Health care disparities are U.S. national public health concerns that disproportionately affect minority populations. The focus of published studies on the health of larger immigrant populations from Europe, Asia, South America, and the Caribbean has revealed a knowledge gap on the health of African and other minority immigrants. The purpose of this phenomenological study was to explore disparities in access to maternal and child health (MCH) care as well as the causes and effects of such disparities to care-seeking experiences of recent African immigrants. Andersen's behavioral model of health services use provided the theoretical lenses to interpret study findings. Eleven recent African immigrant mothers living in metropolitan Boston, Massachusetts, participated in semistructured questions that generated data used in this study. NVivo 11 was used to manage data, which enabled convenient use of Colaizzi's data analysis technique to identify themes and subthemes that were synthesized into final findings. Study results indicated that although participants used MCH care services, factors such as racial/ethnic discrimination, insurance differences, immigration, and socioeconomic status marred the process of seeking care, with notable access disparities that negatively affect MCH care experiences. The field of health for African immigrants is ripe for research. Other researchers could replicate this study elsewhere in the United States and other traditional immigrant-destination countries. Study findings could benefit health care providers, public health professionals, researchers, and immigrant populations. Actions for sustainable positive social change may result in the form of improved health care access and health outcomes for minority immigrants in the United States and beyond.

This mixed-methods study examined patterns of dental health care utilization in adult Hispanic migrant farmworkers (AHMFW) with special emphasis on non-compliance with the American Dental Association (ADA) and the American Dental Hygienists Association (ADHA) recommendation of visiting the dentist at least once a year; while also exploring the group’s social and cultural construction of oral health. A total of 278 farmworkers responded to a close ended survey. Binary and hierarchical logistic regression analysis were employed in identifying predisposing, enabling, and needs factors associated with non-compliance. Following the survey, fourteen ethnographic interviews were conducted with respondents who volunteered to participate in this phase of the study. Most participants (79.5%) were non-compliant with the ADA and the ADHA recommendation. Binary logistic regression results indicated that AHFW reporting need for dental treatment were compliant with the recommendation. In contrast, those who brushed their teeth more often, experienced oral health impact, and reported poor perception of their mouth condition were non-compliant. Hierarchical logistic regression results pointed to those who used floss and reported need for dental treatment as compliant with the recommendation. Participants reporting poor perception of their mouth condition were non-compliant. Eight themes emerged from the qualitative analysis (understanding of the mouth, meaning of oral health, history of dental care; dental problems, barriers to dental care, caring of the teeth/mouth, medications, oral health quality of life). Farmworkers were knowledgeable of oral health, however, this knowledge, particularly the practice of brushing twice a day, made them less likely to seek regular dental care. Ultimately, a dental visit hinged on their limited finances, lack of dental insurance, and family responsibilities. Together, these decreased access to preventive dental services and increased risk of experiencing oral health problems.

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

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The collapse of the communist regimes in Central and Eastern Europe in 1989-1990 heralded the beginning of an economic transition from central planning to market economies. The subsequent period was marked by malfunctioning of these countries’ social sectors, including their health care systems, raising serious issues of equity. This thesis examines the impact of the transition period and the introduction of social insurance on equity in health care provision in Bulgaria. Equity in health care is investigated with respect to function - i.e. financing (according to ability to pay) and delivery (according to need) - and outcomes - i.e. health status, income inequality and poverty. Differences in health, health care financing and delivery are explored by income, education, ethnic, employment, marital status, age and sex groups. Furthermore, the thesis outlines the impact of health care provision, in particular social insurance, on poverty and health inequalities. The thesis employs empirical analysis based on household data. Its methodology includes concentration and decomposition analysis, and provides new ways of modelling health care financing and delivery, as well as the link between health and health care delivery. The thesis concludes that social insurance does not provide a uniform means of improving equity and that the root cause of the problem lies in the large proportion of out-of-pocket payments and the rather limited size of the health insurance sector. Inequity in health care provision leads to poverty and untreated illness. The data suggests that there are differences between socio-economic groups as regards their likelihood to seek treatment for their ill health, which result in differences in their health status. The social factors that have impacted the most on health are low education and low income.

BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population. METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year. RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97). CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.

The prevalence of Hepatitis C Virus (HCV) in the US is estimated at 3.5 million with 18,153 deaths in 2016. It is the most common bloodborne infection, with a higher age-adjusted mortality rate than Hepatitis B Virus or Human Immunodeficiency Virus. Without treatment, nearly 1.1 million people will die from HCV by 2060. About 41,200 new cases of HCV were reported in 41 states in the US in 2016. The reported cases of acute HCV in 2016 is 2.3 per 100,000 in Tennessee, which is more than twice the national goal set by Healthy People 2020. This is a descriptive study to ascertain the HCV prevalence and usefulness of screening in medical outreach settings (MO) compared to indigent healthcare clinics (IHC) in northeast Tennessee. This study period was from April 2017 – February 2019. Participants (n=250), were adults, who engaged in routine, opt-out HCV testing at 4 IHC and 3 MO sites in the Tri-Cities, TN region. During the screening, demographic information- age, gender, race- were collected and the de-identified data were analyzed using Statistical Analysis System (SAS 9.3) to perform a descriptive analysis. Also, several discrete Chi-Square tests of independence between the demographic variables, screening locations, and HCV antibody prevalence was conducted. A total of 250 clients were screened for HCV. The majority of clients screened were non-Hispanic whites 228 (91.20%); females 136 (54.40%); young adults 131 (52.40%) and at IHC clinics 187 (74.80%). Screening showed HCV antibody prevalence of 14.8%. The majority of positive cases were non-Hispanic whites 36 (97.30%; P=0.1561); females 19 (51.35%; P=0.6867) and young adults 23 (62.16%; P=0.286). The prevalence at the IHC clinics and MO settings were 36 (97.30%; P=0.0006) and 1(2.70%) respectively. This analysis shows the higher yield of targeted HCV screening at IHC clinics. Focused HCV screening is critical in the era of opioid epidemic, particularly when direct-acting antiviral agents (DAAs) which offer a Sustained Virologic Response (SVR) rate of more than 90% are available. The use of case control or cohort study designs to establish causality is recommended for improving focused HCV screening.