We used the 2008–2010 American Community Survey Micro-data Sample (N = 9,093,077) to estimate disability and health insurance rates for children and adults in detailed racial/ethnic, immigrant, and socioeconomic groups in the USA. Prevalence and adjusted odds derived from logistic regression were used to examine social inequalities. Disability rates varied from 1.4% for Japanese children to 6.8% for Puerto Rican children. Prevalence of disability in adults ranged from 5.6% for Asian Indians to 22.0% among American Indians/Alaska Natives. More than 17% of Korean, Mexican, and American Indian children lacked health insurance, compared with 4.1% of Japanese and 5.9% of white children. Among adults, Mexicans (43.6%), Central/South Americans (41.4%), American Indians/Alaska Natives (32.7%), and Pakistanis (29.3%) had the highest health-uninsurance rates. Ethnic nativity disparities were considerable, with 58.3% of all Mexican immigrants and 34.0% of Mexican immigrants with disabilities being uninsured. Socioeconomic gradients were marked, with poor children and adults having 3–6 times higher odds of disability and uninsurance than their affluent counterparts. Socioeconomic differences accounted for 24.4% and 60.2% of racial/ethnic variations in child health insurance and disability and 75.1% and 89.7% of ethnic inequality in adult health insurance and disability, respectively. Health policy programs urgently need to tackle these profound social disparities in disability and healthcare access.

We examined trends in adult obesity and overweight prevalence among major Asian/Pacific Islander (API) subgroups and the non-Hispanic whites from 1992 to 2011. Using 1992–2011 National Health Interview Surveys, obesity, overweight, and BMI differentials were analyzed by logistic, linear, and log-linear regression. Between 1992 and 2011, obesity prevalence doubled for the Chinese, the Asian Indians, the Japanese, and the Hawaiians/Pacific Islanders; and tripled for the Filipinos. Obesity prevalence among API adults tripled from 3.7% in 1992 to 13.3% in 2010, and overweight prevalence doubled from 23.2% to 43.1%. Immigrants in each API subgroup had lower prevalence than their US-born counterparts, with immigrants' obesity and overweight risks increasing with increasing duration of residence. During 2006–2011, obesity prevalence ranged from 3.3% for Chinese immigrants to 22.3% for the US-born Filipinos and 41.1% for the Native Hawaiians/Pacific Islanders. The Asian Indians, the Filipinos, and the Hawaiians/Pacific Islanders had, respectively, 3.1, 3.8, and 10.9 times higher odds of obesity than those of the Chinese adults. Compared with Chinese immigrants, the adjusted odds of obesity were 3.5–4.6 times higher for the US-born Chinese and the foreign-born Filipinos, 9 times higher for the US-born Filipinos and whites, 3.8–5.5 times higher for the US-born and foreign-born Asian Indians, and 21.9 times higher for the Native Hawaiians. Substantial ethnic heterogeneity and rising prevalence underscore the need for increased monitoring of obesity and obesity-related risk factors among API subgroups.

OBJECTIVES: Recent census data show that nearly one-quarter of US children have at least 1 immigrant parent; moreover, there has been a dramatic increase in children diagnosed with autism spectrum disorders (ASDs) and select developmental disabilities (DDs). However, little is known about access to medical home and adequacy of insurance coverage for children with ASDs and select DDs from immigrant families.METHODS: By using the 2007 National Survey of Children' s Health, we compared children with ASDs and select DDs from immigrant (n = 413, foreign born or reside with at least 1 immigrant parent) and nonimmigrant (n = 5411) families on various measures of medical home and insurance coverage. We used weighted logistic regression to examine the association between immigrant family and selected outcome measures while controlling for confounding factors. RESULTS:Compared with nonimmigrant families, children with ASD and select DD from immigrant families were more than twice as likely to lack usual source of care and report physicians not spending enough time with family. Furthermore, multivariable analyses indicate that insurance coverage is an important factor in mitigating health care barriers for immigrant families. CONCLUSIONS:The study demonstrates important areas of deficits in the health care experiences of children with ASD and select DD from immigrant households. Public policy implications include increasing access to existing insurance programs, augmenting public awareness resources for ASD and select DD, and offering assistance to immigrant families that are struggling with the medical needs of their children.

Over the last 50 years, the incidence of cervical cancer has dramatically decreased. However, health disparities in cervical cancer screening (CCS) persist for women from racial and ethnic minorities and those residing in rural and poor communities. For more than 45 years, federally funded health centers (HCs) have been providing comprehensive, culturally competent, and quality primary health care services to medically underserved communities and vulnerable populations. To enhance the quality of care and to ensure more women served at HCs are screened for cervical cancer, over eight HCs received funding to support patient-centered medical home (PCMH) transformation with goals to increase CCS rates. The study conducted a qualitative analysis using Atlas.ti software to describe the barriers and challenges to CCS and PCMH transformation, to identify potential solutions and opportunities, and to examine patterns in barriers and solutions proposed by HCs. Interrater reliability was assessed using Cohen's Kappa. The findings indicated that HCs more frequently described patient-level barriers to CCS, including demographic, cultural, and health belief/behavior factors. System-level barriers were the next commonly cited, particularly failure to use the full capability of electronic medical records (EMRs) and problems coordinating with external labs or providers. Provider-level barriers were least frequently cited.

Background:The prevalence of autism spectrum disorder (ASD) in United State (US) has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment.Methods:We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening.Results:Approximately, 28% of parents of children with ASD from non-English primary language (NEPL) households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL) households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator.Conclusions and Global Health Implications:Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of ASD has increased worldwide, understanding of the condition and care-seeking behavior in migrant populations is especially valuable.

Background Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. Methods and findings Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. Conclusions Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health

The CRC screening rate for HC patients was 57.9%, whereas the rate was 65.1% according to the 2012 Behavioral Risk Factor Surveillance System and 58.2% according to the 2013 National Health Interview Survey. The high ratings of patient-provider communication, regardless of the screening status, suggest strides toward a patient-centered medical home practice transformation that will assist in a positive patient experience. Addressing the lack of insurance, making culturally and linguistically appropriate patient education materials available, and training clinicians and care teams in cultural competency are critical for increasing future CRC screening rates. Cancer 2017;123:4185-4192. © 2017 American Cancer Society.

Background In 2017, 46.6 million U.S. adults aged 18 or older self-reported as having mental illness of which 52.0% or 24.2 million are women age 18-49. Perinatal depression and anxiety are linked to adverse outcomes concerning pregnancy, maternal functioning, and healthy child development. Methods and findings Using the 2014 Health Center Patient Survey (HCPS), the objectives of the cross-sectional study are to assess the prevalence of self-reported mental health conditions among female patients of reproductive age and to examine the association between depression and physical health. Physical health conditions of interest included self-rated health, obesity, hypertension, smoking, and diabetes, which all have established associations with potential pregnancy complications and fetal health. The study found 40.8% of patients reported depression; 28.8% reported generalized anxiety; and 15.2% met the criteria for serious psychological distress on the Kessler 6 scale. Furthermore, patients with depression had two to three times higher odds of experiencing co-occurring physical health conditions. Conclusions This study expands the discourse on maternal mental health, throughout the preconception, post-partum, and inter-conception care periods to improve understanding of the inter-correlated physical and mental health issues that could impact pregnancy outcomes and life course trajectory. From 2014 to 2018, the Health Resources and Services Administration (HRSA) has supported investments of nearly $750 million to improve and expand access to mental health and substance use disorder services for prevention, treatment, health