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The update also summarizes recent journal articles and other research developments in the field and features a data slide from a relevant Kaiser Family Foundation publication. 1. Study Finds Poverty is a High Risk Factor for AIDS
9. Obama Admin: Insurers Must Cover Women’s Preventive Care, Including Birth Control, No Copays DISPARITIES IN RESEARCH 10. Suicidality and Depression Disparities between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. 14. Medical Home Disparities between Children With Public and Private Insurance 17. Predictors of Wellness and American Indians DISPARITIES DATA SPOTLIGHTRoughly half of the uninsured are not aware that the health reform law includes several provisions to expand coverage to low- and moderate-income Americans. DISPARITIES IN THE NEWS 1. Study Finds Poverty is a High Risk Factor for AIDS A recent article published in The Philadelphia Inquirer reported on a study from the Centers for Disease Control and Prevention (CDC) that concluded that poverty is more strongly associated with HIV infection rates in urban neighborhoods than is risky behavior. The article noted that the findings from the CDC’s report provided clarity as to why Philadelphia, one of the most impoverished cities in America, has one of the highest HIV rates in the country. The report included data from nearly 15,000 heterosexual adults. Any man who reported having sex with another man and anyone who reported using injected drugs were dismissed from the study. This was done to focus on the effects of the epidemic in urban areas. The findings showed that 2 percent of the individuals surveyed in 24 urban areas were infected with HIV. “Two percent is what you see in some of the sub-Saharan Africa or places like Haiti,” said Paul Denning, lead author of the report. Amy Nunn, an assistant professor of medicine at Brown University, said “Once HIV takes root in a community, it puts everyone in that community at risk, even if people are not necessarily engaging in higher-risk behaviors.” Nunn continued to say that the report signals a significant change in thought of how the government will focus on prevention strategies for HIV/AIDS (Sapatkin 8/12). 2. U.S. Snubs State in Clinic Funds from Health Care Reform Law (Michigan) According to the article, 25 groups in Michigan made an “all-out effort” to receive federal grant monies to help build new clinics or expand on existing ones for local communities. Chris Allen, CEO of the Detroit Wayne County Health Authority, said “Our community deserves better judgment by our government…No state has been hit harder than Michigan in recent years, and no urban area is suffering more than Detroit and Wayne County.” David Bowman, spokesman for the federal Health Resources and Services Administration (HRSA), said California received more funds because it had “substantially had more applications than other states.” Moreover, the agency had to make significant cutbacks based on the allocated amount set by congressional appropriations. Originally HRSA planned to fund 350 centers using $250 million, but that amount was rolled back to only $28.8 million. New York, Texas, North Carolina, Washington and California received 50 percent of the funding. Sen. Debbie Stabenow, D-Mich., said “We need to continue making access to doctors and nurses more available. I intend to find out how this decision was made so I can ensure Michigan has the opportunity to expand access to quality care for our families” (Anstett 8/13). 3. As Americans’ Debt Has Soared, So Has Obesity A recent article published in the Orlando Sentinel discussed the correlation between the increase in debt and obesity rates in the United States. According to experts and studies cited in the article, the increasing obesity rates are highly correlated with the increasing debt among consumers in the United States. According to the Federal Reserve Board, Americans carry 2.6 more times in debt as compared to 30 years ago. Likewise, according to the Centers for Disease Control and Prevention, Americans are 2.3 times more likely to be obese than 30 years ago. “Starting in the ‘60s, they started to believe they had to follow their muse. That continued through the ‘70s and ‘80s, followed by the ‘90s, which many called the era of narcissism: I want it now, I want it big, and I want it intense,” said Maggie Baker, a financial psychologist from Philadelphia and author of “Crazy About Money: How Emotions Confuse Our Money Choices and What to Do About It.” The article mentioned that very little research has explored the possible link, however, one study in Germany explored this correlation and confirmed excessive debt and weight gain are tied. Tarsha Gibson, 42-year-old standing 5-feet-5 weighs 250lbs, is an example of an American citizen who falls into this vicious cycle. However, Gibson has taken steps to reverse the weight and debt problems she had by seeing a financial counselor. Her combined credit-card debt has dropped by a third, from $4,500 to $3,000, and her weight has stabilized, allowing her the pleasure of not having to take her high blood pressure medication. “I was overextended in every way, and now I’m not” said Gibson (Jameson 8/06). 4. More Latinos Insured in State (Massachusetts) A recent article published by the Boston Globe reported on a study that found that coverage for English-speaking Hispanics has improved in the five years following the passage of the Massachusetts health insurance overhaul but coverage for Spanish-speaking Hispanics continues to lag far behind. The report released by the JSI Research and Training Institute, noted that one-third of non-English speaking Hispanics are uninsured. The researchers suggested that this disparity may stem from language barriers and the challenges associated with the complex enrollment process. The health care law placed the elimination of health disparities as a top-priority and as a result, $2.5 million was set aside for people to work, like Evelyn Figueroa, in community groups to help underserved individuals gain insurance coverage. However, amid the recent recession and deep budget cuts from the State, these local programs were eliminated, making it harder for individuals to find help and enroll in health insurance programs. Paulette Song, spokeswoman for the Executive Office of Health and Human Services, said “The national economic crisis has required that States across the country to make significant budget reductions.” People like Rafeal Henriquez, who depend on Figueroa to help him determine what he was eligible for and navigate the insurance enrollment process, will be affected. Figueroa said “They’re all going to be left behind” in response to these cuts. James Maxwell, the lead author of the study and director of research at JSI, said States must develop strategies and targeted programs to reach those non-English speakers in the wake of this economic crisis (Conaboy 8/04). 5. Study: Healthful Diet May Be Too Costly For Some Americans A recent article in The Seattle Times discussed the findings of a study published in the journal Health Affairs that found that individuals whose diets most closely matched the recommended dietary guidelines tended to spend the most on food, while individuals who at the most junk food tended to spend the least. The U.S. Department of Health and Human Services (HHS) and the Department of Agriculture (USDA) released the latest food guidelines last year, emphasize balancing caloric intake with physical activity, while obtaining sufficient nutrients. Based on these guidelines, researchers from the University of Washington, School of Public Health, surveyed more than 1,000 residents in King County to explore and analyze food expenditure and eating habits among the residents. The researchers found that the respondents who did not consume the recommended amount of potassium and exceeded the recommended levels of saturated fat and sugars tended to spend less on groceries than those whose consumption was closer to the recommended levels. The researchers concluded that an additional $380 in fresh fruit expenditure would be necessary to close the nutrition gap for those who spent less. “It shouldn’t cost more to eat a nutritious diet…for some families it’s still too costly to build their diets around fresh vegetables and fruit,” said Pablo Monsivais, lead author of the study. The authors recommend creating an educational campaign to inform consumers about nutritious low-cost foods that can help alleviate such disparities (Daza 8/03). 6. A Sad Fate for Some Southern Women (Virginia) A recent article in the L.A. Times discussed the significant variations in life expectancy among women across the South. According to research by the Institute for Health and Metrics and Evaluation at the University of Washington, women in Greensville County Virginia can expect to die at age 75. This is almost a decade shorter than the women in Fairfax County, 84. The article noted that some of the leading causes for a shortened life span include smoking and obesity. Unfortunately, these causes are common among the women who live in Greensville County. Furthermore, women in this county have trouble accessing quality care. Melanie Barrett, whose parents died from diabetes at the age of 54 (mother) and 57 (father), has not seen a doctor in years. Barrett said some of the explanation for why people wait so long to see a doctor is attributed to the costs associated with seeing a doctor and to the low wage jobs available to local residents. “If you don’t work at the factory or the prison, minimum wage is all there is,” Barrett says. According to the article, only one hospital serves the town of Emporia and hospitals that can provide quality care is at least 90 minutes away. “It’s hard to get into those state doctors. You can call today and it could be two months before you see them,” says Barrett. (Fiore 8/03). 7. HIV Infections in U.S. Stable but Still Disparities Exist According to a recent article in Reuters, nationwide, new HIV infection rates remained stable between 206 and 2009, but increased by nearly 50 percent for young black gay and bisexual men. According to the article, the Centers for Disease Control and Prevention (CDC) recently reported that new HIV infections have remained stable at a rate of 50,000 infections per year. However, young (those between the ages of 13 and 29 years) men you have sex with men are the population most affected. “HIV remains one of the most glaring health disparities in this country,” said Dr. Kevin Fenton, director of the CDC’s National Center for HIV/AIDS. “We saw increases of up to 48 percent – nearly a 50 percent increase between 2006 and 2009.” According to Fenton, the explanation for this disparity is not well understood, but the CDC will need to focus on areas where HIV is most heavily concentrated in order to reduce these disparities. Last summer, the White House outlined a new National HIV/AIDS strategy that calls for better methods to gather data about infected populations and increase preventive tools that have been shown to decrease the likelihood of HIV transmission (Steenhuysen 8/03). 8. Bloomberg to Use Own Funds in Plan to Aid Minority Youth According to an article published in The New York Times, Michael Bloomberg, the Mayor of New York, plans to use $30 million from his foundation to help fund a program aimed at reducing economic and educational disparities among the City's young black and Latino men. The article noted there are approximately 315,000 black and Latino people in New York City, and they are disproportionately undereducated, incarcerated and unemployed. Mayor Bloomberg plans to implement a $130 million program to improve the educational and economic life of these underserved New York residents. He will be providing $30 million of his own money from his foundation, and will receive a matching contribution from George Soros. The money will be used to put job-recruitment centers in public-housing complexes, retrain probation officers to help reduce recidivism, establish new fatherhood classes, and assess schools on academic progress. For the first time, school assessments will include a measurement of how well black and Latino males are progressing. The program will also include a mentoring program and will implement ways to help black and Latino individuals obtain a driver’s license or state identification card. Andrea Batista Schelsinger, a special adviser to the mayor, said having proper identification is one of the major barriers black and Latino populations face when searching for a job. “They didn’t know why they should have it or how to get it,” said Schelsinger. Although these efforts are encouraging, there are some skeptics. “The success rate, in general, is not that promising,” said Elijah Anderson, a professor of sociology at Yale. “Companies have to be much more receptive to these young people and meet people like Bloomberg halfway.” Professor Anderson is referring to the challenge of businesses hiring these people permanently after the program has ended (Barbaro 8/03). 9. Obama Admin: Insurers Must Cover Women’s Preventive Care, Including Birth Control, No Copays A recent article in The Washington Post provided details regarding the Health and Human Services’ (HHS) plan to expand preventive care coverage for women. According to the article, starting January 1, 2013, some health insurance plans will be required to provide women coverage for a myriad of preventive care services with no copays. These services include annual “well-woman” physicals, screening for HPV, counseling on domestic violence, and a variety of birth control options. The plan comes a month after the Institute of Medicine released a committee report with recommendations on the subject, and includes a provision that would allow religious institutions the opportunity to opt out of covering birth control. A provision in the Affordable Care Act would allow current insurance plans or “grandfathered” plans to be exempt from the new requirement, but the article noted that these plans may feel pressured to change. According to Health and Human Services Secretary Kathleen Sebelius, “These historic guidelines are based on science and existing (medical) literature and will help ensure women get the preventive health benefits they need (Associate Press 8/01). DISPARITIES IN RESEARCH 10. Suicidality and Depression Disparities between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. A recent study published in the Journal of Adolescent Health explored the characteristics of youth who are at high risk of suicide by doing a meta-analysis of previous studies. The researchers found depression symptoms and behaviors of suicide are significantly higher among sexual minority youth (SMY) compared to heterosexual youth. The study authors analyzed the existing literature and data concerning suicidal behavior, depression, and health disparities among SMY. They reviewed several studies for both suicide (20 studies) and depression (12 studies). Seven studies examined both suicide and depression. The results indicated that SMY experience significantly higher levels of suicidal behaviors and depression than heterosexual youth. The researchers also noted that several other studies found evidence suggesting that SMY are more at risk for mental and psychosocial problems. The researchers suggest that mental health service professionals should consider an adolescents sexual orientation because they typically face unique or severe negative conditions as compared to heterosexual youth. (Marshal MP, Dietz LJ, Friedman MS, et al. Suicidality and Depression Disparities between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review. Journal of Adolescent Health. 2011 Aug; 49: 115 – 123). 11. Insurance-Related Barriers to Accessing Dental Care among African-American Adults with Oral Health Symptoms in Harlem, New York City A recent study published in the American Journal of Public Health found black Americans in Harlem face a variety of access barriers to dental health treatment. The researchers wanted to obtain a better understanding of why blacks in Harlem experience major disparities in dental health treatment. The study included interviews from 118 participants who met the eligibility requirements. Several consistent themes were expressed by the participants. Costs, not having coverage, having coverage that is not sufficient, and having coverage that is not accepted by local dentists were among the barriers participants expressed. Although several barriers were identified in the study, the researchers expressed that coverage of dental care did not make it any easier for black patients. A female participant who was 50 years old reported “…I had [the plan] for 10 years and I never used it once, you know. I can never find somebody [dentist] that participated in that…program.” 12. Having Health Insurance Does Not Eliminate Race/Ethnicity-Associated Delays in Breast Cancer Diagnosis in the District of Columbia A recent study published in the journal Cancer, found that disparities in breast cancer diagnosis were not eliminated after controlling for health coverage among women of color in the District of Columbia. The study authors sought to determine whether women with health insurance experience to fewer disparities in delayed breast cancer diagnosis. They analyzed data from 1538 women who were examined for breast abnormalities across 6 hospitals and clinics in the District of Columbia. The results showed that black and Hispanic women with health insurance continued to experience longer periods of follow-up than white women. These results were consistent among women with private insurance, women with form of government insurance (Medicare, Medicaid, or the safety net program Alliance), and women who were uninsured. The study also found that black and Hispanic women with private insurance have a faster diagnosis time than black and Hispanic women with government insurance or who were uninsured, their diagnostic times were either similar or worse than white women with government insurance or who were uninsured. The researchers acknowledged that this study only examined health insurance coverage as a possible barrier to slower diagnostic rates for women of color. They suggested that other factors need to be explored in order to determine why this disparity persists among women of color. However, the researchers point to one possible factor that several studies have attributed as a causal link, the influence of race/ethnicity. According to the researchers, race/ethnicity has a stronger or equally important influence on diagnostic delay than insurance status. (Hoffman HJ, LaVerda NL, Levine PH, et. al. Having health insurance does not eliminate race/ethnicity-associated delays in breast cancer diagnosis in the District of Columbia. Cancer. 2011 Aug; 117(16): 3824 – 3832). 13. Racial and Ethnic Disparities in Hospitalizations and Deaths Associated with the 2009 Pandemic Influenza A (H1N1) Virus Infections in the United States A recent study from the journal of Annals of Epidemiology found that people of color infected with the pandemic influenza (pH1N1) were more likely to be hospitalized and experienced a higher death rate among infected children than their white counterparts. Using data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) from 49 states, the District or Columbia and Puerto Rico, the researchers examined self-reported influenza-like illness (ILI), health care-seeking behavior and self-reported hospitalization. The researchers analyzed the influenza-associated hospitalization rate from the April 2009 to January 2010 Emerging Infections Program (EIP), and the influenza-associated pediatric mortality data from the Centers for Disease Control and Prevention (CDC). The study found that approximately 20% of the U.S. population was affected by the H1N1 pandemic. non-Hispanic black and Hispanic respondents were more likely to report having a household member hospitalized of ILI. However, the difference between non-Hispanic white and non-Hispanic black respondents was not statistically significant. Differences in the racial-ethnic hospitalization rates were observed for fall/winter and for spring/summer among non-Hispanic whites, who experienced the largest percentage of hospitalization rates followed by non-Hispanic blacks, Hispanics, and Asians and Pacific Islanders. After the researchers adjusted for age, the findings showed for spring/summer cases, non-Hispanic blacks experienced the highest hospitalization rate (10.9/100,000) followed by Hispanics and Asian and Pacific Islander. Among fall/winter cases, American Indian/Alaskan Native experienced the highest hospitalization rate (32.7/100,000) followed by Hispanics, and non-Hispanic blacks. Furthermore, non-Hispanic white children accounted for the greatest percentage of pediatric deaths (45%), followed by Hispanic (31%) and non-Hispanic black (16%) children. (Dee DL, Bensyl DM, Gindler J, et. al. Racial and ethnic disparities in hospitalizations and deaths associated with 2009 Pandemic Influenza A (H1N1) virus infections in the United States. Annals of Epidemiology. 2011 Aug; 21(8): 623-630) 14. Medical Home Disparities between Children with Public and Private Insurance The journal of Academic Pediatrics published a study that found family-centered care contributed to medical home disparities among children with public and private insurance. The researchers wanted to explore the possible differences in medical home treatment between children who have private insurance and those with public insurance (Public insurance included Medicaid and the State Children’s Health Insurance Program). The researchers analyzed 91,642 cases of children from the 2007 data in the National Survey of Children’s Health (NSCH). Five categories were created, broken down into 18 questions based on the 2002 American Academy of Pediatrics standards to measure the medical homes. The five categories include: a usual source of sick and well care, a personal doctor/nurse, family-centered care, care coordination, and no difficulty getting referrals. Children with a public coverage (29%) were more likely to be younger and from a racial/ethnic minority group compared to children with private insurance (62%). Publicly insured children were also less likely to meet the criteria for a medical home compared to privately insured children. Over 90% of publicly and privately enrolled children reported having a usual source of care. The researchers also found that children with public insurance were less likely to report family-centered care compared to children with private insurance (p < .001). Family-centered care referred to having providers spend enough time, listen carefully, was sensitive to family values and customs, and provided needed information or partnered in care. The researchers suggested that disparities in family-centered care may be attributed to a lack of cross-cultural communication. This arugment is consistent with previous studies that have found that racial and ethnic minorities report less family-centered communication with their child’s provider. The researchers suggest that the lack of resources and the large patient volume in primary care settings may also limit family-centered care. They conclude that interventions promoting the medical home for children with public insurance must extend beyond access to care in order to reduce these disparities. (Zickafoose JS, Gebremariam A, Clark SJ, Davis MM. et. al. Medical home disparities between children with public and private insurance. Academic Pediatrics. 2011 Jul-Aug; 11(4): 305-10). 15. Temporal Trends in Geographic Disparities in Small-Area-Level Colorectal Cancer Incidence and Mortality in the United States A recent study published in Cancer Causes and Control found geographic colorectal cancer (CRC) disparities decreased between 1988 – 2006, but disparities between regions with relatively high cancer rates compared to those with lower cancer rates remained stable. The researchers in this study wanted explore possible changes and disparities of CRC geographically from 1988 – 2006. The data they analyzed were based on six colorectal cancer indicators from the Surveillance, Epidemiology, and End Results (SEER) programs that covered 195 counties and nine percent of the United States population. The SEER indicators are used to analyze different biological, behavioral, and social processes. The six indicators were the overall incidence, descending colon cancer incidence, proximal colon cancer incidence, late-stage CRC incidence, CRC mortality, and 5-year CRC-specific probability of death. With that in mind, they measured the geographic disparity by measuring both the absolute distribution and relative distribution across counties. The results showed a decline in absolute disparities in CRC geographically but stable in relative disparities. The results suggest, according to the researchers, that while the overall disparity has decreased, some counties who experienced a higher burden of CRC than others in 1988 have not changed over time. This data indicates that the counties with higher rates of incidence and mortality rates in 1988 likely had higher rates in 2006. The researchers suggest this relative disparity could be attributed to other risk factors and further research will need to explore those factors. At any rate, this study provided data that shows that the United States did make progress towards the goals laid out by Healthy People 2010 and the National Cancer Institute’s strategic plan. 16. Obesity Disparities in Preventive Care: Findings from the National Ambulatory Medical Care Survey, 2005 – 2007 A recent study published in Obesity found that while obese patients were more likely to receive education about diet and excersice, they were significantly less likely than normal weight patients to receive education in other areas including certain cancer screenings, tobacco, and injury prevention. Obese patients also experienced differences in referral patterns. While numerous studies have examined differences in preventive service utilization by weight, the study authors noted that few studies have accounted for the practice guidelines recommended by the US Preventive Services Task Force. The researchers used preventive measures data from the 2005 – 2007 National Ambulatory Medical Care Survey from the National Center for Health Statistics and examined preventive services utilization across four weight categories: normal-weight, overweight, obese, and morbidly obese. The analyses demonstrated that obese and morbidly obese patients were significantly less likely to receive a breast exam, mammography, pap test, pelvic exam, rectal exam, tobacco education, receive information on injury prevention, psychotherapy or mental health counseling referrals, and have diagnosis screening. However, obese and morbidly obese patients were more likely to receive glycosylated hemoglobin tests, diet and nutrition education, weight reduction education, be refereed to another physician, see a nurse practitioner, and have health education services than normal weight patients. The researchers suggest that the gap between lower routine preventive services and higher weight and health education services among obese and morbidly obese patients may be a result of physicians making weight control a priority over other services. (Hernandez-Boussard T, Ahmed SM, and Morton JM. Obesity disparities in preventive care: findings from the National Ambulatory Medical Care Survey, 2005 – 2007. Obesity. 2011 Aug: 1038 – 1044. doi:10.1038/oby.2011.258). 17. Predictors of Wellness and American Indians The Journal of Health Care for the Poor and Underserved published a study that found American Indians who have a fair to poor perceptions of their wellness are significantly at risk of other general health problems. According to the study, wellness is an important concept held by many traditional American Indian tribes. Wellness does not just include a good health status, but also includes the perception of being in good physical, mental, emotional, spiritual, and environmental traits. This study researched this concept by distributing a modified Behavioral Risk Factor Surveillance System (BRFSS) survey to 457 American Indians residing in rural tribes in California. The measurements concentrated on the socio-demographic characteristics, general health status, wellness, high-risk behaviors, psycho-social characteristics, and cultural factors. The researchers were interested in exploring what was the participants perception of their own wellness, while measuring all the other factors. Their findings showed a higher proportion of participants perceived themselves as having poor wellness. This funneled into other health risk issues for this group. The findings showed that those individuals who reported poor wellness had significantly higher rates of suicide ideation, history of neglect, abuse, sexual abuse both in their childhood and adulthood, and poor general health status. This group also experienced having lower rates of cultural connectivity with their Indian tribe. The findings did, however, show both poor and excellent health groups engaged in risky behaviors, such as smoking and sexual practices. The researchers suggest that these findings are troubling because American Indians are already disproportionately at risk of higher health problems. While the findings demonstrate that American Indian’s perception of their wellness—the concept of being physically, mentally, emotionally, spiritually, and environmentally balanced—is important to their cultural tribes, it also coincides with general health implications. The researchers recommend implementing culturally-sensitive support groups, possibly titled Talking Circles, can afford these individuals the education and space to discuss ways to improve behavioral habits, reduce obesity, substance abuse, healthy living, discuss depression, and to reduce other general health problems. (Hodge FS, Nandy K. Predictors of wellness and American Indians. Journal of Health Care for the Poor and Underserved. 2011 Aug; 22(3): 791 – 803). 18. It Takes At Least Two: Male Partner Factors, Racial/Ethnic Disparity, and Chlamydia Trachomatis among Pregnant Women A recent study published in the journal article Journal of Health Care for the Poor and Underserved explored how male partner’s play a role in the infection rate of Chlamydia trachomatis among pregnant women and found that the race/ethnicity of the male partner has a strong association with the infection rate among women. The researchers acknowledged that previous studies have made correlations between Chlamydia infections among pregnant women and race/ethnicity; however, very few explored how the male partner may play a role in this growing disparity or whether the race or ethnicity of the male partner may make a significant difference. In order to explore this concept, the researchers used the data set from Syracuse Healthy Start and linked the data with the Perinatal Data System to confirm hospital delivery charts. They analyzed nine different zip codes for women who gave birth in the city of Syracuse from 2000 – 2002 and matched that information with the available information provided by the fathers. The findings indicate that a woman’s education, race and ethnicity, marital status, age, and race and ethnicity of the father had a significant association with being infected with Chlamydia trachomatis. Women who were African American or Latina, not married, less than 20 years of age, and had less than a high school education, had a higher odds of ever having an infection. The researchers also found that the race of the father played a significant role for white women, but was not significant for African American women and Latinas. The researchers noted that the racial and ethnic disparities observed in their study were striking, and suggested that that “poverty, segregation, skewed sex ratios, barriers to access to health insurance and sexually transmitted infection treatment, and the type of CT screening using for men” are likely reasons. The authors concluded by recommending that guidelines from the Centers for Disease Control and Prevention and the American College of Gynecologists focus on “the importance of retesting because many women who are treated for CT acquire another infection within a few months.” (Weisz J, Lozyniak S, Lane SD, et. al. It takes at least two: male partner factors racial/ethnic disparity, and chlamydia trachomatis among pregnant women. Journal of Health Care for the Poor and Underserved. 2011 Aug; 22(3): 871-885). 19. Recruitment and Retention of Primary Care Physicians at Community Health Centers: A Survey of Massachusetts Physicians A recent study published in the Journal of Health Care for the Poor and Underserved found some expected and not expected reasons for why Primary Care Physicians (PCP) are attracted to work in Community Health Centers (CHC). The researchers in this study wanted to understand the factors that influence where a primary care provider chooses to work. They analyzed data from 294 survey respondents from 46 of the 62 community health centers in the Commonwealth of Massachusetts. Response rates varied drastically by practice size, and survey respondents were more likely to be female (60%), be over the age 40 (66%), be white (75%), practice in the Greater Boston area (51%), and speak a language other than English (61%). When asked to indicate how important various factors were to their decision to work for a community health center, the overwhelming majority (89%) rated having an organization with a mission they could believe in as important. This was followed by wanting to serve an area with severe medical need (67%), wanting to serve in a specific geographic region (63%), wanting to live near family (52%) and, wanting to serve a specific socioeconomic or ethnic population (51%). The organization's mission also ranked as the most important reason providers continue to work at the CHC (82%). The researchers were surprised by how few respondents said participating in a loan repayment program was an important factor in their decision (19%). That said, nearly half of the respondents were or have participated in a loan repayment program. When asked about the future, the majority of survey respondents said they were likey to continue working with the underserved (87%), remain in their present CHC (66%); and to remain in a CHC somewhere (66%). The authors noted that "One of the most gratifying findings of our study is the overwhelming importance of the CHC mission to serve diverse, underserved population as the most important contribution to the decision to practice in a CHC." They concluded that their study highlights how important family practice and women physicians are to CHCs. (Savageau JA, Ferguson WJ, Bohlke JL, et. al. Recruitment and retention of primary care physicians at community health centers: A survey of Massachusetts physicians. Journal of Health Care for the Poor and Underserved. 2011 Aug; 22(3): 817 – 835).
Source: Kaiser Family Foundation Health Tracking Poll (conducted August 10-15, 2011) It is estimated that 32 million uninsured Americans will gain coverage under the ACA. Yet, only about half of non-elderly Americans currently without coverage say they are familiar with the chief components in the law designed to achieve this goal.Perhaps because awareness of these coverage expansions is low, nearly half (47%) of the uninsured do not expect to be affected at all by the health reform law, either positively or negatively. But three in ten (31%) do say it will help them get health care. Fourteen percent expect to be hurt by the law, mainly because they worry they will be required to buy coverage they cannot afford. To read more about the views of uninsured Americans, please read the August tracking poll and “Uninsured But Not Informed,” the latest Pulling it Together Drew Altman, the Foundation’s president.
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This free, monthly update synthesizes news coverage from hundreds of print and broadcast news sources related to health and health care issues affecting underserved and racial and ethnic communities. 
