the state, strongly impacting short- and long-term wellbeing. In September 2018, the Trump administration announced its intention to change how an immigrant’s likelihood of becoming a “public charge” would be evaluated. Once adopted, the rule would penalize certain classes of noncitizens for using safety net programs, potentially jeopardizing their application for permanent residence. We hypothesize that this proposed change increased psychological and learning burdens for low-income immigrants well beyond those directly impacted by the rule. Specifically, we used difference-in-differences models to analyze whether the announcement reduced safety net use among two groups exempt from the rule’s provisions: any WIC enrollee and noncitizen SNAP enrollees that are already legal permanent residents, refugees, or asylees. Even though the WIC program was excluded from the proposed rule, we find reductions in overall WIC use after the announcement. In addition, we show that SNAP enrollment decreased differentially after the announcement for noncitizens, nearly all of whom were likely exempt from the rule.

Pre-COVID-19 Social Determinants of Health Among Mexican Migrants in Los Angeles and New York City and Their Increased Vulnerability to Unfavorable Health Outcomes During the COVID-19 Pandemic.

COVID-19 has disproportionally affected underrepresented minorities (URM) and low-income immigrants in the United States. The aim of the study is to examine the underlying vulnerabilities of Mexican immigrants in New York City (NYC) and Los Angeles (LA), its correspondence with area-level COVID-19 morbidity and mortality, and to document the role of trusted and culturally sensitive services offered during the pandemic through the Ventanillas de Salud (i.e. VDS, Health Windows) program. The study uses a mixed-methods approach including a cross-sectional survey of Mexican immigrants in LA and NYC collected in the Mexican Consulates at the onset of the pandemic, complemented with a georeferencing analysis and key informant interviews. Data suggested an increased vulnerability to COVID-19 given participants reported health status, health care profile and place of residence, which coincided with the georeferencing analysis. The key informant interviews confirmed the vulnerability of this population and the supporting role of VDS in helping immigrants navigate health systems and disseminate health information. Mexican immigrants had an increased vulnerability to COVID-19 at the individual, geographic and systemic levels. Trusted and culturally sensitive services are needed to overcome some of the barriers and risk factors that increase the vulnerability of URM and immigrant populations to COVID-19.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10903-021-01283-8.

Immigrant Communities and COVID-19: Strengthening the Public Health Response.

The COVID-19 pandemic has exposed the many broken fragments of US health care and social service systems, reinforcing extant health and socioeconomic inequities faced by structurally marginalized immigrant communities. Throughout the pandemic, even during the most critical period of rising cases in different epicenters, immigrants continued to work in high-risk-exposure environments while simultaneously having less access to health care and economic relief and facing discrimination. We describe systemic factors that have adversely affected low-income immigrants, including limiting their work opportunities to essential jobs, living in substandard housing conditions that do not allow for social distancing or space to safely isolate from others in the household, and policies that discourage access to public resources that are available to them or that make resources completely inaccessible. We demonstrate that the current public health infrastructure has not improved health care access or linkages to necessary services, treatments, or culturally competent health care providers, and we provide suggestions for how the Public Health 3.0 framework could advance this. We recommend the following strategies to improve the Public Health 3.0 public health infrastructure and mitigate widening disparities: (1) address the social determinants of health, (2) broaden engagement with stakeholders across multiple sectors, and (3) develop appropriate tools and technologies. (Am J Public Health. 2021;111(S3):S224-S231. https://doi.org/10.2105/AJPH.2021.306433).

1-OR: A Social Media-Based Intervention Improves Glycemic Control in a Low-Income Older Immigrant Population

Purpose: Access to in-person diabetes self-management education (DSME) programs is limited in underserved immigrant communities. In this report, we examined the feasibility, acceptability, and potential efficacy of a social media-based DSME intervention in low-income older Chinese immigrants with type 2 diabetes (T2D). Methods: This was a single-group study in 30 Chinese immigrants with T2D living in NYC. The intervention included 24 culturally and linguistically tailored DSME videos. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Feasibility was defined as ability to achieve: 1) the recruitment goal (n=30); 2) ­&amp;gt;80% retention; and 3) &amp;gt;80% watch rate. Acceptability was assessed via a satisfaction survey at 6 months. HbA1c was collected at baseline and 6 months Results: Recruitment was completed prior to the NYC COVID-19 lockdown. Despite COVID-19, the intervention continued without interruption. Participants were mostly female (70.0%), married (63.3%), with limited English proficiency (86.7%), and a mean age of 61.2 (SD=6.7) years old. Most reported an annual household income of &amp;lt; $25,000 (84.0%) and an education of high school or less (63.3%). Thirty participants were recruited within 2 months, 93.3% were retained at 6 months, and a video watch rate of 92.2% was achieved. The mean baseline HbA1c was 7.4% (SD=1.2) and declined by 0.6% (95% CI: 0.3%-0.9%, p=0.001) to 6.8% (SD=0.8) at 6 months. Participants expressed high satisfaction (96.4%), and all strongly agreed or agreed that they preferred this video-based DSME to face-to-face visits. Conclusions: This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in an aging low-income immigrant population with T2D. These findings provide timely implications in the era of COVID-19, suggesting older low-income immigrants can be engaged in mHealth interventions. Disclosure L. Hu: None. N. Islam: None. A. Y. Kharmats: None. K. Tamura: None. S. Yang: None. X. Xu: None. B. Fan: None. M. Sevick: None. Funding National Institutes of Health (K99MD012811, R00MD012811)

53-LB: Prevalence and Correlates of Diabetes Distress in Low-Income Immigrants with Type 2 Diabetes

Objective: The American Diabetes Association has called for more research on distress in adults with type 2 diabetes (T2D). There is a dearth of data on diabetes distress in underserved immigrants. This study aimed to examine prevalence and correlates of diabetes distress among Chinese immigrants with T2D. Methods: A cross sectional study was conducted among Chinese immigrants with T2D in New York City in 2018. Sociodemographic survey and diabetes distress scale (DDS) were administered face-to-face by bilingual study staff. DDS is a validated 17-item survey to assess diabetes distress and includes 4 subscales: physician, regimen, interpersonal, and emotional-related distress. Responses for each item ranged from 1 (not a problem) to 6 (a very significant problem) with a score greater than 2 indicating a clinically significant and at least a moderate level of distress. Descriptive statistics and multivariable logistic regression modeling were used. Results: The sample (N=94) was mostly female (60.6%), married (75.5%), retired (57.4%), limited English proficient (86.2%) with a mean age of 70.6 (SD=11.6). The majority of participants had a high school education or less (61.7%) and a household income of ≤$25,000/yr (69.1%). Overall, 23.4% of the participants reported at least a moderate level of distress. The most common sources of distress were emotional burden (33.0%), followed by regimen (30.9%), interpersonal (29.8%), and physician (18.1%). Compared to those who were currently employed, those who were retired had a lower odds of diabetes distress (OR=0.12, 95% CI 0.02-0.83). Age, gender, years living in the US, education, and income were not significant correlates. Conclusions: We found high rates of diabetes distress and emotional burden among Chinese immigrants with T2D. Given the known link between diabetes distress and poor health outcomes, it may be important to consider screening for diabetes distress and incorporating psychological counseling in diabetes care. Disclosure L. Hu: None. X. Xu: None. S. Yang: None. L. Lei: None. H. Bao: None. B. Fan: None. M. Sevick: None. Funding National Institutes of Health (U54MD000538-15, K99MD012811, R00MD012811, P30DK111022)

Measuring the Satisfaction of Residents of Mehregan Township of Mashhad from Sustainable Housing Perspective

Demographic developments in Mashhad and surrounding rural areas which are now considered urban break points It is well established that these areas have become centers of attraction for low-income immigrants who intend to migrate to Mashhad, as well as low-income urban strata that have previously lived in Mashhad. Since all four types of worn-out urban textures, including urban heritage, non-urban, marginal and rural urban textures, are the middle and lower decay habitats, "The 5000 unit project of Mehregan Town of Mashhad" has played an important role in the physical and functional organization of these tissues and responding to the needs of the poor. In view of the above, and several years after the project was inaugurated, the superstructure and infrastructure problems of the project are the subject of research in this research. The research method in this study was descriptive-analytical and applied. According to the number of households in the city that formed the statistical population of the study, and based on Cochran's formula, the sample population was 366 persons. Also, Delphi method has distributed 32 questionnaires to expert experts. Descriptive and inferential statistical analysis of completed questionnaires and experts has been done with the help of nonparametric and parametric statistical methods. The results of field surveys showed that the observed frequency of low-satisfaction residents was 222 and above all, so it is safe to say that 95% of respondents are not satisfied with their residence in Mehregan town. It is believed that the residential units constructed in Mehregan town of Mashhad have poor compliance with the standards and standards of sustainable housing.

Abstract PR04: Low-income minorities and immigrants are priority targets in late stage hepatocellular carcinoma hotspots

Abstract Background: Survival for hepatocellular carcinoma (HCC) is highly contingent on stage at diagnosis. Identifying high-risk population groups is crucial for efficient delivery of limited resources. We present a population-based geospatial approach to identifying priority targets for early detection interventions in a defined area with high rates of late stage HCC. Methods: We utilized a high-quality population-based cancer registry for cohort identification. Inclusion criteria were: 1) incident HCC (C22.0, 8170-8175), 2) diagnosis between 2008-2017, and 3) residence within boundaries of a single large metropolitan county (Los Angeles). Late stage included AJCC 7th Edition stages III-VI and unstaged cases. We mapped “hotspots” or areas with high density of late stage disease using address coordinates and kernel density estimation in ArcMap 10.3.1. We selected a hotspot density threshold that best optimized number of hotspots, number of cases, and proportion of late stage cases within hotspots. Individual-level factors associated with residence in a hotspot were identified with univariate logistic regression. Age-adjusted incidence rate (AAIR) and population attributable risk (PAR) of late stage disease if residence in a hotspot were calculated. Results: In Los Angeles County, 3894 (51.8%) of 7519 incident cases of HCC were late stage. We identified 23 discrete hotspots that encompassed 26.7% of all cases and 30.0% of late stage cases. Hotspots had 10% more late stage disease (59.1% within vs 49.1% outside hotspots, p&amp;lt;0.01). The composition of hotspots heavily favored racial/ethnic minorities (86.3% vs 69.5%, p&amp;lt;0.01) and nearly half of hotspot residents were foreign-born (48.6% vs 36.9%, p&amp;lt;0.01; &amp;gt;25% with unknown birthplace). 45.4% of residents within hotspots were in the lowest socioeconomic status (SES) quintile compared to only 19.1% outside hotspots. Factors associated with residence in a hotspot included non-White race/ethnicity (OR 2.6, 2.7, and 3.1 for Black, Hispanic, and Asian, respectively, compared to White), foreign-born (OR 1.3 vs US-born), and Medicaid insurance (OR 1.7 vs non-Medicaid) (all p&amp;lt;0.05). Likelihood of residence in a hotspot sequentially increased with each quintile decrease in SES (OR 3.3 for highest-middle to OR 33.2 for lowest vs highest quintile, p&amp;lt;0.01). The AAIR of late stage HCC was twice as high within compared to outside hotspots (6.85 vs 3.38) and 43% of late stage HCC at diagnosis was attributable to residence in a hotspot (PAR=0.43). Conclusion: Late stage HCC hotspots in Los Angeles County are disproportionately comprised of low-income minority and immigrant populations. Early detection interventions that modify risk in these priority groups have potential to reduce late stage burden by nearly 40%. Our strategy can be replicated in any population-based cancer registry for individualized area-specific targets. Citation Format: Kali Zhou, Laura Thompson, Norah A. Terrault, Myles G. Cockburn. Low-income minorities and immigrants are priority targets in late stage hepatocellular carcinoma hotspots [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR04.

Can outdoor activities and inquiry sessions change the travel behavior of children and their caregivers? Empirical research in public preschools in São Paulo (Brazil)

This manuscript seeks to evaluate changes in the travel behavior of young children (5–6 y/o.) and their caregivers following the implementation of a 4-month program in public preschools in São Paulo (Brazil) with a high prevalence of low-income immigrants. The program was developed around two intervention types: i) weekly inquiry sessions about urban mobility through the Philosophy with Children approach and ii) bimonthly outdoor walking activities in the surroundings of schools. In this way, it was possible to observe positive changes in the perceptions of children's statements and in the social norms of their caregivers about transportation, as well as significant modal shifts as reported by caregivers towards sustainable mobility, which were evaluated using difference-in-differences and time-series analyses.Besides the identification of changes in the behavior of adult caregivers through child-centered intervention types, this empirical research enabled unraveling the effect of the proposed measures according to the child's gender, nationality, and level of social vulnerability, including the significant modal shifts towards walking and cycling identified among caregivers of boys and out of car and motorcycle among those of native children, which were significant both in post and follow-up measures.In addition to contributions to the evaluation of school-based interventions with data from developing countries, the discussions presented in this paper intend to provide insights into the role of early childhood and perceptions in behavioral changes towards sustainable transport.

Making requests: Filipina/o and Latina/o immigrant claims-making and racialization

ABSTRACT Advocacy organizations have reframed immigrants as deserving, and improved their access to services and support; yet, we know little about how low-income immigrants understand organizational frames to make individual requests in public institutions and programmes. Analyzing in-depth interviews and fieldwork over multiple years, we show how Filipina/o and Latina/o immigrants become empowered to make claims through an organization's frame of low-income residents as rightful community members in San Francisco – a self-declared “sanctuary” city where residents have formal access and protections regardless of immigrant or legal status. However, despite newfound confidence and rights awareness, Latina/o participants continually anticipate racialized treatment where others construct them as inferior and illegitimate, which depresses their claims-making. In contrast, Filipina/o participants felt othered in public programmes and institutions, but not blocked by feelings of mistreatment and illegitimacy. We push for attention to how racialization differentially operates for immigrant groups and affects the claims-making process.