Mu Pye

Transportation and Other Nonfinancial Barriers Among Uninsured Primary Care Patients

Introduction: Nonfinancial barriers are frequent causes of unmet need in health-care services. The significance of transportation barriers can weigh more than the issues of access to care. The purpose of this cross-sectional study was to examine transportation and other nonfinancial barriers among low-income uninsured patients of a safety net health-care facility (free clinic). Methods: The survey data were collected from patients aged 18 years and older who spoke English or Spanish at a free clinic, which served uninsured individuals in poverty in the United States. Results: Levels of transportation barriers were associated with levels of other nonfinancial barriers. Higher levels of nonfinancial barriers were associated with elevation in levels of stress and poorer self-rated general health. Higher educational attainment and employment were associated with an increase in other nonfinancial barriers. Conclusion: Focusing only on medical interventions might not be sufficient for the well-being of the underserved populations. Future studies should examine integrative care programs that include medical treatment and social services together and evaluate such programs to improve care for underserved populations.

Cardiovascular Disease–related Health Beliefs and Lifestyle Issues Among Karen Refugees Resettled in the United States From the Thai-Myanmar (Burma) Border

Objectives Refugees resettled in the US may be at risk for cardiovascular disease (CVD). However, little is known about CVD-related issues among Karen refugees who have migrated to the US from the Thai-Myanmar border. The purpose of this study was to examine CVD-related health beliefs and lifestyle issues among Karen refugees resettled in the US. Methods Karen refugees resettled in the US from the Thai-Myanmar border (n=195) participated in a survey study on health beliefs related to CVD, salt intake, physical activity (PA), and smoking in the fall of 2016. Results A high-salt diet, physical inactivity, and smoking were major lifestyle problems. Participants who adhered to a low-salt diet considered themselves to be susceptible to CVD. Most participants did not engage in regular PA. Regular PA was associated with less perceived susceptibility to CVD and greater perceived benefits of a healthy lifestyle for decreasing the likelihood of CVD. Conclusions Each refugee population may require individualized strategies to promote PA and a healthy diet. Future studies should develop health education programs that are specifically designed for Karen refugees and evaluate such programs. In addition to health education programs on healthy lifestyle choices, tobacco cessation programs seem to be necessary for Karen refugees. At the same time, it is important to foster strategies to increase the utilization of preventive care among this population by promoting free or reduced-fee resources in the community to further promote their health.

Peer Smoking and Smoking-related Beliefs Among College Students in Bangladesh

Objectives Smoking is a significant public health issue in Bangladesh. The purpose of this study was to examine peer smoking and smoking-related beliefs among college students in Bangladesh. Methods College students at two universities in Dhaka, Bangladesh participated in a self-administered survey in May and June 2017. Results First, being a current or former smoker is associated with lower levels of beliefs among respondents that they would not smoke even with smoker friends or nervousness, and lower levels of intentions that they would not smoke, while current smokers and former smokers have different smoking-related beliefs. Second, having smoker friends is associated with lower levels of intentions that they would not smoke. Third, higher levels of normative beliefs that it is important not to smoke are associated with higher levels of beliefs that they would not smoke even with smoker friends or nervousness, higher levels of intentions that they would not smoke, and higher levels of avoidance of smoking. Conclusions Smoking-related beliefs and perceived norms in individuals’ social networks are important components in promoting tobacco cessation in Bangladesh. But it is challenging to prevent or intervene in smoking because of the high rates of smoking in this country and the high prevalence of smokers in individuals’ social networks. Future studies should examine the most effective interventions to combat smoking in high-smoking social networks, such as using mobile apps or social media, and evaluate the effectiveness of such interventions.

Health and Well-being of Women Migrating from Predominantly Muslim Countries to the United States

Abstract:The purpose of this study was to examine the health and well-being of women migrating from predominantly Muslim countries to the U.S. Women from predominantly Muslim countries completed a paper survey on the following topics from June to December in 2016 (N=102): depression; physical functioning; self-reported general health; experiences with health care; and demographic characteristics. There were several womens health-related issues: low rates for mammography and Pap smear screening, and preference for female physicians and/or physicians from the same culture. Only one-third of the participants had received a physical exam in the past year, and having done so was related to higher levels of depression and worse physical functioning. The participants who were not in a refugee camp reported higher levels of depression than those who were.

Risks of opioid abuse among uninsured primary care patients utilizing a free clinic

Abstract The annual number of opioid prescriptions for pain relief has been increasing in the United States. This increase has raised concerns about prescription opioid abuse and overdose. The purpose of this study was to examine opioid risks (risk factors that increase the chance of opioid abuse) among uninsured primary care patients utilizing a free clinic. Data were collected using a self-administered paper survey in the waiting room of the free clinic from May to July 2017 (N = 506). Higher levels of somatic symptoms were associated with higher levels of opioid risks. U.S.-born English speakers had higher levels of opioid risk than non–U.S.-born English speakers and Spanish speakers. Being employed was associated with higher levels of opioid risk while attending college or being postcollegiate was related to lower levels of opioid risk. Research surrounding best practices, prescription trends, and population risk is vital in driving health and social policy. Further research would benefit from examining where people are obtaining opioids. In addition, further research on opioid abuse among Hispanic populations would be beneficial. Finally, future studies should examine how prescribing practices are different among free clinic health professionals in comparison to health care professionals working in-patient or at for-profit clinics.

Home Dental Care Education for RefugeeBackground Adults in the United States

Objective: The purpose of this study was to provide and evaluate oral health care education programs for refugees resettled in the US. Methods: This project consisted of six sessions, which were held from February to April 2017. Each session included the following components: 1) a short survey that included demographic questions and oral health-related questions; 2) a class on oral health home care class; 3) a focus group; and 4) a post-class survey on class satisfaction. Participants were individuals who had a refugee background and were ages 18 and older at the time of the session. Results: Twenty-seven refugees from diverse ethnic backgrounds participated in this study. Refugees that have resettled in the US may not have had opportunities to learn about oral health care, but seem to be interested in oral health education, and find the information useful. While brushing teeth seems to be commonly practiced (though their methods of brushing may not be appropriate), flossing teeth is not. Before resettlement, participants had poor oral health practices and habits, lacked resources, and also maintained cultural norms that negatively affected their oral health. Conclusion: It is important to develop and provide educational programs to promote proper oral health practices for refugees. The changes in their environment after migration to the US such as unfamiliarity to dental health practice and the addition of sugary food/drinks to their lives should be considered in oral health education.

Barriers and Facilitators to Healthy Lifestyle among Refugees Resettled in the United States

Objective: The purpose of this project included: to provide health education for refugees and to gather perspectives on barriers; and facilitators toward healthy eating and regular physical activity. Methods: Six health promotion classes were held between February and June, 2017. Data were collected using a pre-class survey, focus groups, and field notes. Qualitative data were mapped to constructs of the Health Belief Model. Twenty-eight participants of diverse refugee populations participated in this project, of which 12 participated in 4 focus groups. Results: Desires to “stay healthy” and “to be there for family” appeared to be key facilitators for healthy lifestyle. Key barriers to healthy lifestyle include “busy schedule,” and “not able to afford healthy food.” Participants described their struggles to access affordable fresh food and believed having adopted the American diet caused adverse health outcomes. Throughout the project, participants showed interests in utilizing local parks but lacked information on access and use. Conclusion: Future health promotion interventions should focus on familiarizing refugee families with local produce whilst being culturally sensitive on different cooking methods and diet preferences. More health classes and opportunities for free to low-cost exercise are needed.

Stress Management Classes for Uninsured Free Clinic Patients in the United States

Objective: Stress has become a growing public health concern in the United States (US). Uninsured, low-income or minority patients utilizing a free clinic are exposed to stress disproportionately across various areas of life. Health promotion programs regarding stress management have the potential to benefit vulnerable, low income populations by reducing stressrelated health issues. The purpose of this study was to describe and evaluate the “stress-management” education class taught at a free clinic that provides healthcare to uninsured patients. Methods: Data for this study were collected by a prestress management class survey, field notes during the stress management class, and post-class survey at a free clinic for low-income, uninsured patients. The surveys and class took place in June 2018. Direct observations were based off the Theory of Planned Behavior (TPB). Results: Fifty-five stress management classes were offered with a total of 83 participants. Among the class participants, 71 filled out the survey. Free clinic patients experience cumulative negative situations. One strategy to cope with stress is to organize participant responsibilities. Main stressors among the participants included finances, family, emotions, work, health, social relationships, and a sense of not belonging. Conclusion: Providing resources regarding stressors would be a feasible solution for patients at free clinics. Future projects should work to develop stress management class which responds to the results of this study.

Perceptions of mental health and mental health services among college students in Vietnam and the United States

The global burden of mental health disorders is a significant public health issue. One population that has a risk for mental health issues is college students. Little is known about perceptions of mental illness and mental health services among college students in Vietnam. The purpose of this study is to describe perceptions of mental illness and mental health services among college students in Vietnam, and to compare them with those in the United States (US). The cross-sectional data were collected using a self-administered survey from January to March in 2018 at a national university in Vietnam, and a state university in the US. The study revealed differences in perceptions of causes of mental health between Vietnamese and US participants. Vietnamese participants tended to believe that individuals with mental illness were dangerous and need to be kept out from the community, while US participants perceived that mental illnesses are the same as other illnesses. An important indicator of Vietnamese perceptions of mental health was the low likelihood of seeking formal help because of preference for seeking help from family or friends for mental illness. Interventions, such as mental health awareness campaigns or training courses should be provided for college students in Vietnam. Some strategies to improve mental health among college students used in the US may help to reduce stigma toward mental illness in Vietnam.

Patient Satisfaction and Perspectives of Continuityof Care among Free Clinic Patients in the USA: AQualitative Study

Introduction: Free clinics are important resources for those who do not have access to health care other than the emergency room services in the United States. The purpose of this study was to explore continuity of care and patient satisfaction from the perspectives of free clinic patients. Methods: Five focus groups were conducted with patients at a free clinic in June 2017 (N=25). Thematic analysis was performed to identify themes in issues relating to continuity of care and patient satisfaction. Results: Continuity of care was not always perceived positively. There were potential miscommunications between providers or receptionists and patients. Patients may not be well informed of the available resources at the clinic. Discussion: Since the majority of free clinic providers are volunteers and may not be with a free clinic long-term, continuity of care should not be just seeing the same doctor over time, but also seeing well-coordinated providers. Because free clinics serve a wide variety of underserved populations, cultural competence trainings in medical education may not wholly fit the socioeconomic and/or cultural realities of free clinic patients. More in-person communication would be beneficial to distribute the information about available resources for free clinic patients. Conclusion: Communication among patients and receptionists, providers, and interpreters seemed to be a prevalent recurring topic across groups. The communication of health programs and appointment reminders are the areas to be improved. Trainings in communications with patients or cultural competence in medical education may need to consider a wide variety of patient backgrounds.