Lee A. Crandall

Prenatal care utilization in rural areas and urban areas of Haiti

OBJECTIVES This study is based on the 2000 Demographic and Health Survey (DHS) conducted in Haiti. Using the DHS information on women aged 15 to 49 who had given birth during the three years preceding the survey interview, this study was intended to: (1) examine the determinants of the likelihood of the women using prenatal care in the rural areas and in the urban areas of the country and (2) for the women who made at least one prenatal care visit, examine the determinants of the number of prenatal visits in the rural areas and the urban areas. METHODS The multivariate analysis used logistic models to identify which factors explained the decision to seek prenatal care, and negative binomial models were used to determine how many prenatal visits were conducted by the subgroup of women who did make prenatal care visits. RESULTS Estimated at the mean values of the control variables, the expected probability of using prenatal care services in rural Haiti was 77.16%, compared to 85.83% in urban Haiti. Among users of prenatal care services, mothers in rural areas made an expected number of 3.78 prenatal care visits, compared to 5.06 visits for the women in urban areas. CONCLUSIONS A substantial percentage of pregnant women have access to prenatal care services in Haiti, but mothers in rural areas who decided to seek care still fell slightly below the four visits recommended by the World Health Organization. The education levels of both mothers and their partners is a dominant predictor of prenatal care use. Longer travel times and greater distances to health centers in rural areas constituted barriers to repeated visits. Policymakers and health care providers need to take these findings into consideration as they decide on the delivery and management of health care services in Haiti.

Sources and Barriers to Health Care Coverage for Haitian Immigrants in Miami-Dade County, Florida

Haitian immigrants represent one of the largest foreign-born groups in Florida. Limited information is available on the health care issues that they face. This studys objective was to identify and evaluate the sources of and barriers to health care coverage for the Haitian immigrant community of Miami-Dade County, Florida. Information was collected on demographic characteristic and health needs and access from a probability sample of county residents of Haitian origin. Chi-square and logistic regression methods were used for data analysis. Only half of the participants had any type of health coverage, including 28% with private insurance and 15% with publicly financed coverage. Education, family income, U.S. citizenship status, length of U.S. residence, and English proficiency were associated with health coverage in bivariate analysis. Gender, citizenship, family income, and length of residence were also associated with coverage in adjusted analysis. These findings suggest that this community confronts serious access challenges that may negatively affect the health outcomes of Haitians in the U.S.

Utilization of preventive care by Haitian immigrants in Miami, Florida.

In order to evaluate the health needs and consequences of barriers to health care access for the Haitian immigrant community of Miami-Dade County, Florida, we collected in 2001 demographic and health needs and access data from a probability sample of county residents of Haitian origin. We computed frequencies and prevalence ratios, and employed chi-square and logistic regression methods for data analysis. Hypertension and diabetes were among the most prevalent health conditions mentioned. Up to 39% of participants failed to have an annual physical and 10% failed to receive care for their serious health conditions. On bivariate analysis, insurance coverage, a usual place of care, educational attainment, household income, citizenship status, and duration of residency were associated with services utilization. Citizenship status was the strongest independent predictor of services utilization. The findings suggest that this community faces distinct health needs and daunting challenges to meet those needs.

Met and unmet need for dental services among active drug users in Miami, Florida.

This study considers both met and unmet need for dental services among chronic drug users in Miami, Florida, and compares them with non-drug users recruited from the same neighborhoods (N=1,479). Three primary findings emerged: (1) dental problems are among the most frequently reported health problems, (2) drug use is independently associated with need for dental services, and (3) injection drug use is independently associated with increased odds of unmet need for dental services. These findings suggest that policies that increase access to dental services for drug users and other disadvantaged groups are needed. These services could be integrated into existing behavioral health programs already targeting active drug users.

Risk and Protective Factors for Binge Drinking Among Hispanic Subgroups in Florida

Abstract This study examines differences in risk and protective factors for binge drinking among six ethnic/national subgroups of Hispanic adolescents in Florida. We note differences in the frequency of binge drinking by gender and ethnic subgroup as well as differences in the salience of items drawn from the five domains of risk and protective factors among these subgroups. Rather than treating all Hispanics as a unitary culture, tailoring of prevention programs to address risk and protective factors that differentially affect national/ethnic subgroups may be a valuable strategy when adolescents live in communities that are relatively homogenous in terms of nationality/ethnicity.

The Florida Clergy End-of-Life Education Enhancement Project: A description and evaluation

The Florida Clergy End-of-Life Education Enhancement Project was a model program developed to provide an interdenominational and statewide model of clergy education on loss, grief, dying, and death. The authors describe the project including materials and curriculum as well as present data from the project’s evaluation. Clergy and their partners in ministry responded enthusiastically to the project. As a whole, they reported higher levels of knowledge on end-of-life (EOL) issues at the conclusion of the training. Clergy and their ministerial teams also reported that they were better informed about the technical, procedural, medical, and legal issues that arise at the end of life and expressed the desire for subsequent training. The project indicates that clergy both recognize the need for additional training and are anxious to improve their abilities to minister to the dying and bereaved. The model presented here could easily be applied to local organizations such as hospices or denominational training.

Chronic drug use and reproductive health care among low-income women in Miami, Florida: a comparative study of access, need, and utilization.

Interviews of low-income women in Miami, FL, addressed reproductive health issues in a stratified, network-referred sample of chronic drug users (CDUs) and socially and ethnically similar women who were not CDUs. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled.

Psychosocial Mediators of the Impact of Acculturation on Substance Abuse Among Hispanic Youth: Findings From the Florida Youth Substance Abuse Survey

ABSTRACT The objective of the study was to identify and evaluate factors that are associated with differences in substance abuse between non-acculturated and acculturated Hispanic youth. We employed t-test and logistic regression to analyze self-reported survey data from 8,200 self-described Hispanic students. The outcome variable was past 30-day use of marijuana and the key independent variable was language used at home (English/Spanish). The covariates were 32 psychosocial risk and protective factors for drug use. All the risk factor scores that were significantly different for the two groups had higher means, indicating greater risk, for English-speakers, while all the seven protective factors that were significantly different had higher mean scores, indicating greater protection, for the Spanish speakers. In multivariate analysis, the odds ratios for language used at home range from 1.60 (p < 0.00) for the basic model to 1.05 (p = 0.62) for models that incorporated the psychosocial factors. Findings confirm literature reports suggesting that language used at home is a strong predictor of adolescent substance use. This effect may be mediated principally through the family and peer/individual psychosocial domains.

The CDRC principles of international health research

The Comprehensive Drug Research Center (CDRC) at the University of Miami was established in the early 1970s. Through the decades, investigators from the CDRC have worked with investigators from several countries to establish joint research efforts. Countries often do not have the infrastructure or monetary resources to carry out research on their own. Collabo rating with institutions in these countries to build a sustainable capacity for research is a worthwhile and satisfying endeavor, and it presents a method for initiating research and building the necessary research structures. However, working with other countries presents a unique set of challenges and ethical dilemmas. this article presents some of the specific challenges encountered in these research efforts and describes what we have done to resolve the problems and work more effectively and efficiently with foreign investigators.