Background:This paper provides statewide estimates on health care access and utilization patterns and physical and behavioral health by citizenship and documentation status among Latinos in California.Methods:This study used data from the 2011–2015 California Health Interview Survey to examine health care access and utilization and physical and behavioral health among a representative sample of all nonelderly Latino and US-born non-Latino white adults (N=51,386). Multivariable regressions estimated the associations between the dependent measures and citizenship/documentation status among Latinos (US-born, naturalized citizen, green card holder, and undocumented).Results:Adjusted results from multivariable analyses observed worse access and utilization patterns among immigrant Latinos compared with US-born Latinos, with undocumented immigrants using significantly less health care. Undocumented Latinos had lower odds of self-reporting excellent/very good health status compared with US-born Latinos, despite them having lower odds of having several physical and behavioral health outcomes (overweight/obesity, physician-diagnosed hypertension, asthma, self-reported psychological distress, and need for behavioral health services). Among those reporting a need for behavioral health services, access was also worse for undocumented Latinos when compared with US-born Latinos.Conclusions:Patterns of poor health care access and utilization and better physical and behavioral health are observed across the continuum of documentation status, with undocumented immigrants having the worst access and utilization patterns and less disease. Despite fewer reported diagnoses and better mental health, undocumented Latinos reported poorer health status than their US-born counterparts.

Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

Objectives: We examined changes in health care access and utilization associated with the Patient Protection and Affordable Care Act (ACA) for different Asian American subgroups relative to non-Latino whites (whites). Research Design: Using 2003–2017 California Health Interview Survey data, we examined changes in 4 health care access measures and 2 utilization measures among whites and 7 Asian American subgroups. We estimated the unadjusted and adjusted percentage point changes on the absolute scale from the pre-ACA to post-ACA periods. Adjusted estimates were obtained from multivariable logistic regression models that controlled for predisposing, enabling, and need factors. We also estimated the pre-ACA to post-ACA changes between whites and Asian American subgroups using a difference-in-difference approach. Results: After the ACA was implemented, uninsurance decreased among all Asian American subgroups, but improvements in disparities relative to whites in these measures were limited. In particular, Koreans had the largest absolute reduction in uninsurance (−16.8 percentage points) and were the only subgroup with a significant reduction in terms of disparities relative to whites (−10.1 percentage points). However, little or no improvement was observed in the other 3 access measures (having a usual source of care, delayed medical care in past year, or delayed prescription drug use in past year) and 2 utilization measures (having a physician visit or emergency department visit in past year). Conclusions: Despite coverage gains among Asian American subgroups, especially Koreans, disparities in access and utilization persisted across all Asian American subgroups.

Latino girls (Latinas) experience disproportionate rates of emotional distress, including suicidal ideation, which may be indicative of inadequate coping abilities. Prevention of mental health problems, a U.S. public health priority, is particularly critical for Latina adolescents due to lack of access to mental health treatments. The purpose of this study was to examine the feasibility of Project Wings, a 14-session stress management/coping intervention. Latinas in school (ages 15-21) met weekly for 2-hr with two bilingual experienced facilitators to participate in sharing circles, relaxation exercise, and skill building. Intervention participation and post-intervention focus group data were analyzed. Fall semester intervention (n = 10) occurred during school (72% attendance rate); spring semester intervention (n = 11) was after school (84% attendance rate). Focus group data confirmed acceptability. Latina adolescents will participate in a school-based, group-based stress management/coping intervention. The findings offer insights about intervention recruitment and retention that are specifically relevant to school nurses. Future research includes intervention testing using a randomized study design.Keywords adolescent girls; Latina; school-based intervention; mental health; coping; prevention In the United States, adolescents are demonstrating mental health problems that portend problematic trajectories into adulthood (Knopf, Park, & Mulye, 2008). By high school, nearly 40% of ninth-grade Latino females (Latinas) are reporting they have experienced depressive symptoms or suicidal ideations in the past year compared to 20% of non-Latino ninth-grade girls (Grunbaum et al., 2004;Garcia, Skay, Sieving, Naughton, & Bearinger, 2008). Latinas report more symptoms of emotional distress compared to their non-Latino female peers and to Latino males. These mental health problems have immediate and future consequences. In the short term, youth with depressive symptoms are at greater risk of suicidal ideation and social isolation, including high school dropout (Center for Mental Health in Schools, 2007). Latina high school students are twice as likely as their female peers in other racial and ethnic groups to drop out of high school, and up to 40% of Latino students, boys and girls, are not completing high school (Pew Hispanic Center, 2004 Leading adolescent health researchers have established guiding principles for intervention success. These are grounded in promoting healthy youth development and include being strength-based, competence-focused, and relationship-centered (Bernat & Resnick, 2006;Rodriguez & Morrobel, 2004). Using these principles, we developed Project Wings, a mental health promotion intervention to increase the coping repertoire available to Latina adolescents. The purpose of this article is to discuss the participant characteristics, feasibility, and acceptability of Project Wings, a school-based coping intervention for girls. MethodA pre and post intervention, single group design was used with ...

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Key Points Question Was the Patient Protection and Affordable Care Act Medicaid expansion associated with an increase in health insurance coverage among persons with a disability? Findings In this cross-sectional analysis of more than 2.5 million US adults aged 26 to 64 years with incomes up to 138% of the federal poverty level, Medicaid expansion was significantly associated with lower uninsurance rates and higher Medicaid and private insurance coverage for persons with a disability. Meaning These findings suggest that Medicaid expansion was associated with improved health insurance coverage among persons with a disability.

Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

The authors examined the feasibility and preliminary outcomes of Project Wings Girls' Groups, a school-based mental health promotion program designed to improve well-being in Latina adolescents, as observed in outcomes, including perceived stress, depressive symptoms, coping, and connectedness. This pilot randomized controlled trial compared outcomes over 9 months postintervention for 42 9th and 10th grade adolescents attending two urban high schools. Girls were randomized to Project Wings Girls' Groups, a 16-session facilitated curriculum, including sharing circles, mind-body exercises, and coping skills building or the attention control (i.e., similar format but focused on general health topics). Feasibility of retention and long-term follow-up data collection was demonstrated, with lessons learned for future study. Although not statistically powered, this trial demonstrated findings in the expected direction, including reduced perceived stress and depression and increased connectedness. A trial with sufficient power is warranted to examine Project Wings' effects on mental health problems among Latina adolescents.