Jessie Kemmick Pintor

Feasibility and acceptability of a school-based coping intervention for Latina adolescents.

Latino girls (Latinas) experience disproportionate rates of emotional distress, including suicidal ideation, which may be indicative of inadequate coping abilities. Prevention of mental health problems, a U.S. public health priority, is particularly critical for Latina adolescents due to lack of access to mental health treatments. The purpose of this study was to examine the feasibility of Project Wings, a 14-session stress management/coping intervention. Latinas in school (ages 15−21) met weekly for 2-hr with two bilingual experienced facilitators to participate in sharing circles, relaxation exercise, and skill building. Intervention participation and post-intervention focus group data were analyzed. Fall semester intervention (n = 10) occurred during school (72% attendance rate); spring semester intervention (n = 11) was after school (84% attendance rate). Focus group data confirmed acceptability. Latina adolescents will participate in a school-based, group-based stress management/coping intervention. The findings offer insights about intervention recruitment and retention that are specifically relevant to school nurses. Future research includes intervention testing using a randomized study design.

Reports of insurance-based discrimination in health care and its association with access to care

OBJECTIVES We examined reports of insurance-based discrimination and its association with insurance type and access to care in the early years of the Patient Protection and Affordable Care Act. METHODS We used data from the 2013 Minnesota Health Access Survey to identify 4123 Minnesota adults aged 18 to 64 years who reported about their experiences of insurance-based discrimination. We modeled the association between discrimination and insurance type and predicted odds of having reduced access to care among those reporting discrimination, controlling for sociodemographic factors. Data were weighted to represent the states population. RESULTS Reports of insurance-based discrimination were higher among uninsured (25%) and publicly insured (21%) adults than among privately insured adults (3%), which held in the regression analysis. Those reporting discrimination had higher odds of lacking a usual source of care, lacking confidence in getting care, forgoing care because of cost, and experiencing provider-level barriers than those who did not. CONCLUSIONS Further research and policy interventions are needed to address insurance-based discrimination in health care settings.

Project Wings, a Coping Intervention for Latina Adolescents: A Pilot Study

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

The Projected Effect of the Affordable Care Act on Dental Care for Adult Medicaid Enrollees

Fewer than half of all U.S. states provide dental care for non-elderly adult Medicaid enrollees. Although the Affordable Care Act (ACA) expands Medicaid eligibility for adults, states are not required to offer dental care to adults. We project the effect of the ACA on patient-identified barriers to dental care based on a framework developed using data from a 2008 survey of Minnesota Medicaid enrollees with and without an annual dental visit. The rate of annual visits (55%) was below that of all Minnesotans (79%) with 40% reporting difficulties accessing services. We found no racial/ethnic disparities in annual dental visits among adult Medicaid enrollees. Adult Medicaid recipients with no annual visit reported individual (51%), provider (27%), and system-level (22%) barriers. Hmong, Somali, and American Indian adults were more likely than others to report barriers to receiving dental care. We project that the ACA will not reduce barriers to dental care for adult Medicaid enrollees.

Coverage Gains After the Affordable Care Act Among the Uninsured in Minnesota

OBJECTIVES We determined whether and how Minnesotans who were uninsured in 2013 gained health insurance coverage in 2014, 1 year after the Affordable Care Act (ACA) expanded Medicaid coverage and enrollment. METHODS Insurance status and enrollment experiences came from the Minnesota Health Insurance Transitions Study (MH-HITS), a follow-up telephone survey of children and adults in Minnesota who had no health insurance in the fall of 2013. RESULTS ACA had a tempered success in Minnesota. Outreach and enrollment efforts were effective; one half of those previously uninsured gained coverage, although many reported difficulty signing up (nearly 62%). Of the previously uninsured who gained coverage, 44% obtained their coverage through MNsure, Minnesotas insurance marketplace. Most of those who remained uninsured heard of MNsure and went to the Web site. Many still struggled with the enrollment process or reported being deterred by the cost of coverage. CONCLUSIONS Targeting outreach, simplifying the enrollment process, focusing on affordability, and continuing funding for in-person assistance will be important in the future.

Need, Availability, and Quality of Interpreter Services among Publicly Insured Latino, Hmong, and Somali Individuals in Minnesota

Limited English proficiency (LEP) is a common barrier that negatively affects access to health care and quality of care. Prior studies have examined interpreter services as a means of ameliorating LEP, but have focused on Spanish-language services, largely overlooking comparisons with other, less-established ethnic groups. Furthermore, few if any studies have assessed the quality of interpreter services provided. Data come from 2,489 Hispanic/Latino, Hmong, and Somali enrollees of public health insurance programs in Minnesota. We employ weighted, regression-adjusted comparisons of enrollee-reported need and availability of interpreters, access to professional and consistent interpreters, and problems with quality of interpreter-assisted communication. Compared with Latinos, Hmong and Somali enrollees reported greater needs and more communication problems, Somali enrollees reported lower availability, and Hmong enrollees reported lower access to professional interpreters. Further training of interpreters for relatively less-established ethnic groups is needed to increase availability of professional, high-quality communication among publicly insured ethnic minorities.

Propensity score matching to measure the effect of survey mode on reports of racial and ethnic discrimination in health care.

Objective:To examine the effect of survey mode (mail vs. telephone) on the likelihood of reporting health care–related discrimination based on race, ethnicity, or nationality. Methods:We use data from a mixed-mode, mail and telephone survey of public health care program enrollees (N=2807), including Somali, Hmong, African American, American Indian, and Latino populations. Self-reported discrimination was measured as the experience of unfair treatment by health care providers due to race, ethnicity, or nationality. We use propensity score matching to create exchangeable groups of phone and mail respondents based on the probability of completing the survey by phone. Results:Overall, 33.1% of respondents reported having experienced discrimination in health care, but only 23.6% of telephone respondents reported discrimination compared with 36.8% of mail respondents. After matching phone and mail respondents based on probability of responding by telephone, all observable significant differences between respondents that were brought about by differential self-selection into mode were erased, allowing us to estimate the effect of survey mode on report of discrimination. Even after matching, the mode effect remains, where report of health care discrimination for telephone respondents would have been 12.6 percentage points higher had they responded by mail (22.6% vs. 35.2%). Conclusions:Survey mode has a significant effect on report of discrimination. Respondents may be more willing to disclose experiences of discrimination in a mail survey than to a telephone interviewer. Findings have substantial policy and clinical significance as variation in report of discrimination based on mode may lead to underestimation of the extent of the problem.

Promotion of Effective Coping Among Adolescents of Color

Purpose – To synthesize the literature on coping among adolescents of color in the U.S., we examine normative and circumstantial stressors, describe coping strategies, and summarize the literature on coping for the promotion of well-being among adolescents of color, including descriptive and intervention studies. Methods/approach – We conducted an extensive review of the literature in four scientific databases (medline, CINAHL, ERIC, and PyschInfo) between July 2010 and June 2011 (key words: (minority) adolescent(s) (of color), cope/coping, stress (ors), and adaptation/psychological). Studies included in our review were peer-reviewed articles published between 2000 and June 2011 that presented original data on the coping strategies and outcomes of adolescents of color (e.g., studies including a majority from underrepresented racial/ethnic communities) between the ages of 12 and 18. Findings – We identified a total of 91 articles for inclusion, including 83 descriptive and 8 intervention studies. We use a matrix approach to compare descriptive studies by their purpose, study design, sample, targeted stressors, and outcomes. We then discuss the eight interventions we identified, highlighting the targeted population, intervention protocol/adaptation, feasibility/acceptability, and study outcomes. Implications – The breadth and depth of research on coping among adolescents of color has improved significantly over the past decade, yet our review reveals several areas where further exploration is needed, including research on intra-group differences, validation of coping measures in diverse groups, measurement of the effectiveness of coping strategies over time, and most importantly, the translation of available knowledge on effective coping into culturally relevant, multifaceted interventions for adolescents and their families.