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Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed. / Doctor of Philosophy / LGBTQIA+ older adults are at increased risk of negative health outcomes, but helping professions have limited resources for understanding their health care needs at present. Because nearly half of older sexual minority women (SMW) have disabilities, this study examined health care access and outcomes among older SMW with disabilities. This is relevant to counseling given the field's focus on social justice, advocacy, and equity, as well as the interconnected nature of physical and mental health. Across different ways of measuring health care access, external barriers related to health care systems and societal injustice were related to whether older SMW with disabilities could access health care. Health care stereotype threat, or internalized stigma related to experiences in health care, predicted health care access and health among disabled older SMW as well. These findings suggest that poor health care utilization and poorer health outcomes among older SMW with disabilities are the result of structural oppression rather than individual choices, which requires systemic interventions to correct. More research is needed to determine how counselors and other helping professionals can enhance strengths to support health among older SMW with disabilities.

Yes / Introduction Despite the interconnectedness of the European Union, there are significant variations in pregnant women’s legal status as migrants and therefore their ability to access maternity care. Limited access to maternity care can lead to higher morbidity and mortality rates in migrant women and their babies. This study aimed to investigate and compare maternal health access policies and the context in which they operate across European countries for women who have migrated and are not considered citizens of the host country. Methods The study adopted a mixed-methods research design exploring policies on migrant women’s access to maternity care across the migration regimes. Data were extracted from legal documents and research reports to construct a new typology to identify the inclusiveness of policies determining access to maternity care for migrant women. Results This study found inconsistency in the categorisation of migrants across countries and significant disparities in access to maternity care for migrant women within and between European countries. A lack of connection between access policies and migration regimes, along with a lack of fit between policies and public support for migration suggests a low level of path dependency and leaves space for policy innovation. Discussion Inequities and inconsistencies in policies across European countries affect non-citizen migrant women’s access to maternity care. These policies act to reproduce structural inequalities which compromise the health of vulnerable women and newborns in reception countries. There is an urgent need to address this inequity, which discriminates against these already marginalised women. / This article is based upon work from COST Action IS1405 BIRTH: “Building Intrapartum Research Through Health—An interdisciplinary whole system approach to understanding and contextualising physiological labour and birth” (http://www.cost.eu/COST_Actions/isch/IS1405), supported by EU COST (European Cooperation in Science and Technology). The work of Alena Pařízková was supported by project Migration and maternal health: pregnancy, birth and early parenting (The Czech Science Foundation, grant 16-10953S). Open access publishing supported by the National Technical Library in Prague.

Poor oral care is detrimental to the overall health of the population. In the United States, oral health diseases affect millions of individuals, especially children and adolescents. Guided by the health belief model, the purpose of this study was to identify parents' perceived barriers to oral health care access among their 5- to 10-year-old children. A phenomenological approach was used to gather data and thematically analyze interview data from 20 parents who were recruited from a health center in the northeastern United States. All participants had at least one child between 5-10 years old and all identified as under-served. Data were coded and analyzed for emerging themes, with the assistance of Nvivo software. The findings demonstrated that lack of time, the location of dental facilities, and the lack of sensitivity of dental providers were issues for parents in managing their children's oral health. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating the constraints faced by the underserved population in Massachusetts.

In recent years, Florida has acquired a reputation as fertile ground for human trafficking. On the heels of state and federal anti-human trafficking legislation, a host of organizations have risen to provide a range of services. In this thesis, I discuss findings from 26 interviews conducted with law enforcement, service providers, legal representatives and trafficked persons to contextualize the variability in the way anti-trafficking work is conceptualized by stakeholders across the state. Additionally, I explore how conflicting organizational policies on the local, state, and federal levels impact stakeholder collaboration and complicate trafficked persons' attempts to navigate already complex processes of social/health services and documentation. Lastly, I provide policy recommendations that attempt to address the major issues associated with anti-trafficking work identified through the analysis of participant interviews.

To achieve the goal of universal coverage of health insurance for the Americans, in March 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA targets at providing help to improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. One of the precedent mandates, implemented in September 2010, is to expand coverage on young adults of age 19 to 26, who may lose insurance coverage due to the remove from their parents’ plan after age 18 and lacking of productivity to bargain with employers in the labor market. This dissertation looks into the impact of the ACA health insurance coverage expansion for young adults on the subsequent health outcomes, health care utilization, and further social impact on traffic fatalities. Difference-in-differences models are used with different treatment groups and corresponding control groups. Chapter I uses survey data (BRFSS) to evaluate health care access, health behavior and self-assessed health status. The results suggest an improvement in health care access and self-assessed health but more risky behavior. Chapter II uses hospital discharge data (NIS) to estimate avoidable hospitalization in order to assess primary care utilization. The result shows that less primary care was consumed, which leads to more avoidable hospitalization but health may have been improved by using more hospital care. The results from both chapters imply potential ex ante moral hazard among young adults in the policy targeting age group. Thus, chapter III uses accident records data (FARS) to examine the impact of the health insurance expansion on traffic fatality for young adults, to see whether young drivers perform ex ante moral hazard through risky behavior like drunk and/or reckless driving after they get covered by the health insurance expansion policy. Primary result shows that there is an increase in traffic accidents and fatalities for those younger adults as a result of the ACA dependent coverage expansion.

L’objet de ce travail de recherche est d’étudier l’accès financier à la complémentaire santé et aux soins des populations modestes en France. Nous nous intéressons plus particulièrement au dispositif d’Aide complémentaire santé (ACS) introduit afin d’inciter les ménages dont les ressources se situent juste au-dessus du plafond d’attribution de la Couverture maladie universelle (CMUC), à acquérir une complémentaire santé. À partir notamment d’une expérimentation sociale et d’un échantillon inédit de ménages éligibles à ces dispositifs, nous sommes en mesure d’éclairer les connaissances sur trois questions : (i) La compréhension et la réduction du non-recours à l’ACS. (ii) Les comportements de recours à la complémentaire santé et aux soins. (iii) L’existence d’un effet de seuil de la CMUC. Les résultats de cette thèse permettent ainsi de nourrir la réflexion afin d’améliorer l’efficacité de ces dispositifs et plus généralement celle des politiques publiques futures visant à améliorer l’équité dans l’accès aux soins. / The purpose of this research is to study the financial access to complementary health insurance (CHI) and to health care of low-income populations in France. We are particularly interested in evaluating a subsidized health insurance program (ACS) introduced to encourage households whose resources are just above the free means-tested complementary health insurance program (CMUC), to purchase a CHI plan. In implementing a randomized experiment and in using a sample of eligible households for these programs, we are able to enhance the knowledge base on three issues: (i) Understanding and reducing the ACS non-take-up. (ii) The take-up of CHI plan and the health care use of low-income populations. (iii) The existence of a CMUC threshold effect. Results of this thesis provide some important tracks to improve the effectiveness of these programs and more generally that of future public policies aiming to improve equity in access to health care.