Browsing by keyword "Emigration and Immigration"
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Access to health care for nonmetro and metro Latinos of Mexican origin in the United StatesBACKGROUND: A growing number of Latinos are moving to nonmetro areas, but little research has examined how this trend might affect the Latino-disadvantage in access to healthcare. OBJECTIVE: We investigate health care access disparities between non-Latino whites and Latinos of Mexican origin, and whether the disparities differ between metro and nonmetro areas. METHODS: A series of logistic regression models provide insight on whether individuals have a usual source of care and whether they have had any physician visits in the past year. Our analyses focus on the interaction between Mexican origin descent and nonmetro residence. SUBJECTS: Nationally representative data from the 2002-2003 Medical Expenditure Panel Survey are analyzed. The sample consists of working-aged adults age 18-64, yielding a sample size of 29,875. RESULTS: The Mexican disadvantage in having a usual source of care is much greater among nonmetro residents than among those living in metro areas. The Mexican disadvantage in the likelihood of seeing a physician at least 1 time during the year does not differ across locations. Although general and ethnicity-specific predictors explain the disadvantage of Mexicans in having a usual source of care, they do not explain the added disadvantage of being Mexican and living in nonmetro areas. CONCLUSIONS: This study identifies a new challenge to the goal of eliminating health care disparities in the United States. The Latino population living in nonmetro areas is growing, and our findings suggest that Latinos in nonmetro areas face barriers to having a usual source of care that are greater than those faced by Latinos in other areas.
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Effect of a global longitudinal pathway on medical students' attitudes toward the medically indigentBACKGROUND: The increase in people with insufficient health insurance has largely been fueled by a record influx of immigrants, who often live in medically underserved areas of inner cities. An increase in the desire of medical students to practice in underserved areas is needed to counter low physician-to-population ratios in these areas. PURPOSE: To assess the effect of a Pathway on Serving Multicultural and Underserved Populations, which includes domestic and international experiences with recent immigrant groups, on the attitudes of students toward the indigent. METHODS: Students from the classes of 2002 and 2003, including a cohort in the Pathway program, were participants in this study. Changes in attitudes within Pathway and non-Pathway students were studied over their 4 years of medical school. RESULTS: There was no statistically significant difference between the two groups in the rate of change of attitudes over time. The determination of any potential difference was hampered by small sample sizes. Thus, interesting trends, especially related to a more rapid decline in attitudes of non-Pathway students, including their sense of professional responsibility, did not achieve statistical significance. CONCLUSIONS: Further research, both quantitative and qualitative, is needed before we can state more definitively that the Pathway curriculum supports positive attitudes toward serving the medically indigent.
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Obesity and diabetes in vulnerable populations: reflection on proximal and distal causesAround the world obesity and diabetes are climbing to epidemic proportion, even in countries previously characterized by scarcity. Likewise, people from low-income and minority communities, as well as immigrants from the developing world, increasingly visit physicians in North America with obesity, metabolic syndrome, or diabetes. Explanations limited to lifestyle factors such as diet and exercise are inadequate to explain the universality of what can be called a syndemic, a complex and widespread phenomenon in population health produced by multiple reinforcing conditions. Underlying the problem are complex factors-genetic, physiological, psychological, familial, social, economic, and political-coalescing to overdetermine these conditions. These interacting factors include events occurring during fetal life, maternal physiology and life context, the thrifty genotype, the nutritional transition, health impact of urbanization and immigration, social attributions and cultural perceptions of increased weight, and changes in food costs and availability resulting from globalization. Better appreciation of the complexity of causation underlying the worldwide epidemic of obesity and diabetes can refocus the work of clinicians and researchers to work at multiple levels to address prevention and treatment for these conditions among vulnerable populations.
