Disparities in Access to Health Care Among US-Born
and Foreign-Born US Adults by Mental Health
Status, 2013–2016
Reema Dedania, MD, MPH, and Gilbert Gonzales, PhD, MHA
Objectives. To compare access to care between US-born and foreign-born US adults
by mental health status.
Methods. We analyzed data on nonelderly adults (n = 100 428) from the 2013–2016
National Health Interview Survey. We used prevalence estimates and multivariable lo-
gistic regression models to compare issues of affordability and accessibility between
US-born and foreign-born individuals.
Results. Approximately 22.2% of US-born adults and 18.1% of foreign-born adults
had symptoms of moderate to severe psychological distress. Compared with US-born
adults with no psychological distress, and after adjustment for sociodemographic
characteristics, US-born and foreign-born adults with psychological distress were much
more likely to report multiple emergency room visits and unmet medical care, mental
health care, and prescription medications because of cost.
Conclusions. Our study found that adults with moderate to severe psychological
distress, regardless of their immigration status, were at greater risk for reporting issues
of affordability when accessing health care compared with US-born adults with no
psychological distress.
Public Health Implications. Health care and mental health reforms should focus
on reducing health care costs and establishing innovative efforts to broaden access to
care to diverse populations. (Am J Public Health. 2019;109:S221–S227. doi:10.2105/
AJPH.2019.305149)
Health care access is an important factorassociated with mental illness pre-
vention, early-stage diagnosis and treatment,
and overall prognosis of psychiatric disorders.1
However, disparities in health care access and
health services utilization between immi-
grants and native-born populations in the
United States have been well documented for
a number of reasons, including stigmatization,
fear of deportation, challenges navigating a
complex health insurance system, and the
absence of culturally sensitive care and health
information.2,3 Studies show that, on average,
immigrants report better self-rated health and
less health services utilization compared with
native-born populations. However, consid-
erable debate remains over whether lower
utilization rates reflect a lesser need or an issue
of accessibility.4–7 This problem can be
unremitting and even aggravated in the
treatment of mental health disorders, which
are among the most expensive medical con-
ditions in the United States in recent years.8
There are a variety of factors that influence
the mental health of immigrants in particu-
lar. First, it is essential to recognize that
immigrants enter the United States through
a variety of means, including elective immi-
gration (e.g., family-based and employment-
based immigration) and forced migration
(e.g., refugees or asylees who are fleeing
persecution or are unabl ...
2 mental health and disorders mental health and dismile790243
This document discusses a rising trend of mental health disorders among individuals on Chicago's south side. It notes that African Americans have higher rates of mental health disorders like post-traumatic stress disorder and schizophrenia. The document proposes a research study called Project IMPACT that would survey adults in south side Chicago neighborhoods about their mental health using questionnaires. The expected result is an increased risk of mental health disorders among African Americans in those areas. It concludes that decreasing this risk is important for improving the overall health of the African American population.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
This document summarizes a study examining factors that affect access to mental health care. The study focuses on environment (rural vs. urban), socioeconomic status, financial barriers, and awareness of stigma. Literature is reviewed finding rural residents have less access to care than urban residents. Lower socioeconomic status and lack of insurance also reduce access. Stigma and negativity towards mental illness can deter people from seeking treatment. The study aims to determine if these factors influence access to mental health care using GSS survey data from 2006. Hypotheses predict less access to care for rural residents, those with lower socioeconomic status, activity limitations, and awareness of stigma.
Effects of the Affordable Care Act MedicaidExpansion on Subj.docxgidmanmary
Effects of the Affordable Care Act Medicaid
Expansion on Subjective Well-Being in the US Adult
Population, 2010–2016
Lindsay C. Kobayashi, PhD, Onur Altindag, PhD, Yulya Truskinovsky, PhD, and Lisa F. Berkman, PhD
Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion
affected well-being in the low-income and general adult US populations.
Methods. We obtained data from adults aged 18 to 64 years in the nationally rep-
resentative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We
used a difference-in-differences analysis to compare access to and difficulty affording
health care and subjective well-being outcomes (happiness, sadness, worry, stress, and
life satisfaction) before and after Medicaid expansion in states that did and did not
expand Medicaid.
Results. Access to health care increased, and difficulty affording health care declined
following the Medicaid expansion. Medicaid expansion was not associated with changes
to emotional states or life satisfaction over the study period in either the low-income
population who newly gained health insurance or in the general adult population as a
spillover effect of the policy change.
Conclusions. Although the public health benefits of the Medicaid expansion are in-
creasingly apparent, improved population well-being does not appear tobe among them.
Public Health Implications. Subjective well-being indicators may not be informative
enough to evaluate the public health impact of expanded health insurance. (Am J Public
Health. 2019;109:1236–1242. doi:10.2105/AJPH.2019.305164)
See also Galea and Vaughan, p. 1169.
Akey component of the US AffordableCare Act (ACA) was the expansion of
Medicaid eligibility to nonelderly adults with
incomes up to 138% of the federal poverty
level.1 This policy resulted in 9.6 million
people becoming newly eligible for Medicaid
beginning in 2014.2 The rapidly growing
literature documents a range of beneficial
outcomes for the newly eligible population,
including higher rates of insurance coverage,
increased access to health care providers,
improved quality of care, increased use of
preventive health services, reduced likelihood
of emergency department visits, and reduced
financial difficulties.3–7 Public health spill-
over effects with relevance to the general
population also have been documented,
including lower rates of crime, higher
prescribing of opioid treatments, and reduced
socioeconomic disparities in access to health
care.8–11 Evidence of direct effects on health
outcomes is relatively scarce,5 whereas a
growing body of evidence shows mixed re-
sults for its effect on self-rated health.7,11–14
The effects of the ACA Medicaid expansion
on population well-being in the United States
are unknown.
Human well-being is gaining attention
from researchers and policymakers as a metric
of social welfare that goes beyond standard
indicators for health policy evaluation.15–18
Broadly defined, subjective w ...
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
The document discusses the need for behavioral health services in Nueces County, Texas. It provides statistics on mental illnesses like bipolar disorder and major depressive disorder treated in the county. Suicide rates are also discussed both locally and nationally. The nursing implications are early detection, education on risk factors, and management of disorders. Nurses play a role in comprehensive assessment, advocacy, and linking patients to support services. Barriers to mental healthcare include stigma, lack of perceived need, and cost of treatment. Community education and support can help address these barriers.
reply with three references H.R. 721 Mental Health Servic.docxWilheminaRossi174
reply with three references
H.R. 721: Mental Health Services for Students Act of 2021
Mental Health, we hear about it all the time. Mental health is a driving force in the media, when law enforcement officers in America, engage in a critical incident, involving a subject with “Mental health problems”. Mental health continues to take countless lives, from our Military Veterans, as each day passes. Children in school experienced an extreme disrupt in their daily lives, when they were forced to stay indoors, and attend school through a screen, in the early stages of the Covid-19 Pandemic. Homelessness in America is rising, and the amount of homeless Americans with untreated mental health issues is staggering. We don’t need to see a fact sheet, read a medical journal, or test subjects in a clinical trial, to be cognizant of the amount of persons with unattended mental health disorders, in America. American children’s health should be a priority, they are our future professor’s, philosophers, engineers, doctors, free thinkers; they are the future “Us”.
The Mental Health Services for Students Act of 2021, was introduced by Congresswoman Grace Napolitano. HR 721 passed in the house on May 12th, 2021. HR 721 has 86 cosponsors (82(D) & 4(R)). Since 2001, Congresswoman Napolitano has had this program implemented into 35 schools, which has shown to be extremely helpful (Facts on the Mental Health Services for Students Act, n.d.). With low funds nationally, for on site mental health care professionals in schools, HR 721 would provide additional funding. HR 721 will provide $130,000,000 in competitive grants. The Substance Abuse and Mental Health Services Adminsitration (SAMHSA), would be delegated with distribution of funds. HR 721 would expand on
Project AWARE
, which is an educational grant.
Project AWARE
aims at educating and informing families, students, and school faculty about mental health.
Project AWARE
partners with state mental health agencies, where they train school faculty how to identify and respond to children with behavioral health issues (SAMHSA, 2020). HR 721 would expand on this program, by implementing on site mental health professionals in schools.
Personally, I support HR 721, from what I have researched thus far. The problem is, 49.4% of children in the United States did not receive treatment or counseling for a mental health disorder. (Whitley, G., 2019). According to the CDC, the third leading cause of death for adolescents aged 15-19 was suicide (CDC, 2021). Those two statistics alone, show the deprivation of resources and funding in the American school system. My husband, being a police officer, noticed a significant spike in “suicidal juvenile” calls, over the past two years. I myself, work on a occasion, at the juvenile detention facility. I have watched these children, over the past couple of years, destroy their lives due to untreated mental health illnesse.
2 mental health and disorders mental health and dismile790243
This document discusses a rising trend of mental health disorders among individuals on Chicago's south side. It notes that African Americans have higher rates of mental health disorders like post-traumatic stress disorder and schizophrenia. The document proposes a research study called Project IMPACT that would survey adults in south side Chicago neighborhoods about their mental health using questionnaires. The expected result is an increased risk of mental health disorders among African Americans in those areas. It concludes that decreasing this risk is important for improving the overall health of the African American population.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
This document summarizes a study examining factors that affect access to mental health care. The study focuses on environment (rural vs. urban), socioeconomic status, financial barriers, and awareness of stigma. Literature is reviewed finding rural residents have less access to care than urban residents. Lower socioeconomic status and lack of insurance also reduce access. Stigma and negativity towards mental illness can deter people from seeking treatment. The study aims to determine if these factors influence access to mental health care using GSS survey data from 2006. Hypotheses predict less access to care for rural residents, those with lower socioeconomic status, activity limitations, and awareness of stigma.
Effects of the Affordable Care Act MedicaidExpansion on Subj.docxgidmanmary
Effects of the Affordable Care Act Medicaid
Expansion on Subjective Well-Being in the US Adult
Population, 2010–2016
Lindsay C. Kobayashi, PhD, Onur Altindag, PhD, Yulya Truskinovsky, PhD, and Lisa F. Berkman, PhD
Objectives. To determine whether the 2014 Affordable Care Act Medicaid expansion
affected well-being in the low-income and general adult US populations.
Methods. We obtained data from adults aged 18 to 64 years in the nationally rep-
resentative Gallup-Sharecare Well-Being Index from 2010 to 2016 (n = 1 674 953). We
used a difference-in-differences analysis to compare access to and difficulty affording
health care and subjective well-being outcomes (happiness, sadness, worry, stress, and
life satisfaction) before and after Medicaid expansion in states that did and did not
expand Medicaid.
Results. Access to health care increased, and difficulty affording health care declined
following the Medicaid expansion. Medicaid expansion was not associated with changes
to emotional states or life satisfaction over the study period in either the low-income
population who newly gained health insurance or in the general adult population as a
spillover effect of the policy change.
Conclusions. Although the public health benefits of the Medicaid expansion are in-
creasingly apparent, improved population well-being does not appear tobe among them.
Public Health Implications. Subjective well-being indicators may not be informative
enough to evaluate the public health impact of expanded health insurance. (Am J Public
Health. 2019;109:1236–1242. doi:10.2105/AJPH.2019.305164)
See also Galea and Vaughan, p. 1169.
Akey component of the US AffordableCare Act (ACA) was the expansion of
Medicaid eligibility to nonelderly adults with
incomes up to 138% of the federal poverty
level.1 This policy resulted in 9.6 million
people becoming newly eligible for Medicaid
beginning in 2014.2 The rapidly growing
literature documents a range of beneficial
outcomes for the newly eligible population,
including higher rates of insurance coverage,
increased access to health care providers,
improved quality of care, increased use of
preventive health services, reduced likelihood
of emergency department visits, and reduced
financial difficulties.3–7 Public health spill-
over effects with relevance to the general
population also have been documented,
including lower rates of crime, higher
prescribing of opioid treatments, and reduced
socioeconomic disparities in access to health
care.8–11 Evidence of direct effects on health
outcomes is relatively scarce,5 whereas a
growing body of evidence shows mixed re-
sults for its effect on self-rated health.7,11–14
The effects of the ACA Medicaid expansion
on population well-being in the United States
are unknown.
Human well-being is gaining attention
from researchers and policymakers as a metric
of social welfare that goes beyond standard
indicators for health policy evaluation.15–18
Broadly defined, subjective w ...
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. ColTawnaDelatorrejs
By Beth Han, Wilson M. Compton, Carlos Blanco, and Lisa J. Colpe
Prevalence, Treatment, And Unmet
Treatment Needs Of US Adults
With Mental Health And
Substance Use Disorders
ABSTRACT We examined prevalence, treatment patterns, trends, and
correlates of mental health and substance use treatments among adults
with co-occurring disorders. Our data were from the 325,800 adults who
participated in the National Survey on Drug Use and Health in the period
2008–14. Approximately 3.3 percent of the US adult population, or
7.7 million adults, had co-occurring disorders during the twelve months
before the survey interview. Among them, 52.5 percent received neither
mental health care nor substance use treatment in the prior year. The
9.1 percent who received both types of care tended to have more serious
psychiatric problems and physical comorbidities and to be involved with
the criminal justice system. Rates of receiving care only for mental
health, receiving treatment only for substance use, and receiving both
types of care among adults with co-occurring disorders remained
unchanged during the study period. Low perceived need and barriers to
care access for both disorders likely contribute to low treatment rates of
co-occurring disorders. Future studies are needed to improve treatment
rates among this population.
S
ubstance use disorders and mental
disorders influence each other, and
their combined presentation (here-
after referred to as co-occurring
disorders) results in more profound
functional impairment; worse treatment out-
comes; higher morbidity and mortality; in-
creased treatment costs; and higher risk for
homelessness, incarceration, and suicide than
each of the individual disorders.1–4 Current treat-
ment guidelines recommend that people with co-
occurring disorders receive treatments for both
disorders.5–7 However, little is known about the
twelve-month prevalence, service use patterns,
correlates of mental health and substance use
treatments, and unmet treatment need among
US adults with co-occurring disorders.
Recent studies indicate that the prevalence of
opioid use disorders and marijuana use among
adults has increased in recent years.8,9 It is im-
portant to determine whether these specific in-
creases led to greater overall prevalence of co-
occurring disorders, because adults with opioid
or marijuana use disorders are likely to have co-
occurring mental illness.8,9 Also, two recent stud-
ies reported that between 2005–07 and 2014 and
between 2004 and 2013, respectively, among the
overall US adult population, receipt of mental
health care increased (primarily as a result of
increasing use of psychiatric medications), and
receipt of substance use treatment remained
stable.10,11 However, it is unknown whether there
have been similar changes in patterns of care for
adults with co-occurring disorders.
The Paul Wellstone and Pete Domenici Mental
Health Parity and Addiction Equity Act of 2008
required insurance coverage of mental he ...
The document discusses research on health care access disparities among Latino populations and their families. It notes that Latinos are more likely than other groups to have uninsured family members. Research shows socioeconomic factors play a role, but people of color experience different health care even with similar insurance and conditions. The document then outlines several research implications and opportunities for systemic interventions to address barriers Latinos face in accessing health care.
The document discusses the need for behavioral health services in Nueces County, Texas. It provides statistics on mental illnesses like bipolar disorder and major depressive disorder treated in the county. Suicide rates are also discussed both locally and nationally. The nursing implications are early detection, education on risk factors, and management of disorders. Nurses play a role in comprehensive assessment, advocacy, and linking patients to support services. Barriers to mental healthcare include stigma, lack of perceived need, and cost of treatment. Community education and support can help address these barriers.
reply with three references H.R. 721 Mental Health Servic.docxWilheminaRossi174
reply with three references
H.R. 721: Mental Health Services for Students Act of 2021
Mental Health, we hear about it all the time. Mental health is a driving force in the media, when law enforcement officers in America, engage in a critical incident, involving a subject with “Mental health problems”. Mental health continues to take countless lives, from our Military Veterans, as each day passes. Children in school experienced an extreme disrupt in their daily lives, when they were forced to stay indoors, and attend school through a screen, in the early stages of the Covid-19 Pandemic. Homelessness in America is rising, and the amount of homeless Americans with untreated mental health issues is staggering. We don’t need to see a fact sheet, read a medical journal, or test subjects in a clinical trial, to be cognizant of the amount of persons with unattended mental health disorders, in America. American children’s health should be a priority, they are our future professor’s, philosophers, engineers, doctors, free thinkers; they are the future “Us”.
The Mental Health Services for Students Act of 2021, was introduced by Congresswoman Grace Napolitano. HR 721 passed in the house on May 12th, 2021. HR 721 has 86 cosponsors (82(D) & 4(R)). Since 2001, Congresswoman Napolitano has had this program implemented into 35 schools, which has shown to be extremely helpful (Facts on the Mental Health Services for Students Act, n.d.). With low funds nationally, for on site mental health care professionals in schools, HR 721 would provide additional funding. HR 721 will provide $130,000,000 in competitive grants. The Substance Abuse and Mental Health Services Adminsitration (SAMHSA), would be delegated with distribution of funds. HR 721 would expand on
Project AWARE
, which is an educational grant.
Project AWARE
aims at educating and informing families, students, and school faculty about mental health.
Project AWARE
partners with state mental health agencies, where they train school faculty how to identify and respond to children with behavioral health issues (SAMHSA, 2020). HR 721 would expand on this program, by implementing on site mental health professionals in schools.
Personally, I support HR 721, from what I have researched thus far. The problem is, 49.4% of children in the United States did not receive treatment or counseling for a mental health disorder. (Whitley, G., 2019). According to the CDC, the third leading cause of death for adolescents aged 15-19 was suicide (CDC, 2021). Those two statistics alone, show the deprivation of resources and funding in the American school system. My husband, being a police officer, noticed a significant spike in “suicidal juvenile” calls, over the past two years. I myself, work on a occasion, at the juvenile detention facility. I have watched these children, over the past couple of years, destroy their lives due to untreated mental health illnesse.
Quality Data Sources Organizer Discussion Paper.docxwrite22
The document discusses five quality data sources from the 2017 National Healthcare Quality and Disparities Report. It provides details on each data source such as the primary content collected, target population, demographic data included, frequency of data collection, and whether it is a primary or secondary source. The sources discussed are the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Ambulatory Medical Care Survey, National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database, and National Health Interview Survey.
1. The document analyzes the relationship between health literacy, demographic factors, and disparities in health insurance coverage using a nationally representative sample of U.S. adults.
2. It finds that lower health literacy directly predicts lack of health insurance, and that health literacy mediates the impact of race/ethnicity, education, and other factors on insurance coverage.
3. The results suggest health literacy initiatives should target systemic barriers to improve access to health insurance for vulnerable groups defined by demographics and socioeconomic status.
LGBT college students in Pennsylvania experience significantly higher rates of mental health conditions, self-harm, and suicidality compared to heterosexual and cisgender peers and the general college population. Over half of LGBT students surveyed had been diagnosed with a mental health condition. Barriers to accessing mental health care included cost, lack of time, and health insurance issues. Minority stress from discrimination, family rejection, and internalized homophobia/transphobia likely contribute to poorer mental health outcomes for LGBT students.
O R I G I N A L P A P E RInvoluntary commitment and detain.docxvannagoforth
O R I G I N A L P A P E R
Involuntary commitment and detainment in adolescent
psychiatric inpatient care
Riittakerttu Kaltiala-Heino
Received: 14 January 2009 / Accepted: 31 July 2009 / Published online: 19 August 2009
� Springer-Verlag 2009
Abstract
Objective To evaluate whether adolescents committed to
psychiatric inpatient care are the most disturbed, and
whether psychosocial factors other than psychiatric symp-
toms are associated with commitment to and detainment in
psychiatric care among adolescents.
Materials and methods The case histories of 187 13- to
17-year-old adolescents consecutively admitted to the
study clinic were scrutinized with the help of a structured
data collection form. Psychiatric, demographic and family-
related characteristics of those referred involuntarily
(n = 93) and voluntarily (n = 94), and those detained
involuntarily (n = 42) and treated on a voluntary basis
(n = 145) were compared.
Results Involuntary referral and involuntary detainment
were associated with psychotic symptoms, temper tantrums
and breaking property, involuntary referral also with vio-
lent and hostile behaviours and suicidal ideation and talk.
They were not associated to family adversities, previous
treatment history or sociodemographic factors. The risk for
being committed when presenting with aggressive behav-
iours was greater in girls.
Conclusion Involuntary referral and detainment in ado-
lescents is associated with symptom severity, and not with
aspects of the adolescent’s living conditions. This is in
agreement with the legislation. Gender bias resulting in
girls’ greater risk of being involuntarily committed if dis-
playing aggressive behaviours may be an ethical and legal
problem.
Keywords Involuntary treatment �
Involuntary admission � Health services research �
Adolescent psychiatry
Introduction
In Western democracies, individuals basically have a right
to make decisions concerning themselves, including deci-
sions concerning their health that experts consider harmful.
In psychiatry, however, the patient’s wish not to be treated
can be overridden both referring to her/his need for treat-
ment and to dangerousness to her/himself or others. Mental
illness is considered to alter the patient’s understanding of
her/his situation and the consequences of her/his choices so
that s/he can no longer be deemed competent to make
decisions. Therefore, others can, or even must intervene.
Compulsory intervention is assumed to result in greater
good than no (coercive) intervention [10, 12, 16, 18, 34,
35]. On the other hand, coercive treatment may result in
greater harm than good, if ‘‘costs’’ such as violation of
autonomy, not improving or even getting worse, or being
pushed away from psychiatric services due to negative
experiences weigh more than benefits received [21, 28].
In order to be competent to make decisions, a patient
must be able to understand information as relevant to her/
his ...
1
Literature Review Assignment
STUDENT NAME
Class
Date
2
Part A: Annotated Bibliography
Article 1: Immigration as a Social Determinant of Health
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J.
(2015). Immigration as a Social Determinant of Health. Annual Review of Public
Health, 36(1), 375–392. doi: 10.1146/annurev-publhealth-032013-182419
Abstract
Although immigration and immigrant populations have become increasingly important foci in
public health research and practice, a social determinants of health approach has seldom been
applied in this area. Global patterns of morbidity and mortality follow inequities rooted in
societal, political, and economic conditions produced and reproduced by social structures,
policies, and institutions. The lack of dialogue between these two profoundly related
phenomena—social determinants of health and immigration—has resulted in missed
opportunities for public health research, practice, and policy work. In this article, we discuss
primary frameworks used in recent public health literature on the health of immigrant
populations, note gaps in this literature, and argue for a broader examination of immigration as
both socially determined and a social determinant of health. We discuss priorities for future
research and policy to understand more fully and respond appropriately to the health of the
populations affected by this global phenomenon.
Annotated Bibliography
The article reports on the importance of identifying social determinants and the effects of
socially determined structures among immigrant populations in the United States. The study
identifies ways in which immigrants health outcomes are based on biases due to using
3
information based on group behaviors instead of on an induvial case. The impact of migrant and
immigrant individuals, physical and mental health in these communities’ changes as social,
economic, and political policies take place. This article is helpful in that broadens the
immigration experience including more central factors than just language, income, or education
as the cause of all health related problems in this community. But to show factors of power
structures and the ability to put in place effective health interventions that respond to direct
causes of poor or declining health in these populations.
Article 2: Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes
Vargas, Edward & Sanchez, Gabriel & Juárez, Melina. (2017). Fear by Association: Perceptions
of Anti-Immigrant Policy and Health Outcomes. Journal of Health Politics, Policy and
Law. 42. 3802940. 10.1215/03616878-3802940.
Abstract
The United States is experiencing a renewed period of immigration and immigrant policy
activity as well as heightened enforcement of such policies. This intensified activity can affect
various aspects of im ...
BRIEF REPORTScreening for Depression Among Minority Young VannaSchrader3
BRIEF REPORT
Screening for Depression Among Minority Young Males Attending a
Family Planning Clinic
Ruth S. Buzi and Peggy B. Smith
Baylor College of Medicine
Maxine L. Weinman
University of Houston
The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression among
535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. The
assessment indicated that 119 (22.2%) males met criteria for depression. The study also examined the
associations between depression, sociodemographics, and service requests. Depressed males were more
likely than nondepressed males to be Hispanic and to request services related to relationships, feelings,
financial resources, physical issues, and well-being. The findings indicated that young males who are
affected by depression have unmet needs, but when given an opportunity, are able to express those needs.
Because family planning clinics are increasing the number of male clients, they are well positioned to
screen them for depression.
Keywords: young males, depression, request for services
Major Depressive Disorder (MDD) is recognized as one of
the most common chronic conditions today. According to the
U.S. Department of Health and Human Services (2012), ap-
proximately 2 million adolescents, or 8.0% of the population
ages 12 to 17, had at least one major depressive episode during
2010. A recent report by the Substance Abuse and Mental
Health Services Administration (SAMHSA, 2012) indicates
that one in five American adults aged 18 or older, or 45.6
million, people had mental illness in the past year. The rate of
mental illness was twice as high among those 18 –25 (29.8%)
than among those aged 50 and older (14.3%).
Males experience more persistent depressive symptoms and
disorders from adolescence into adulthood than females (Dunn
& Goodyer, 2006; Colman, Wadsworth, Croudace, & Jones,
2007). Non-Hispanic African American males tend to have the
highest rates of MDD at 13.2%, followed by Hispanics or
Latinos (12.7%) and then non-Hispanic Whites (8.7%) U.S.
Department of Health & Human Services, 2012). Depression
among minority adolescents and young adults was found to be
related to stress, lack of social resources, and low socioeco-
nomic status (Brown, Meadows, & Elder, 2007). Risk factors
for African American men’s depression include economic
strain, interpersonal conflicts, and racial discrimination (Wat-
kins, Green, Rivers, & Rowell, 2006). Hispanic and African
American males also display significantly earlier onset of MDD
compared with their White counterparts (Riolo, Nguyen, Gre-
den, & King, 2005).
Despite the fact that males also suffer from depression, they
seek mental help from health care professionals less frequently
than females, which only further decreases the likelihood of
diagnosing their mental health disorders (Addis & Mahalik,
2003; Smith, Braunack-Mayer, & Wittert, 2006). Males often
feel pressured to avoid emotional expres ...
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
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Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
The document discusses the role of statistics and mathematicians in public health practice and HIV/AIDS surveillance. It provides examples of how HIV/AIDS data is collected through disease reporting and used by statisticians to analyze trends, identify at-risk groups, and inform prevention strategies. Specific projects highlighted include using population attributable risk to quantify how social determinants influence racial disparities in HIV incidence among women and analyzing mediators of behavioral interventions.
1) The document discusses gaps in post-sexual assault healthcare among homeless young adults. It reports on a study of 1,405 young adults aged 18-26 across 7 US cities.
2) The study found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received post-assault medical care.
3) Latinx young adults were more likely than other groups to receive post-assault care. Participants frequently did not seek care because they did not want to involve the legal system and did not think it was important.
Gaps in Sexual Assault Health Care Among Homeless Young Adults.pdfsdfghj21
This document summarizes a study examining gaps in sexual assault health care among homeless young adults in the United States. The study surveyed 1,405 homeless young adults aged 18-26 across 7 cities. It found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received a post-sexual assault medical examination. The study aims to identify barriers and facilitators to receiving post-assault care in order to improve prevention and healthcare services for this at-risk population.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
Depressive Symptoms, Hostility, and HopelessnessSavannah Kalman
The document describes a study that examined depressive symptoms, hostility, and hopelessness in 246 adolescent patients at an inner-city health clinic. The researchers hypothesized that the factors would form a single construct and be associated with demographic characteristics. Confirmatory factor analysis found the factors were best characterized as three separate constructs. General linear modeling showed hopelessness was significantly higher in White males, accounting for 6% of the variance. The study provides insight into negative psychological factors in urban teens but notes gaps in understanding how the factors relate and are affected by demographics.
Quality Data Sources Essay Example Paper.docxwrite22
This document discusses several quality data sources used in healthcare:
1. The National Health and Nutrition Examination Survey collects health data from US civilians including chronic conditions, health, nutrition, and risk factors.
2. The National HIV/AIDS Surveillance System collects HIV exposure and demographic data from all US states to monitor HIV infection rates.
3. The Behavioral Risk Factor Surveillance System surveys US adults about preventive health behaviors and chronic conditions.
4. The National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database collects patient experience data about healthcare providers and health plans.
5. The National Ambulatory Medical Care Survey collects data from medical visits including diagnoses, treatments, and patient dem
BRIEF REPORTScreening for Depression Among Minority Young .docxjackiewalcutt
The study assessed depression among 535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. Using the CES-D scale, 22.2% of participants met criteria for depression. Depressed males were more likely to be Hispanic and request services related to relationships, feelings, finances, physical health, and well-being. The findings suggest family planning clinics could help meet the unidentified mental health needs of young males by screening for depression.
Low Health Literacy in the Older Adult: Identification & Intervention power p...Jeanne Baus
Low Health Literacy in Older Adults is a common challenge for home health care nurses. This powerpoint addresses how to identify low health literacy levels and how to effectively meet the patient needs to improve health education goals and outcomes.
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
This study analyzed US health care spending from 1996-2013 using 183 data sources to estimate spending for 155 conditions stratified by age, sex, and type of care. The key findings were:
1) Diabetes had the highest spending in 2013 at $101.4 billion, with 57.6% spent on pharmaceuticals and 23.5% on ambulatory care.
2) Ischemic heart disease and low back/neck pain had the second and third highest spending in 2013.
3) Spending increased for 143 of 155 conditions from 1996-2013, with the largest increases for diabetes ($64.4 billion) and low back/neck pain ($57.2 billion).
4) Emergency
Prescription opioid use among adults with mental health disorders in the US.Paul Coelho, MD
This study analyzed nationally representative health survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other health factors.
Prescription Opioid Use Among Adults with Mental Health Disorders in the USPaul Coelho, MD
This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
Velasco-Mondragon et al. Public Health Reviews (2016) 3731 .docxjessiehampson
Velasco-Mondragon et al. Public Health Reviews (2016) 37:31
DOI 10.1186/s40985-016-0043-2
REVIEW Open Access
Hispanic health in the USA: a scoping
review of the literature
Eduardo Velasco-Mondragon1* , Angela Jimenez2, Anna G. Palladino-Davis3, Dawn Davis4
and Jose A. Escamilla-Cejudo5
* Correspondence:
[email protected]
1College of Osteopathic Medicine,
Touro University California, 1310
Johnson Lane; H-82, Rm. 213,
Vallejo, CA 94592, USA
Full list of author information is
available at the end of the article
Abstract
Hispanics are the largest minority group in the USA. They contribute to the economy,
cultural diversity, and health of the nation. Assessing their health status and health needs
is key to inform health policy formulation and program implementation. To this end, we
conducted a scoping review of the literature and national statistics on Hispanic health in
the USA using a modified social-ecological framework that includes social determinants
of health, health disparities, risk factors, and health services, as they shape the leading
causes of morbidity and mortality. These social, environmental, and biological forces have
modified the epidemiologic profile of Hispanics in the USA, with cancer being the
leading cause of mortality, followed by cardiovascular diseases and unintentional injuries.
Implementation of the Affordable Care Act has resulted in improved access to health
services for Hispanics, but challenges remain due to limited cultural sensitivity, health
literacy, and a shortage of Hispanic health care providers. Acculturation barriers and
underinsured or uninsured status remain as major obstacles to health care access.
Advantageous health outcomes from the “Hispanic Mortality Paradox” and the “Latina
Birth Outcomes Paradox” persist, but health gains may be offset in the future by
increasing rates of obesity and diabetes. Recommendations focus on the adoption of the
Health in All Policies framework, expanding access to health care, developing cultural
sensitivity in the health care workforce, and generating and disseminating research
findings on Hispanic health.
Keywords: Hispanics, Latinos, Scoping study, Social determinants of health, Health care
inequalities, Health care access
Background
Hispanics are the largest ethnic minority in the USA; in 2014, Hispanics comprised
17.4% of the US population (55.4 million), and this percentage is expected to increase
to 28.6% (119 million) by 2060. Hispanics in the USA include native-born and foreign-
born individuals immigrating from Latin America, the Caribbean, and Spain [1].
Hispanics are disproportionately affected by poor conditions of daily life, shaped by struc-
tural and social position factors (such as macroeconomics, cultural values, income, educa-
tion, occupation, and social support systems, including health services), known as social
determinants of health (SDH). SDH exert health effects on individuals through allostatic
load [2], a phenomenon purported t ...
. According to your textbook, Contrary to a popular misconception.docxmadlynplamondon
According to a cross-cultural study of 186 societies, attitudes toward homosexuality vary significantly across cultures. Only 31% of societies studied stigmatized homosexual behavior, while 38% viewed it as a normal developmental phase for youth and 18% accepted committed same-sex relationships as an alternative form of marriage. The historical stigmatization of homosexuality in America is a product of enculturation rather than universal moral values.
-How did artwork produced in America from 1945 to 1960 compare to ar.docxmadlynplamondon
Post-World War II American art differed from European art by embracing abstract expressionism through artists like Jackson Pollock and his drip paintings, while European art focused more on figurative styles. Pollock's painting Number 1, 1950 (Lavender Mist) used dripped and splattered oil paint on canvas in 1950, as did Willem de Kooning's Woman I in 1952, showing the abstract expressionist movement in America. European art of the time included Alberto Giacometti's figurative sculpture Woman of Venice II from 1956.
More Related Content
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Quality Data Sources Organizer Discussion Paper.docxwrite22
The document discusses five quality data sources from the 2017 National Healthcare Quality and Disparities Report. It provides details on each data source such as the primary content collected, target population, demographic data included, frequency of data collection, and whether it is a primary or secondary source. The sources discussed are the National Health and Nutrition Examination Survey, Behavioral Risk Factor Surveillance System, National Ambulatory Medical Care Survey, National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database, and National Health Interview Survey.
1. The document analyzes the relationship between health literacy, demographic factors, and disparities in health insurance coverage using a nationally representative sample of U.S. adults.
2. It finds that lower health literacy directly predicts lack of health insurance, and that health literacy mediates the impact of race/ethnicity, education, and other factors on insurance coverage.
3. The results suggest health literacy initiatives should target systemic barriers to improve access to health insurance for vulnerable groups defined by demographics and socioeconomic status.
LGBT college students in Pennsylvania experience significantly higher rates of mental health conditions, self-harm, and suicidality compared to heterosexual and cisgender peers and the general college population. Over half of LGBT students surveyed had been diagnosed with a mental health condition. Barriers to accessing mental health care included cost, lack of time, and health insurance issues. Minority stress from discrimination, family rejection, and internalized homophobia/transphobia likely contribute to poorer mental health outcomes for LGBT students.
O R I G I N A L P A P E RInvoluntary commitment and detain.docxvannagoforth
O R I G I N A L P A P E R
Involuntary commitment and detainment in adolescent
psychiatric inpatient care
Riittakerttu Kaltiala-Heino
Received: 14 January 2009 / Accepted: 31 July 2009 / Published online: 19 August 2009
� Springer-Verlag 2009
Abstract
Objective To evaluate whether adolescents committed to
psychiatric inpatient care are the most disturbed, and
whether psychosocial factors other than psychiatric symp-
toms are associated with commitment to and detainment in
psychiatric care among adolescents.
Materials and methods The case histories of 187 13- to
17-year-old adolescents consecutively admitted to the
study clinic were scrutinized with the help of a structured
data collection form. Psychiatric, demographic and family-
related characteristics of those referred involuntarily
(n = 93) and voluntarily (n = 94), and those detained
involuntarily (n = 42) and treated on a voluntary basis
(n = 145) were compared.
Results Involuntary referral and involuntary detainment
were associated with psychotic symptoms, temper tantrums
and breaking property, involuntary referral also with vio-
lent and hostile behaviours and suicidal ideation and talk.
They were not associated to family adversities, previous
treatment history or sociodemographic factors. The risk for
being committed when presenting with aggressive behav-
iours was greater in girls.
Conclusion Involuntary referral and detainment in ado-
lescents is associated with symptom severity, and not with
aspects of the adolescent’s living conditions. This is in
agreement with the legislation. Gender bias resulting in
girls’ greater risk of being involuntarily committed if dis-
playing aggressive behaviours may be an ethical and legal
problem.
Keywords Involuntary treatment �
Involuntary admission � Health services research �
Adolescent psychiatry
Introduction
In Western democracies, individuals basically have a right
to make decisions concerning themselves, including deci-
sions concerning their health that experts consider harmful.
In psychiatry, however, the patient’s wish not to be treated
can be overridden both referring to her/his need for treat-
ment and to dangerousness to her/himself or others. Mental
illness is considered to alter the patient’s understanding of
her/his situation and the consequences of her/his choices so
that s/he can no longer be deemed competent to make
decisions. Therefore, others can, or even must intervene.
Compulsory intervention is assumed to result in greater
good than no (coercive) intervention [10, 12, 16, 18, 34,
35]. On the other hand, coercive treatment may result in
greater harm than good, if ‘‘costs’’ such as violation of
autonomy, not improving or even getting worse, or being
pushed away from psychiatric services due to negative
experiences weigh more than benefits received [21, 28].
In order to be competent to make decisions, a patient
must be able to understand information as relevant to her/
his ...
1
Literature Review Assignment
STUDENT NAME
Class
Date
2
Part A: Annotated Bibliography
Article 1: Immigration as a Social Determinant of Health
Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M.-E. D., Beyeler, N., & Quesada, J.
(2015). Immigration as a Social Determinant of Health. Annual Review of Public
Health, 36(1), 375–392. doi: 10.1146/annurev-publhealth-032013-182419
Abstract
Although immigration and immigrant populations have become increasingly important foci in
public health research and practice, a social determinants of health approach has seldom been
applied in this area. Global patterns of morbidity and mortality follow inequities rooted in
societal, political, and economic conditions produced and reproduced by social structures,
policies, and institutions. The lack of dialogue between these two profoundly related
phenomena—social determinants of health and immigration—has resulted in missed
opportunities for public health research, practice, and policy work. In this article, we discuss
primary frameworks used in recent public health literature on the health of immigrant
populations, note gaps in this literature, and argue for a broader examination of immigration as
both socially determined and a social determinant of health. We discuss priorities for future
research and policy to understand more fully and respond appropriately to the health of the
populations affected by this global phenomenon.
Annotated Bibliography
The article reports on the importance of identifying social determinants and the effects of
socially determined structures among immigrant populations in the United States. The study
identifies ways in which immigrants health outcomes are based on biases due to using
3
information based on group behaviors instead of on an induvial case. The impact of migrant and
immigrant individuals, physical and mental health in these communities’ changes as social,
economic, and political policies take place. This article is helpful in that broadens the
immigration experience including more central factors than just language, income, or education
as the cause of all health related problems in this community. But to show factors of power
structures and the ability to put in place effective health interventions that respond to direct
causes of poor or declining health in these populations.
Article 2: Fear by Association: Perceptions of Anti-Immigrant Policy and Health Outcomes
Vargas, Edward & Sanchez, Gabriel & Juárez, Melina. (2017). Fear by Association: Perceptions
of Anti-Immigrant Policy and Health Outcomes. Journal of Health Politics, Policy and
Law. 42. 3802940. 10.1215/03616878-3802940.
Abstract
The United States is experiencing a renewed period of immigration and immigrant policy
activity as well as heightened enforcement of such policies. This intensified activity can affect
various aspects of im ...
BRIEF REPORTScreening for Depression Among Minority Young VannaSchrader3
BRIEF REPORT
Screening for Depression Among Minority Young Males Attending a
Family Planning Clinic
Ruth S. Buzi and Peggy B. Smith
Baylor College of Medicine
Maxine L. Weinman
University of Houston
The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression among
535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. The
assessment indicated that 119 (22.2%) males met criteria for depression. The study also examined the
associations between depression, sociodemographics, and service requests. Depressed males were more
likely than nondepressed males to be Hispanic and to request services related to relationships, feelings,
financial resources, physical issues, and well-being. The findings indicated that young males who are
affected by depression have unmet needs, but when given an opportunity, are able to express those needs.
Because family planning clinics are increasing the number of male clients, they are well positioned to
screen them for depression.
Keywords: young males, depression, request for services
Major Depressive Disorder (MDD) is recognized as one of
the most common chronic conditions today. According to the
U.S. Department of Health and Human Services (2012), ap-
proximately 2 million adolescents, or 8.0% of the population
ages 12 to 17, had at least one major depressive episode during
2010. A recent report by the Substance Abuse and Mental
Health Services Administration (SAMHSA, 2012) indicates
that one in five American adults aged 18 or older, or 45.6
million, people had mental illness in the past year. The rate of
mental illness was twice as high among those 18 –25 (29.8%)
than among those aged 50 and older (14.3%).
Males experience more persistent depressive symptoms and
disorders from adolescence into adulthood than females (Dunn
& Goodyer, 2006; Colman, Wadsworth, Croudace, & Jones,
2007). Non-Hispanic African American males tend to have the
highest rates of MDD at 13.2%, followed by Hispanics or
Latinos (12.7%) and then non-Hispanic Whites (8.7%) U.S.
Department of Health & Human Services, 2012). Depression
among minority adolescents and young adults was found to be
related to stress, lack of social resources, and low socioeco-
nomic status (Brown, Meadows, & Elder, 2007). Risk factors
for African American men’s depression include economic
strain, interpersonal conflicts, and racial discrimination (Wat-
kins, Green, Rivers, & Rowell, 2006). Hispanic and African
American males also display significantly earlier onset of MDD
compared with their White counterparts (Riolo, Nguyen, Gre-
den, & King, 2005).
Despite the fact that males also suffer from depression, they
seek mental help from health care professionals less frequently
than females, which only further decreases the likelihood of
diagnosing their mental health disorders (Addis & Mahalik,
2003; Smith, Braunack-Mayer, & Wittert, 2006). Males often
feel pressured to avoid emotional expres ...
ADVANCED NURSING RESEARCH
1
ADVANCED NURSING RESEARCH 2
Evidence Based Practice Grant Proposal
Table of Contents
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4
5
6
6
7
8
8
9
9
9
11
11
11
11
12
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13
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19
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Grant Proposal-Assessing the role of stigma towards mental health patients in help seeking
Study problem
There are several studies that have shown that stigmatization towards mental health patients have been present throughout history and even despite the evolution in modern medicine and advanced treatment. For example, Verhaeghe et al., (2014), captures in a publication in reference to a study that he conducted that stigmatization towards mental health patients has been there even as early is in the 18th Century. People were hesitant to interact with people termed or perceived to have mental health conditions.
Stigmatization has resulted from the belief that those with mental problem are aggressive and dangerous creating a social distance (Szeto et al., 2017). Also, mental health-related stigma has become of major concern as it creates crucial barriers to access treatment and quality care since it not only influences the behaviour of the patients but also the attitude of the providers hence impacting help-seeking. Timmermann, Uhrenfeldt and Birkelund (2014), have identified stigma as a barrier that is of significance to care or help seeking while the extent to which it still remains a barrier have not been reviewed deeply. Therefore, this study will assess the role contributed by stigma in help seeking in depth. 1. Purpose
The intention of the research study is to review the association between stigma, mental illness and help seeking in order to formulate ways in which the stigma that is around mental health is done away with to enable as many people suffering from mental health complications to seek medical help.2. Background
Mental health is crucial in every stage of life. It is defined as the state of psychological well-being whereby the individual realizes a satisfactory integration instinctual drive acceptable to both oneself and his or her social setting (Ritchie & Roser, 2018). The status of mental health influences physical health, relationships, and most importantly day-to-day life. Mental health problems arise when there is a disruption in mental well-being.
The risk factors to mental health problems are not limited and therefore everyone is entitled to the problem irrespective of gender, economic status, and ethnic group. For example, data shows that in America one out of five individuals experience mental health problems annually; with mental disorders being recognized as the leading cause of disability not only in the United States but also globally (Ritchie & Roser, 2018). Mental health disorders are seen to be complex and of many forms such as anxiety, mood, and schizophren.
The document discusses the role of statistics and mathematicians in public health practice and HIV/AIDS surveillance. It provides examples of how HIV/AIDS data is collected through disease reporting and used by statisticians to analyze trends, identify at-risk groups, and inform prevention strategies. Specific projects highlighted include using population attributable risk to quantify how social determinants influence racial disparities in HIV incidence among women and analyzing mediators of behavioral interventions.
1) The document discusses gaps in post-sexual assault healthcare among homeless young adults. It reports on a study of 1,405 young adults aged 18-26 across 7 US cities.
2) The study found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received post-assault medical care.
3) Latinx young adults were more likely than other groups to receive post-assault care. Participants frequently did not seek care because they did not want to involve the legal system and did not think it was important.
Gaps in Sexual Assault Health Care Among Homeless Young Adults.pdfsdfghj21
This document summarizes a study examining gaps in sexual assault health care among homeless young adults in the United States. The study surveyed 1,405 homeless young adults aged 18-26 across 7 cities. It found high rates of sexual assault (22%) and forced sex (24%) among participants. However, only 29% of those forced to have sex received a post-sexual assault medical examination. The study aims to identify barriers and facilitators to receiving post-assault care in order to improve prevention and healthcare services for this at-risk population.
This document summarizes a study on systems-level barriers that contribute to secondary conditions in individuals with fetal alcohol spectrum disorders (FASD). The study involved interviews and focus groups with parents of children with FASD and service providers.
The key findings were:
1) A pervasive lack of knowledge about FASD exists throughout multiple systems, including healthcare, education, and social services. This lack of knowledge contributes to barriers across different systems.
2) Systems-level barriers that interfere with preventing secondary conditions include delayed diagnosis of FASD, difficulty qualifying for and accessing services, poor implementation of services, and challenges maintaining services long-term.
3) Broad system changes are needed using a public
Depressive Symptoms, Hostility, and HopelessnessSavannah Kalman
The document describes a study that examined depressive symptoms, hostility, and hopelessness in 246 adolescent patients at an inner-city health clinic. The researchers hypothesized that the factors would form a single construct and be associated with demographic characteristics. Confirmatory factor analysis found the factors were best characterized as three separate constructs. General linear modeling showed hopelessness was significantly higher in White males, accounting for 6% of the variance. The study provides insight into negative psychological factors in urban teens but notes gaps in understanding how the factors relate and are affected by demographics.
Quality Data Sources Essay Example Paper.docxwrite22
This document discusses several quality data sources used in healthcare:
1. The National Health and Nutrition Examination Survey collects health data from US civilians including chronic conditions, health, nutrition, and risk factors.
2. The National HIV/AIDS Surveillance System collects HIV exposure and demographic data from all US states to monitor HIV infection rates.
3. The Behavioral Risk Factor Surveillance System surveys US adults about preventive health behaviors and chronic conditions.
4. The National Consumer Assessment of Healthcare Providers and Systems Benchmarking Database collects patient experience data about healthcare providers and health plans.
5. The National Ambulatory Medical Care Survey collects data from medical visits including diagnoses, treatments, and patient dem
BRIEF REPORTScreening for Depression Among Minority Young .docxjackiewalcutt
The study assessed depression among 535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. Using the CES-D scale, 22.2% of participants met criteria for depression. Depressed males were more likely to be Hispanic and request services related to relationships, feelings, finances, physical health, and well-being. The findings suggest family planning clinics could help meet the unidentified mental health needs of young males by screening for depression.
Low Health Literacy in the Older Adult: Identification & Intervention power p...Jeanne Baus
Low Health Literacy in Older Adults is a common challenge for home health care nurses. This powerpoint addresses how to identify low health literacy levels and how to effectively meet the patient needs to improve health education goals and outcomes.
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
This study analyzed US health care spending from 1996-2013 using 183 data sources to estimate spending for 155 conditions stratified by age, sex, and type of care. The key findings were:
1) Diabetes had the highest spending in 2013 at $101.4 billion, with 57.6% spent on pharmaceuticals and 23.5% on ambulatory care.
2) Ischemic heart disease and low back/neck pain had the second and third highest spending in 2013.
3) Spending increased for 143 of 155 conditions from 1996-2013, with the largest increases for diabetes ($64.4 billion) and low back/neck pain ($57.2 billion).
4) Emergency
Prescription opioid use among adults with mental health disorders in the US.Paul Coelho, MD
This study analyzed nationally representative health survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other health factors.
Prescription Opioid Use Among Adults with Mental Health Disorders in the USPaul Coelho, MD
This study used nationally representative survey data to examine prescription opioid use among US adults with mental health disorders. The key findings were:
1) An estimated 18.7% of the 38.6 million American adults with mental health disorders use prescription opioids, accounting for 51.4% of the total opioid prescriptions distributed in the US each year.
2) Adults with mental health disorders were over 3 times more likely to use opioids compared to adults without mental health disorders.
3) Having a mental health disorder, such as depression or anxiety, was associated with a more than 2 times greater odds of prescription opioid use after adjusting for other factors.
Velasco-Mondragon et al. Public Health Reviews (2016) 3731 .docxjessiehampson
Velasco-Mondragon et al. Public Health Reviews (2016) 37:31
DOI 10.1186/s40985-016-0043-2
REVIEW Open Access
Hispanic health in the USA: a scoping
review of the literature
Eduardo Velasco-Mondragon1* , Angela Jimenez2, Anna G. Palladino-Davis3, Dawn Davis4
and Jose A. Escamilla-Cejudo5
* Correspondence:
[email protected]
1College of Osteopathic Medicine,
Touro University California, 1310
Johnson Lane; H-82, Rm. 213,
Vallejo, CA 94592, USA
Full list of author information is
available at the end of the article
Abstract
Hispanics are the largest minority group in the USA. They contribute to the economy,
cultural diversity, and health of the nation. Assessing their health status and health needs
is key to inform health policy formulation and program implementation. To this end, we
conducted a scoping review of the literature and national statistics on Hispanic health in
the USA using a modified social-ecological framework that includes social determinants
of health, health disparities, risk factors, and health services, as they shape the leading
causes of morbidity and mortality. These social, environmental, and biological forces have
modified the epidemiologic profile of Hispanics in the USA, with cancer being the
leading cause of mortality, followed by cardiovascular diseases and unintentional injuries.
Implementation of the Affordable Care Act has resulted in improved access to health
services for Hispanics, but challenges remain due to limited cultural sensitivity, health
literacy, and a shortage of Hispanic health care providers. Acculturation barriers and
underinsured or uninsured status remain as major obstacles to health care access.
Advantageous health outcomes from the “Hispanic Mortality Paradox” and the “Latina
Birth Outcomes Paradox” persist, but health gains may be offset in the future by
increasing rates of obesity and diabetes. Recommendations focus on the adoption of the
Health in All Policies framework, expanding access to health care, developing cultural
sensitivity in the health care workforce, and generating and disseminating research
findings on Hispanic health.
Keywords: Hispanics, Latinos, Scoping study, Social determinants of health, Health care
inequalities, Health care access
Background
Hispanics are the largest ethnic minority in the USA; in 2014, Hispanics comprised
17.4% of the US population (55.4 million), and this percentage is expected to increase
to 28.6% (119 million) by 2060. Hispanics in the USA include native-born and foreign-
born individuals immigrating from Latin America, the Caribbean, and Spain [1].
Hispanics are disproportionately affected by poor conditions of daily life, shaped by struc-
tural and social position factors (such as macroeconomics, cultural values, income, educa-
tion, occupation, and social support systems, including health services), known as social
determinants of health (SDH). SDH exert health effects on individuals through allostatic
load [2], a phenomenon purported t ...
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According to a cross-cultural study of 186 societies, attitudes toward homosexuality vary significantly across cultures. Only 31% of societies studied stigmatized homosexual behavior, while 38% viewed it as a normal developmental phase for youth and 18% accepted committed same-sex relationships as an alternative form of marriage. The historical stigmatization of homosexuality in America is a product of enculturation rather than universal moral values.
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After an individual is arrested, I will obtain fingerprints and photographs of the subject and complete a number of forms that are used to start a criminal file on the subject. I will use the Buccal Collection DNA test kit provided by the FBI on my subject. Once completed properly and submitted to the FBI, the kit will be sent to the Federal DNA Database Unit (FDDU). The FDDU will take the DNA test kit and upload it into NDIS creating a DNA profile for my subject. The subject’s DNA profile will be searched against unknown forensic profiles from crime scenes across the country. If my subject’s DNA matches with another crime from another state he can be charged for that crimes as well. In my opinion this is the most important service the FBI has. This allows all agencies to communicate and share information based off of DNA evidence. The flaw is that they need the criminal to be apprehended and processed in order for the DNA to be in the system.
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respond to this discussion question 150 words
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-You will also need to complete the calculations in assignment.
Assignment file below...
.
. EDU 571 Week 5 Discussion 1 -
"Data Collection" Please respond to the following:
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·
EDU 571 Week 5 Discussion 2 -
"Benefits of Meta-Evaluation" Please respond to the following:
· Your client told you that a meta-evaluation should not be included in the plan or budget. Explain two (2) reasons for including a meta-evaluation in the evaluation plan. Recommend two (2) ways to reduce the costs.
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EDU 571 Week 3 Target of Program Evaluation Plan, Part 1 -
Target of Program Evaluation Plan, Part 1
Assignment 1 is the first part of a five-part project to plan the various elements of a program evaluation for education. Select a program target from your school district, workplace, (e.g., business training program) or your university (where you are a student). For you to gain the most from the assignment, you should select a program that you are interested in, would like to see evaluated, and are able to obtain information about. (Possible programs include: student assessment, teacher assessment, pay for student achievement, new teacher or employee training, online classrooms, anti-bullying, gender equity for girls in math and science, school to work, retention of at-risk students, and schools of choice (charter schools), etc.). As you develop the entire plan, gather information, and receive feedback from your professor (or others), you should revise and refine each part of the project. Think of your professor as your project evaluator and supervisor who will help guide you so that you produce an outstanding, well-developed evaluation plan for the stakeholders.
Write a 1000 words paper in which you:
1. Describe three (3) elements of a worthy object for program evaluation - its type, the department administrating it, and target population.
2. Describe the program's history, primary purpose(s), and / or expected outcomes.
3. Explain three (3) reasons for selecting the program (e.g., program's value or lack of it, issues surrounding it, age, relevance, cost, impact on students, etc.).
4. Discuss three (3) advantages of evaluating the program at this time.
5. Discuss two (2) major constraints in conducting an evaluation on this program and a method of addressing them.
6. Use at least three (3) peer-reviewed academic resources in this assignment. Note: Wikipedia and many Websites do not qualify as academic resources. Peer-reviewed academic resources refer to articles and scholarly journals that are reviewe.
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.
. Complete the prewriting for the progress reportPrewriting p.docxmadlynplamondon
. Complete the prewriting for the progress report:
Prewriting prepares you to write and helps you organize your ideas.
You may print the lesson and jot notes for yourself on the paper, or you may write notes on your own.
You do not have to submit prewriting for any points, but don't skip this important step!
2. Complete a draft of the progress report:
Remember to use the memo format style in typing this progress report.
This report should be two or more pages when you are completed.
The draft will be much shorter than your final report.
Follow a logical structure: introduction, what is finished, what is underway, what is left to do, and a conclusion.
Use specifics such as dates, proper names, numbers, costs, etc.
Include one or more visuals may such as pictures, graphs, charts, tables, etc.
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-how does Nilda feel about Sophies's presence in her home?
-how is bilingualism used in the story "Filomena"? Support your opinions with examples from the story
-describe the incident with the vanilla ice cream . Why was it so upsetting for Nilda?
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-Write about a violent religious event in history.(Ex. Muslim ex.docxmadlynplamondon
-Write about a violent religious event in history.
(Ex. Muslim extremist acts in history, or the Christian crusades, etc.)
-Write about belief/reasoning/justification those certain people believe their actions have and affects of...
-(Identity)They're view of the world and themselves. Is it rationale or is it a problem. Why?
5-pages minimum
4-scholarly sources min. 2 of 4 book sources Need Dec. 2nd by 9pm.
.
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-The CD reviewed is one that will allow reflection about how music can provide people the opportunity to imagine the lives and experiences of others different from oneself. Questions to guide reflection while listening should include:
1. Who are the peoples performing the music or who is the music about?
2.What type of life is presented through the music's lyrics and musical sound?
3.What themes or issues are presented by the music?
4. How do the various musical selections relate to each other?
5.What can be learned about people by listening to this CD?
6.Why should other people listen to this music?
-A list of CDs is available for this assignment. CDs may be downloaded for a fee from a preferred site.
-The review will need to include:
1.CD title, artist, genre, release date, etc
2.Background information about the artist or artists for those who may not be familiar.
-The review should be between 800 and 1000 words.
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.
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Judge A belongs to the legal positivist school of thought. He bases his decision solely on statutory law and case precedents interpreting the law, without considering other factors.
Judge B belongs to the natural law school of thought. He believes the laws of nature apply in extraordinary situations where people are cut off from civilization, rather than man-made laws.
Judge C belongs to the sociological jurisprudence school of thought. She bases her decision on a scientific survey of the community's beliefs, rather than just statutory law or precedent.
-1. Are the three main elements of compensation systems—internal.docxmadlynplamondon
-1.
Are the three main elements of compensation systems—internal consistency, market competitiveness, and recognizing employee contributions—equally important, or do you believe that they differ in importance? If different, which do you believe is most important? Least important? Give your rationale.
use 1 online reference and
Martocchio, J. (2017). Strategic Compensation: A human resource management approach (9th ed.). Upper Saddle River, NJ: Pearson.
.
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Cite at least 2 peer reviewed journal/article. Write in APA format
.
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Alfons Heck participated in the Hitler Youth and Nazi culture as a child, which helped shape his sense of purpose and identity. In his memoir "A Child of Hitler", written many decades later, Heck reflects on his experiences and how the acts of writing and reflection allowed him to craft a new identity in the present. Students are asked to analyze how Heck's participation in the Hitler Youth influenced his identity, and how writing his memoir also impacted his identity later in life, in a 2-4 page paper with citations.
------ Watch an online speechpresentation of 20 minutes or lo.docxmadlynplamondon
------
Watch an online speech/presentation of 20 minutes or longer.
( please cite the presentation you would use)
Write a speech analysis essay of
2-3 pages
I: List the speaker, date, location, & topic, and describe the audience. Describe each of these elements and analyze the effect that each of these elements had on the speaker and/or speech.
II: Describe and analyze the effectiveness of each part of the speaker's introduction (attention getter, revelation of topic, statement of credibility, statement of central idea, preview of main points).
III: Summarize each of the speaker's main points. What pattern of organization did the speaker utilize? Was this effective? Why or why not?
IV: Describe and analyze the effectiveness of the evidence/supporting material that the speaker used.
V: Describe and analyze the effectiveness of the speaker's language.
VI: Describe and analyze the effectiveness of the speaker's delivery.
VII: Describe and analyze the effectiveness of each part of the speaker's conclusion.
.
) Florida National UniversityNursing DepartmentBSN.docxmadlynplamondon
)
Florida National University
Nursing Department
BSN Program
NUR 4636-Community Health Nursing
Prof. Eddie Cruz, RN MSN
Please choose one infectious disease or communicable disease and present a 1,000 words essay including the follow;
Name of the disease including agents that cause Infectious/Communicable Disease, the mode of contamination or how it is spread.
The modes of prevention applying the three levels of prevention with at least one example of each one.
Prevalence and control of the condition according to the Center for Disease Control and Prevention (CDC) including morbidity and mortality.
Implications of the disease in the community and the role of the community health nurse in the control and prevention of the disease.
The essay must be presented in a Word Document, APA format, Arial 12 font attached to the forum in the tab of the Discussion Question title “Infections/Communicable disease essay” and in the assignment tab under the exercise title “SafeAssign infectious/communicable disease”. A minimum of 3 references no older than 5 years must be used. If you use any reference from any website make sure they are reliable sites such as CDC, NIH, Institute of Medicine, etc.
There is a rubric attached to the assignment for your guidance.
Below please see the definitions of infectious disease and communicable disease. They are similar but differ in some characteristics.
Infectious diseases
are disorders caused by organisms — such as bacteria, viruses, fungi or parasites. Many organisms live in and on our bodies. They're normally harmless or even helpful. But under certain conditions, some organisms may cause
disease
. Some
infectious diseases
can be passed from person to person.
Communicable
, or infectious
diseases
, are caused by microorganisms such as bacteria, viruses, parasites and fungi that can be spread, directly or indirectly, from one person to another. Some are transmitted through bites from insects while others are caused by ingesting contaminated food or water.
.
- Please answer question 2 at the end of the case.- cita.docxmadlynplamondon
- Please answer
question 2
at the end of the case.
- citations and references in
IEEE
style
( at least two)
- your answer should be in regards to the case
+
regarding the question itself.
Do it twice ( two different copies)
.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
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4. BCP, Surveying volume 1
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Disparities in Access to Health Care Among US-Bornand Foreig.docx
1. Disparities in Access to Health Care Among US-Born
and Foreign-Born US Adults by Mental Health
Status, 2013–2016
Reema Dedania, MD, MPH, and Gilbert Gonzales, PhD, MHA
Objectives. To compare access to care between US-born and
foreign-born US adults
by mental health status.
Methods. We analyzed data on nonelderly adults (n = 100 428)
from the 2013–2016
National Health Interview Survey. We used prevalence
estimates and multivariable lo-
gistic regression models to compare issues of affordability and
accessibility between
US-born and foreign-born individuals.
Results. Approximately 22.2% of US-born adults and 18.1% of
foreign-born adults
had symptoms of moderate to severe psychological distress.
Compared with US-born
adults with no psychological distress, and after adjustment for
sociodemographic
characteristics, US-born and foreign-born adults with
2. psychological distress were much
more likely to report multiple emergency room visits and unmet
medical care, mental
health care, and prescription medications because of cost.
Conclusions. Our study found that adults with moderate to
severe psychological
distress, regardless of their immigration status, were at greater
risk for reporting issues
of affordability when accessing health care compared with US-
born adults with no
psychological distress.
Public Health Implications. Health care and mental health
reforms should focus
on reducing health care costs and establishing innovative efforts
to broaden access to
care to diverse populations. (Am J Public Health.
2019;109:S221–S227. doi:10.2105/
AJPH.2019.305149)
Health care access is an important factorassociated with mental
illness pre-
vention, early-stage diagnosis and treatment,
and overall prognosis of psychiatric disorders.1
However, disparities in health care access and
health services utilization between immi-
3. grants and native-born populations in the
United States have been well documented for
a number of reasons, including stigmatization,
fear of deportation, challenges navigating a
complex health insurance system, and the
absence of culturally sensitive care and health
information.2,3 Studies show that, on average,
immigrants report better self-rated health and
less health services utilization compared with
native-born populations. However, consid-
erable debate remains over whether lower
utilization rates reflect a lesser need or an issue
of accessibility.4–7 This problem can be
unremitting and even aggravated in the
treatment of mental health disorders, which
are among the most expensive medical con-
ditions in the United States in recent years.8
There are a variety of factors that influence
the mental health of immigrants in particu-
lar. First, it is essential to recognize that
immigrants enter the United States through
a variety of means, including elective immi-
gration (e.g., family-based and employment-
based immigration) and forced migration
(e.g., refugees or asylees who are fleeing
persecution or are unable to return to their
homeland because of life-threatening and
oftentimes extraordinary conditions).
Depending on the reason for relocation,
immigrants may experience resettlement
stress during the acclimation and adjust-
ment period caused by changes in socio-
economic status. Isolation and absence of
4. social support may also serve as catalysts for
undue stress to develop into persistent psy-
chiatric pathology and reduced quality of
life.9,10 Furthermore, traumatic and adverse
life experiences, particularly in the refugee
and asylee population, serve as forerunners
for acute stress disorder and posttraumatic
stress disorder in these groups.9,10 Because
immigrants and children of immigrants
constitute 24% of the US population,11 their
mental health concerns—and acculturative
stress in particular—have ramifications for the
overall health of the nation.
Although immigrants may have greater
mental health care needs, barriers to medical
and mental health care may prevent some
immigrants from accessing needed treatment.
For instance, immigrants are at higher risk for
encountering hostile attitudes in the health
care delivery system,12 which impedes access
to routine medical care for this vulnerable
population. Evidence suggests that height-
ened vigilance related to perceived prejudice
also has pathogenic effects on the mental
health of immigrant populations.12 A recent
study of Hispanics in 38 states found higher
rates of mental illness in states with more
ABOUT THE AUTHORS
Reema Dedania is with the Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center,
Nashville, TN. Gilbert Gonzales is with the Department of
Health Policy, Vanderbilt University School of Medicine,
Nashville.
5. Correspondence should be sent to Reema Dedania, Department
of Psychiatry and Behavioral Sciences, 1601 23rd Ave South,
Nashville, TN 37212 (e-mail: [email protected]). Reprints can
be ordered at http://www.ajph.org by clicking the
“Reprints” link.
This article was accepted April 21, 2019.
doi: 10.2105/AJPH.2019.305149
Supplement 3, 2019, Vol 109, No. S3 AJPH Dedania and
Gonzales Peer Reviewed Research S221
AJPH RESEARCH
mailto:[email protected]
http://www.ajph.org
exclusionary policies and attitudes toward
immigrants.13 Other research suggests that
some immigrant groups may experience
barriers to medical care,11 but very little re-
search has directly examined access to care for
immigrants living with psychological distress
in the United States.
This study compared access to care and
health services utilization between US-born
and foreign-born US adults by mental health
status. We hypothesized that foreign-born
individuals with moderate or severe psy-
chological distress may be more likely to face
barriers to care compared with US-born in-
dividuals with no psychological distress.
Knowing the patterns in health care access
between these groups across a spectrum
6. of mental health statuses is important for
informing ongoing efforts to narrow health
disparities between immigrant and native-
born populations in the United States.
METHODS
This study used data from the 2013–2016
National Health Interview Survey (NHIS),
a nationally representative health survey of
the civilian, noninstitutionalized population.
Conducted annually by the National Center
for Health Statistics at the Centers for Disease
Control and Prevention, the NHIS provides
comprehensive data used to monitor the
nation’s health.14 The questionnaire records
basic demographic, health, and disability in-
formation for each household member. A
single random adult in each household is
selected for a detailed interview on more
specific health information, including health
insurance coverage, access to health care, and
health services utilization. We drew our study
sample from the sample adult component of
the 2013–2016 NHIS, which we accessed
through the University of Minnesota’s
Integrated Public Use Microdata Series,
a systematized and publicly available
version of the NHIS.15
We used demographic data from sampled
adults to identify nonelderly US-born and
foreign-born adults in the NHIS. Consistent
with previous research using the NHIS,
US-born adults included all adults born in 1
of the 50 states, the District of Columbia, or
7. any US territory.16,17 The NHIS considered
adults born outside the United States and its
territories to be foreign-born; they might
include naturalized citizens, legal permanent
residents, refugees, undocumented immi-
grants, and adults on long-term temporary
visas (e.g., students and guest workers). We
restricted the analysis to nonelderly adults
aged 18 to 64 years (n = 104 196) to examine
health care needs in the working-age pop-
ulation. Our final sample included 85 217
US-born adults and 18979 foreign-born adults.
To measure mental health status, we relied
on the K6 scale of Kessler et al.18 for non-
specific psychological distress. The K6 scale is
a 6-item screening instrument widely used to
assess mental illness in epidemiological stud-
ies. The screening instrument asked how
often during the previous 30 days the re-
spondent felt nervous, hopeless, worthless, so
sad that nothing could cheer him or her up,
restless or fidgety, and that everything was an
effort. Using a 24-point scale, we defined
adults scoring 0 to 4 points, 5 to 12 points, and
13 to 24 points as having no psychological
distress (NPD), moderate psychological dis-
tress (MPD), and severe psychological distress
(SPD), respectively.19
Study Outcomes
We compared 5 dimensions of health care
access and health services utilization by im-
migration status and mental health status.
8. Three measures of barriers to care due to cost
were unmet medical care, unmet prescription
medications, and unmet mental health care,
all in the prior year. We also included 2
measures that assessed barriers to routine care:
having no usual source of medical care that
included a doctor’s office, a clinic, or health
center, and reporting multiple emergency
room (ER) visits in the prior year (which may
be a source of care when an individual lacks a
regular primary care provider). Of note, all
measures analyzed in this study were self-
reported, but these measures are regularly
used to monitor access to health care in the
United States.14
Statistical Analysis
We used descriptive statistics to charac-
terize the study sample and to compare the
differences between US-born and foreign-
born individuals by mental health status. We
then estimated multivariable logistic re-
gression models comparing each outcome
across 6 groups: US-born with no psycho-
logical distress, US-born with MPD,
US-born with SPD, foreign-born with no
psychological distress, foreign-born with
MPD, and foreign-born with SPD; US-born
adults with no psychological distress served as
the reference group. All models adjusted for
variables associated with health care access,
including gender, age category (18–25, 26–
34, 35–49, and 50–64 years), race/ethnicity
(non-Hispanic White, non-Hispanic Black,
9. non-Hispanic other races, Hispanic), educa-
tional attainment (less than high school, high
school, some college, college graduate), re-
lationship status (married, divorced or sepa-
rated, widowed, never married), household
income relative to the US Census Bureau’s
poverty guidelines (£ 100%, 100%–199%,
200%–399%, or ‡ 400% of federal poverty
guidelines), health insurance status, self-rated
health status (excellent, very good, good,
poor or fair), number of chronic conditions
(including cancer, hypertension, coronary
heart disease, stroke, chronic obstructive
pulmonary disease, asthma, diabetes, arthritis,
hepatitis, and weak or failing kidneys), US
Census region, and survey year. Follow-up
regression models included interactions be-
tween immigration and mental health status
to determine whether foreign-born adults
were more or less likely to experience barriers
to care compared with US-born adults of the
same mental health status. We conducted
analyses in Stata version 15 (StataCorp LP,
College Station, TX) using survey weights
and the SVY command to adjust standard
errors for the complex survey design of the
NHIS and to generate nationally represen-
tative estimates.20 Results from all logistic
regression models are presented as adjusted
prevalence ratios with 95% confidence in-
tervals. We calculated prevalence ratios using
postestimation predictions at the mean value
for each covariate with the MARGINS
command in Stata. Hypothesis tests compared
the value of each prevalence ratio to 1 using
adjusted Wald tests to reflect the complex
10. survey design. We also estimated prevalence
ratios for models with interactions using
predicted probabilities for all 6 possible
combinations between immigration (foreign-
born and US-born) and mental health status
(NPD, MPD, and SPD) based on post-
estimation predictions at the mean value for
each covariate.
AJPH RESEARCH
S222 Research Peer Reviewed Dedania and Gonzales AJPH
Supplement 3, 2019, Vol 109, No. S3
RESULTS
Table 1 presents characteristics of non-
elderly adults in the United States by
immigration and mental health status. Ap-
proximately 18.1% and 4.1% of US-born
adults reported moderate or severe psycho-
logical distress, respectively. US-born adults
with MPD or SPD were more likely to be
female, divorced or separated, never married,
in low-income households, unemployed,
uninsured, report poor or fair health, and have
multiple chronic conditions compared with
US-born adults with NPD. Age distributions
and racial/ethnic composition across mental
health categories were relatively similar for
US-born adults. About 15.4% and 2.7% of
foreign-born adults reported symptoms of
moderate or severe psychological distress,
respectively. Foreign-born adults with MPD
11. or SPD were more likely to be female,
Hispanic, divorced or separated, and from
lower levels of educational attainment and
family incomes. Foreign-born adults with
MPD or SPD were also more likely to report
poor or fair self-rated health and multiple
chronic conditions compared with foreign-
born adults with no psychological distress.
Compared with their US-born counterparts,
foreign-born adults were more likely to be
racially and ethnically diverse, married, un-
insured, and to have no chronic condition
diagnoses. Foreign-born adults were also
more likely to have lower education levels
and to reside in low-income households
compared with US-born adults.
Table 2 presents prevalence estimates and
logistic regression results on barriers to care
by immigration and mental health status. On
the basis of unadjusted prevalence estimates,
US-born and foreign-born adults with MPD
or SPD were significantly more likely to have
no usual source of care, multiple ER visits, and
unmet medical care, mental health care, and
prescription medication needs due to cost
compared with US-born adults with no psy-
chological distress. There were no unadjusted
differences inunmet health careneeds between
US-born and foreign-born adults with NPD.
However,comparedwithUS-bornadultswith
NPD, foreign-born adults with NPD were
more likely to have no usual source of care
and less likely to have multiple ER visits.
Table 2 also presents results from multi-
12. variable logistic regression models that
compared access to care by immigration and
mental health status categories, with US-born
adults with NPD used as the reference group.
After we controlled for sociodemographic
characteristics, US-born adults with moderate
or severe psychological distress were more
likely to have no usual source of care, multiple
ER visits, and unmet medical, mental, and
pharmaceutical care due to cost. After we
controlled for sociodemographic character-
istics, foreign-born adults with NPD were
more likely to have no usual source of care
and less likely to have multiple ER visits and
unmet medical, prescription, or medication
needs due to cost than their US-born
counterparts with NPD. Finally, foreign-
born adults with MPD or SPD were more
likely to have unmet medical care needs,
unmet mental health care needs, and unmet
prescription medication needs compared with
US-born adults with NPD. After we con-
trolled for sociodemographic characteristics,
foreign-born adults with MPD were more
likely to have no usual source of care, and
foreign-born adults with SPD were more
likely to have multiple ER visits compared
with US-born adults with NPD.
Table 3 presents regression adjusted results
on barriers to care with interactions between
immigration and mental health status.
Overall, compared with US-born adults,
foreign-born adults were less likely to report
multiple ER visits and unmet medical care,
13. mental health care, and prescription medi-
cations due to cost. Foreign-born adults with
NPD and MPD, however, were more likely
to have no usual source of care compared with
their US-born counterparts with NPD and
MPD.
DISCUSSION
The size of the US immigrant population
has increased over time and shows no signs
of abating: the number of foreign-born in-
dividuals in the United States has more than
quadrupled since 1965 and is expected to
reach 78 million by 2065.21 Understanding
the dynamics of immigrant health will help
elucidate the effects on health patterns of both
departing and receiving countries, including
the overall health of the United States.21,22
This analysis complements recent studies in
the immigrant mental health literature that
examined disparities in utilization between
US-born and foreign-born populations. We
found that both US-born and foreign-born
adults with psychological distress experience
wide barriers in care, particularly financial-
related barriers to medical, mental health, and
pharmaceutical care. Previous research has
suggested that immigration status is a de-
terrent to mental health utilization in the
United States. For example, prior studies have
noted that immigrants are significantly less
likely to take prescription drugs and that
having no usual source of care is a major
14. contributing factor for disparities between
US-born and foreign-born groups’ utilization
rates.23 Conversely, our research suggests
that individuals with psychological distress
living in the United States have unmet health
needs—including the ability to afford pre-
scription drugs—irrespective of immigration
status. Furthermore, in our study, foreign-
born adults with NPD and MPD were much
less likely to have a usual source of care
compared with their US-born counterparts
with NPD and MPD, respectively. These
findings may be explained, in part, by a
growing literature that suggests that it is not
nativity per se that accounts for differences in
immigrants’ health utilization but that the
differences may be rooted in contextual and
interpersonal circumstances among these
groups, such as social support, community
cohesion, or perceived discrimination.23,24
Health care cost was a major barrier to care
for both US-born and foreign-born adults
with psychological distress. More research
should identify best practices for improving
access to routine and affordable medical care
for adults living with psychological distress.
Policymakers should prioritize the develop-
ment of more affordable interventions that
destigmatize treatment of mental illness. An
emphasis on integrated care models and
partnerships between primary care providers
and psychiatrists for both immigrants and
US-born adults, for example, would nor-
malize the screening process of mental illness
and create additional access points to target
15. those in need. Heightened attention to
mental health prevention services (such as
depression and suicide screening) in primary
care offices or emotional resilience training
in schools may strengthen protective factors
and allow for the early identification and
treatment of mental illness. Similarly,
AJPH RESEARCH
Supplement 3, 2019, Vol 109, No. S3 AJPH Dedania and
Gonzales Peer Reviewed Research S223
TABLE 1—Descriptive Statistics of Nonelderly Adults, by
Mental Health and Immigration Status: National Health
Interview Survey, United
States, 2013–2016
US-Born Foreign-Born
No Psychological Distress, No.
or Weighted %
Moderate Psychological
Distress, No. or Weighted %
Severe Psychological
Distress, No. or Weighted %
No Psychological Distress, No.
or Weighted %
Moderate Psychological
Distress, No. or Weighted %
17. Married 52.8 40.2 32.7 66.6 58.1 52.1
Divorced/separated 12.5 17.9 26.9 9.9 14.6 22.8
Widowed 1.5 2.5 3.8 1.2 2.1 3.1
Never married 33.1 39.4 36.5 22.2 25.1 22.1
Missing data 0.2 0.1 0.2 0.2 0.1 0.0
Educational
attainment
< high school 7.3 11.2 21.3 24.6 29.8 40.7
High school
graduate
24.3 26.9 32.3 21.0 20.6 21.3
Some college 34.4 37.8 36.5 19.9 22.1 18.7
‡ bachelor’s degree 33.8 23.8 9.6 33.7 26.7 17.7
Missing data 0.2 0.3 0.4 0.9 0.7 1.7
Family income relative to poverty
£ 100% FPG 9.7 18.3 33.1 16.2 22.2 36.0
100%–199% FPG 13.3 20.6 27.0 22.2 27.0 28.4
200%–399% FPG 26.6 27.7 21.1 25.6 24.7 19.0
18. ‡ 400% FPG 43.5 28.2 14.3 28.5 20.3 10.4
Missing data 7.1 5.1 4.6 7.5 5.8 6.2
Health insurance status
Insured 88.5 83.9 79.9 72.2 67.8 66.0
Uninsured 10.9 15.5 19.6 27.4 31.5 33.2
Missing data 0.6 0.7 0.5 0.5 0.7 0.8
Health status
Excellent 34.9 19.2 7.8 35.9 20.4 15.1
Very good 35.5 29.3 14.6 31.4 25.7 14.1
Good 22.9 30.2 26.4 25.7 36.0 26.9
Poor/fair 6.7 21.3 51.2 7.1 17.9 43.9
Missing data 0.0 0.1 0.1 0.0 0.1 0.0
No. of chronic conditionsa
0 58.9 45.2 26.7 71.4 57.3 40.2
1 25.0 26.2 25.8 19.6 24.9 26.9
‡ 2 15.6 27.5 45.8 8.4 16.8 31.9
Missing data 0.4 1.1 1.7 0.6 1.0 1.0
Note. FPG = federal poverty guidelines (from US Census). Data
are from the 2013–2016 National Health Interview Survey,
19. adults aged 18–64 years.
aChronic conditions include cancer, hypertension, coronary
heart disease, stroke, chronic obstructive pulmonary disease,
asthma, diabetes, arthritis, hepatitis,
and weak or failing kidneys.
AJPH RESEARCH
S224 Research Peer Reviewed Dedania and Gonzales AJPH
Supplement 3, 2019, Vol 109, No. S3
community-based programs that improve
mental health literacy and promote help
seeking at the onset of symptoms can lead to
early treatment and reduce the chance of
subsequent episodes. For example, we rec-
ommend subsidizing cognitive behavior
therapy as an early intervention method to
prevent posttraumatic stress disorder for in-
dividuals at heightened risk for experiencing
trauma.
Our research also suggests that both
US-born and foreign-born adults with SPD
were more likely to utilize ER services, even
after we controlled for sociodemographic
characteristics. Because health care costs
prevent US-born and foreign-born adults
from receiving necessary medical care, re-
ducing costs toprimary careand mental health
services may also reduce the increased utili-
zation of ERs, which tend to be more ex-
pensive visits. Policymakers and health care
administrators should invest in programs that
20. use ER visits as an opportunity to employ
care-coordination models consisting of so-
cial services, mental health referrals, and
pharmacist-conducted patient education.
Investing in case managers who proactively
identify patients that frequent the ER but
have chronic and low-acuity mental health
conditions or psychological distress should
connect patients with available community
providers to ensure longitudinal care.
Limitations
A limitation to using the NHIS is that all
responses were self-reported, which can lead
to response and recall bias when describing
access to care. However, the health care access
outcomes we examined are commonly used
to monitor access to care in the United
States.14 Additionally, reporting immigration
status may be limited by selection bias. Prior
research has explored different types of se-
lection, including the “healthy immigrant
effect” or “immigrant paradox” that may
account for better health in immigrant pop-
ulations compared with native-born pop-
ulations.25,26 Experiences of “double
discrimination”—that is, prejudicial treat-
ment based on a history of psychological
distress and race/ethnicity—may prevent
some foreign-born individuals with psycho-
logical distress from participating in the
NHIS. Furthermore, for immigrants who are
undocumented, fear of deportation or legal
21. repercussions may also discourage participa-
tion in a formal research study. Moreover,
the potential for reverse causality is not
negligible, given the overlap between out-
comes studied (the past year) and exposure of
mental health status (the last 30 days). On-
going longitudinal data would have allowed
for a larger and more detailed examination
of the relationship between psychological
distress and health care access.
Another consideration when interpreting
our results is the fact that the K6 is a screening
tool, not a diagnostic instrument based on
criteria from the Diagnostic and Statistical
Manual of Mental Disorders. As a result, our
psychological outcomes are self-reported
data and not clinical diagnoses. Furthermore,
research on the K6’s sensitivity to change
with culturally diverse groups is needed. In a
study that examined over 1000 articles uti-
lizing the K6 scale, there was inconsistent
evidence for its cultural appropriateness in
TABLE 2—Adjusted and Unadjusted Prevalence Ratios of
Barriers to Care, by Immigration and Mental Health Status:
National Health Interview
Survey, United States, 2013–2016
No Usual Source of Care Multiple ER Visits Unmet Medical
Care Due to Cost
Unmet Mental Health
Care Due to Cost
Unmet Prescription Medications
Due to Cost
24. 24.8 1.38 (1.20, 1.55) 7.0 1.07 (0.86, 1.28) 14.3 1.75 (1.48,
2.03) 3.1 2.77 (1.94, 3.60) 12.9 1.64 (1.36, 1.93)
Severe
psychological
distress
20.7 1.23 (0.91, 1.55) 19.5 2.18 (1.56, 2.81) 24.0 2.55 (1.90,
3.20) 13.2 10.35 (6.07, 14.64) 30.7 3.44 (2.50, 4.38)
Note. CI = confidence interval; ER = emergency room; PR =
prevalence ratio. Data are from the 2013–2016 National Health
Interview Survey, adults aged 18–64
years. Adjusted prevalence ratios are from logistic regression
models controlling for gender, age category, race/ethnicity,
educational attainment, marital
status, household income relative to poverty, health insurance
status, self-rated health status, no. of chronic conditions, US
Census region, and survey year.
Sampling weights were used when estimating prevalence and
adjusted prevalence ratios.
AJPH RESEARCH
Supplement 3, 2019, Vol 109, No. S3 AJPH Dedania and
Gonzales Peer Reviewed Research S225
clinic settings.27 The lower prevalence of
MSD and SPD reported by our foreign-born
respondents may not be representative of each
culturally diverse group and may inaccurately
deflate this heterogonous group’s level of
25. psychological distress. Caution should be
exercised when interpreting K6 scores, and
further research would benefit from the
formulation of a psychological distress con-
struct that includes culturally andlinguistically
diverse clients. Similarly, caution should also
be exercised when generalizing the experi-
ence of all foreign-born adults, as aggregating
immigrants into a single group may conceal
variability within subgroups.28
Another limitation to our analysis was a
relatively small sample size of foreign-born
adults compared with US-born adults. Be-
cause of the small number of foreign-born
adults with severe psychological distress (2.7%
of all foreign-born adults), we were reluctant
to explore additional subgroup analysis such as
method and duration of entry into the United
States, or global region of birth. Furthermore,
we were unable to stratify our results of
immigrants on the basis of elective versus
forced migration because this information was
not collected. Because displaced persons and
refugees are at higher risk for mental health
disorders, our results may be biased to the
extent that immigrants from this subset may
be missing in the analysis.
Another marginalized group that was ex-
cluded is patients within the criminal justice
system, including jails, prisons, and probation
and parole settings, which are known to have
an overrepresentation of mental illness.29–33
26. One recent meta-analysis that evaluated 28
studies focusing on mental illness in US prisons
found that the range of prevalence estimates
for particular disorders was much greater in
prisons than in community samples.34 Un-
fortunately, this key cohort, which is more
representative of the total population with
mental illness, was excluded from our analysis.
Other research should focus on how health
outcomes vary among US- and foreign-born
individuals within the prison and homeless
populations to allow for a more representative
sample of the mentally ill population.
Finally, because of the cross-sectional
nature of this study, we can establish corre-
lations but not pinpoint the causal mecha-
nisms underlying the health care disparities
for US-born and foreign-born groups.
Unobserved variables—such as experiences
of discrimination in employment or health
care settings—are missing from our analy-
sis and may explain the differences found
in this study. Relatedly, the NHIS does
not ascertain identity-specific reasons for
barriers to care (e.g., care denied because of
immigration status). Therefore, we cannot
definitely establish the link between dis-
crimination and barriers to care measured
here, but ongoing research can help fill this
research gap.
Conclusions
This study found substantial barriers to care
27. for US-born and foreign-born adults living
TABLE 3—Adjusted Prevalence Ratios of Barriers to Care,
With Interactions Between Immigration and Mental Health
Status: National Health
Interview Survey, United States, 2013–2016
No Usual Source of Care,
Adjusted PR (95% CI)
Multiple ER Visits,
Adjusted PR (95% CI)
Unmet Medical Care Due to
Cost, Adjusted PR (95% CI)
Unmet Mental Health Care Due
to Cost, Adjusted PR (95% CI)
Unmet Prescription Medications
Due to Cost, Adjusted PR (95% CI)
Immigration status
US-born (Ref) 1 1 1 1 1
Foreign-born 1.23 (1.14, 1.32) 0.62 (0.54, 0.70) 0.85 (0.76,
0.94) 0.74 (0.55, 0.93) 0.77 (0.68, 0.86)
Mental health status
No psychological
distress (NPD; Ref)
1 1 1 1 1
28. Moderate
psychological distress
(MPD)
1.16 (1.02, 1.29) 2.78 (2.46, 3.11) 2.70 (2.42, 2.97) 15.58
(13.09, 18.06) 3.77 (3.37, 4.16)
Severe psychological
distress (SPD)
1.16 (1.09, 1.23) 1.79 (1.65, 1.93) 2.07 (1.92, 2.22) 4.99 (4.30,
5.67) 2.36 (2.20, 2.53)
Immigration status ·
mental health status
Foreign-born with NPD
vs US-born with NPD
1.25 (1.16, 1.35) 0.61 (0.52, 0.71) 0.84 (0.74, 0.94) 0.81 (0.57,
1.06) 0.78 (0.68, 0.88)
Foreign-born with
MPD vs US-born with
MPD
1.18 (1.01, 1.34) 0.60 (0.47, 0.72) 0.85 (0.71, 0.99) 0.51 (0.37,
0.66) 0.68 (0.56, 0.80)
29. Foreign-born with SPD
vs US-born with SPD
1.02 (0.72, 1.31) 0.83 (0.59, 1.07) 0.97 (0.72, 1.23) 0.64 (0.38,
0.90) 0.95 (0.68, 1.21)
Note. CI = confidence interval; ER = emergency room; PR =
prevalence ratio. Data are from the 2013–2016 National Health
Interview Survey, adults aged 18–64
years. Adjusted prevalence ratios are from logistic regression
models controlling for gender, age category, race/ethnicity,
educational attainment, marital
status, household income relative to poverty, health insurance
status, self-rated health status, no. of chronic conditions, US
Census region, and survey year.
Sampling weights were used when estimating adjusted
prevalence ratios.
AJPH RESEARCH
S226 Research Peer Reviewed Dedania and Gonzales AJPH
Supplement 3, 2019, Vol 109, No. S3
with psychological distress. Our results
demonstrate a need for the development of
treatment interventions that target adults
living with psychological distress regardless of
immigration status. We urge public health
practitioners to continue to prioritize in-
dividuals living with psychological distress as
a vulnerable and marginalized population.
Additionally, more work is needed to in-
vestigate the specific biopsychosocial
30. components that are protective against psy-
chopathology, as well as the risk factors for
psychiatric morbidity for individuals with
psychological distress. High-quality, afford-
able medical and mental health care for the
nation’s heterogeneous population will be
achieved only if the health care and policy
arenas jointly prioritize this endeavor.
CONTRIBUTORS
R. Dedania led the idea formulation and overall direction
and planning of the article, as well as its data analysis and
drafting. G. Gonzales assisted with the statistical analysis
and interpretation of the results and participated in
the writing and editing of the article as well as overall
supervision. Both authors provided critical feedback;
participated in the research, analysis, and writing of the
article; and approved the final version to be published.
CONFLICTS OF INTEREST
No competing financial interests exist for either author.
HUMAN PARTICIPANT PROTECTION
This study was deemed exempt from review because
de-identified data were analyzed from secondary sources.
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https://nhis.ipums.org/nhis-
action/variables/group?id=mental_adult
https://nhis.ipums.org/nhis-
action/variables/group?id=mental_adult
https://nhis.ipums.org/nhis-
action/variables/group?id=mental_adult
ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documen
tation/NHIS/2015/srvydesc.pdf
ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documen
tation/NHIS/2015/srvydesc.pdf
https://www.migrationpolicy.org/article/frequently-requested-
statistics-immigrants-and-immigration-united-states
https://www.migrationpolicy.org/article/frequently-requested-
statistics-immigrants-and-immigration-united-states
https://www.migrationpolicy.org/article/frequently-requested-
statistics-immigrants-and-immigration-united-states
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