Examination of the geographical variation in human West Nile virus: a spatial filtering approach.

This paper examines the importance of environmental factors (mosquito pools and home foreclosures) in human West Nile virus (WNV) transmission in California and Colorado. The role of environmental factors is investigated by applying an instrumental variable technique to a spatial filtering random-effects negative binomial model to correct for both spatial autocorrelation and endogeneity. The results suggest that mosquito pools and home foreclosures are significant in explaining the prevalence of human WNV. An innovative aspect of this research is that it emphasizes the role of home foreclosures in WNV transmission and in the allocation of resources. Knowledge of the factors associated with WNV prevalence is crucial for abatement of future outbreaks. The results suggest that more resources should be allocated to areas that have a high number of home foreclosures and mosquito pools for surveillance and mitigation of the disease.

Prevalence of leptospirosis in dairy cattle from small rural production units in Toluca Valley, State of Mexico.

In order to know the seroprevalence of Leptospira spp. in stabled dairy cattle, a study was conducted from 2004 to 2006 in which 416 sera were tested using a microscopic agglutination test conducted on microplates. A collection of culture reference antigens, each representing a serogroup, was used for these tests. Results showed that 10.33% (43) of the animals had antibody titers ranging from 1:100 to 1:1600. The main serovars detected in these tests were L. interrogans serovar hardjo and L. interrogans serovar canicola. It is important to note that these serovars represent a high risk for transmission to other susceptible animal species, between individuals, and to human health. This serological survey provides useful information establishing the presence or absence of these serovars in this type of herd. The range of antigens used in this study included serovars representative of all common serogroups.

The influence of knowledge and attitudes about breast cancer on mammography use among Latinas and Anglo women.

We conducted a telephone survey of randomly selected Latinas (n = 208) and Anglo women (n = 222) to determine predictors of mammography use. The cooperation rate was 78.5%. Relatively high proportions of Latinas (61%) and Anglo women (79%) reported mammography use within the past 2 years. A logistic regression analysis revealed that knowledge and attitudes did not independently predict use. On the other hand, having health insurance, being married, and being Latino were consistent independent predictors. We conclude that mammography use among Latinas and Anglo women is increasing. However, further gains in use must address difficult barriers such as lack of health insurance.

Undocumented Latina immigrants in Orange County, California: a comparative analysis.

"This article examines a unique data set randomly collected from Latinas (including 160 undocumented immigrants) and non-Hispanic white women in Orange County, California, including undocumented and documented Latina immigrants, Latina citizens, and non-Hispanic white women. Our survey suggests that undocumented Latinas are younger than documented Latinas, and immigrant Latinas are generally younger than U.S.-citizen Latinas and Anglo women. Undocumented and documented Latinas work in menial service sector jobs, often in domestic services. Most do not have job-related benefits such as medical insurance.... Despite their immigration status, undocumented Latina immigrants often viewed themselves as part of a community in the United States, which significantly influenced their intentions to stay in the United States. Contrary to much of the recent public policy debate over immigration, we did not find that social services influenced Latina immigrants' intentions to stay in the United States."

Medicaid enrollment and health services access by Latino children in inner-city Los Angeles.

OBJECTIVES: To understand the role of parental immigration status on Medicaid enrollment and access to health services for young Latino children. DESIGN: A cross-sectional household survey of the parents of inner-city Latino children. SETTING: South Central and East Los Angeles, Calif, 1992. POPULATION: Children 12 to 36 months old and their parents from 817 Latino families. MAIN OUTCOME VARIABLES: Continuous Medicaid enrollment, continuity of care, deferral of care, and number of visits. METHODS: Univariate analysis, logistic and linear regression by demographic and socioeconomic characteristics, residency status, and language use. RESULTS: Children were primarily born in the United States (96%), but most parents were not citizens (80%). Only 40.0% of eligible children had continuous Medicaid coverage since birth, 18.6% had never been insured, and 20.7% had received episodic Medicaid coverage. Continuous Medicaid coverage was negatively associated with either the caregiver (odds ratio [OR],0.32; 95% confidence interval [CI], 0.19-0.56) or their partner (OR=0.33, 95% CI =0.20-0.55) working. Residency status, language preference, and length of US residency were not associated with continuous Medicaid enrollment. Insurance coverage was associated with more physician visits, greater continuity of care, and fewer deferrals of care. CONCLUSION: While most (84%) young Latino children in inner-city Los Angeles were eligible for Medicaid, a substantial proportion (39.3%) have episodic or no coverage. Insurance status and provider type were more consistently associated with access rather than residency and language preference. In the aftermath of California's Proposition 187 and federal welfare reform, insurance status and access are likely to worsen for these young children unless the wave of antiimmigration sentiments is held in check.

The influence of fatalism on self-reported use of Papanicolaou smears.

OBJECTIVE: Our objective was to examine the demographic and other predictors of fatalistic beliefs among Latinas (Hispanic women) and Anglo (non-Hispanic Caucasian) women and to assess the impact of these beliefs on the use of cervical cancer screening services. METHODS: We used ethnographic interviews and a cross-sectional telephone survey in Orange County, California. Our sample included 94 Latinas and 27 Anglo women selected through organization-based network sampling for the ethnographic interviews and 803 Latinas and 422 Anglo women randomly selected for the telephone survey. RESULTS: Latina immigrants (Latinas born outside the United States) were more likely than U.S.-born Latinas or Anglo women to have fatalistic beliefs. Immigration, education levels, and insurance status predicted fatalistic beliefs. Fatalistic beliefs were independent predictors of Pap smear use by Latinas but not Anglo women. For example, after adjusting for potentially confounding variables, Latinas who believed that fate was a risk factor for cervical cancer (odds ratio [OR] = .58), that they would rather not know if they had the disease (OR = .58), and that there is nothing one can do to prevent it (OR = .45) were less likely than others to report that they have had a Pap smear within the prior three years. Health insurance status, marital status, and immigration also predicted use of Pap smears. Insured Latinas were more likely than uninsured Latinas (OR = 2.89) to report having a Pap smear within the prior three years. In addition, married Latinas (OR = 2.32) and Anglo women (OR = 3.09) were more likely than unmarried women to report having appropriate cervical cancer screening. Finally, Latina immigrants were less likely than other Latinas to report having a Pap smear (OR = .26). CONCLUSIONS: We conclude that fatalistic beliefs are among the factors that negatively influence Latinas' use of Pap smears and that it is important for health care professionals to address those beliefs. Continued efforts are also necessary to decrease the economic and structural barriers to cervical cancer screening.

Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women.

BACKGROUND: Latinas use cervical cancer prevention services less often than Anglo women. OBJECTIVE: To assess whether beliefs about cervical cancer influence the use of Papanicolaou (Pap) smears among Latinas and Anglo women in Orange County, California. METHODS: We conducted a telephone survey using the computer-assisted telephone interview system, randomdigit dialing, and an instrument adapted from national surveys and a previous ethnographic study. RESULTS: Participants included 1225 noninstitutionalized Spanish- or English-speaking respondents 18 years or older-803 Latinas (533 immigrants and 270 US born) and 422 Anglo women. Latina immigrants were more likely than US-born Latinas or Anglo women to believe that a variety of behaviors were risk factors for this disease. These behaviors included medically accepted risk factors such as early initiation of sexual intercourse (53% vs 41% vs 39%; P < .01) as well as unaccepted factors such as having sex during menstruation (56% vs 10% vs 3%; P < .01). Logistic regression analysis revealed that Latinas who held such beliefs were significantly less likely than others to report receiving a Pap smear within the past 3 years. Other independent predictors of Pap smear use included health insurance status, martial status, and acculturation. CONCLUSIONS: Latinas have culturally based beliefs about cervical cancer that reflect the moral framework within which they interpret diseases and that may influence their use of Pap smears. These beliefs are most prevalent among Latina immigrants. Because the known risk factors for cervical cancer are primarily related to sexual activities and because such activities are private and sensitive for many Latinas, physicians should be cautious when counseling these patients about the cause of this disease. Indeed, stressing the sexual transmission of cervical cancer could even discourage Latina immigrants from obtaining appropriate Pap smear screening.

Differing beliefs about breast cancer among Latinas and Anglo women.

To improve breast cancer control among Latinas, it is important to understand culturally based beliefs that many influence the way women view this disease. We did a telephone survey of randomly selected Latinas and non-Hispanic white (Anglo) women in Orange County, California, to explore such beliefs using questions from previous national surveys and an ethnographic study of breast cancer. Respondents included 803 Latinas and 422 Anglo women. Latinas were more likely than Anglo women to believe that factors such as breast trauma (71% versus 39%) and breast fondling (27% versus 6%) increased the risk of breast cancer, less likely to know that symptoms such as breast lumps (89% versus 98%) and bloody breast discharge (69% versus 88%) could indicate breast cancer, and more likely to believe that mammograms were necessary only to evaluate breast lumps (35% versus 11%) (P < .01 for each). After adjusting for age, education, employment status, insurance status, and income, logistic regression analysis confirmed that Latino ethnicity and acculturation levels were significant predictors of these beliefs. We conclude that Latinas' beliefs about cancer differ in important ways from those of Anglo women and that these beliefs may reflect the moral framework within which Latinas interpret diseases. These findings are important for the development of culturally sensitive breast cancer control programs and for practicing physicians.

Geographic variation in rates of selected surgical procedures within Los Angeles County.

OBJECTIVE: We explore the contribution of income and ethnicity to geographic variation in utilization of surgical procedures. DATA SOURCES/STUDY SETTING: We assessed the use of eight procedures from 1986 through 1988 among residents of Los Angeles County using data from the California Discharge Dataset, the 1980 census, and other secondary sources. Procedures chosen for evaluation were coronary artery bypass grafting (CABG), coronary artery angioplasty, permanent pacemaker insertion, mastectomy, simple hysterectomy, transurethral prostate resection (TURP), carotid endarterectomy, and appendectomy. STUDY DESIGN: The amount of inter-zip code variation for each procedure was first measured using various estimates including the analysis of variance coefficient of variation (CVA). Population-weighted multivariate regression analysis was used to model variation in age- and gender-adjusted rates of procedure use among 236 residential zip codes. PRINCIPAL FINDINGS: Highest-variation procedures were coronary artery angioplasty (CVA = .392) and carotid endarterectomy (CVA = .374). The procedures with the lowest degree of variation were cardiac pacemaker implantation (CVA = .194) and hysterectomy (CVA = .195). Variation was significantly related to income (carotid endarterectomy) and either African American or Latino zip code ethnicity for all procedures except pacemaker implantation. For all procedures except appendectomy, the direction of the effect was toward fewer procedures with lower income. However, the effect of African American or Latino population ethnicity varied. CONCLUSIONS: In this large urban area both population ethnicity and socioeconomic status are significantly associated with the geographic utilization of selected surgical procedures.

Improving access to health care in Latino communities.

Public debate about health care reform often focuses on the need for health insurance coverage, but in Latino communities many other barriers also inhibit access to medical care. In addition, basic public health services often go underfunded or ignored. Thus, health care reform efforts, nationally and in each State, must embrace a broader view of the issues if the needs of Latino communities are to be served. This report reviews and summarizes information about the mounting problems Latino communities face in gaining access to medical care. Access to appropriate medical care is reduced by numerous financial, structural, and institutional barriers. Financial barriers include the lack of health insurance coverage and low family incomes common in Latino communities. More than 7 million Latinos (39 percent) go without health insurance coverage. Latinos without health insurance receive about half as much medical care as those who are insured. Structurally, the delivery system organization rarely reflects the cultural or social concerns of the communities where they are located. Therefore, providers and patients fail to communicate their concerns adequately. These communication problems are exacerbated by the extreme shortage of Latino health care professionals and other resources available. Institutional barriers often reflect the failure to consider what it means to provide good service as well as high-quality medical care. Reducing these barriers to medical care requires modifying governmental and institutional policies, expanding the supply of competent providers, restructuring delivery system incentives to ensure primary care and public health services, and enhancing service and satisfaction with care.

Insuring Latinos against the costs of illness.

OBJECTIVE: To examine the determinants of health insurance coverage for Latinos in the United States and how different targeted strategies for health care reform differentially affect the country's major ethnic groups, focusing on the implications for the Latino population. DESIGN: Data from the 1980 and 1990 Current Population Surveys were used to compare the insurance status of nonelderly (< 65 years) Latinos with the Anglo (non-Hispanic white), black, and Asian and other populations by estimating the attributable fraction for selected covariates. The effects of health care reform strategies on the coverage of the major ethnic groups were simulated from these data. MAIN OUTCOME MEASURES: Percentage uninsured, percentage insured by Medicaid, and attributable fraction for covariates. RESULTS: Latinos have the worst health insurance coverage of any ethnic group in the country. Approximately 39% of Latinos are uninsured compared with 13.8% for the Anglo and 24% for the black population. Providing coverage to all the poor could reduce the uninsured rate for Anglos by about 23%, whereas the reduction among Latinos could be about 37% and among blacks about 42%. Similar reductions could be achieved by covering all workers and their minor dependents. Regardless of the approach to reform, however, Latinos would remain with high absolute rates of uninsured. CONCLUSIONS: Differences in Medicaid eligibility, labor force characteristics, and family composition between Latinos and other ethnic groups suggest that policy initiatives may affect Latinos differently. Targeted strategies, such as employer mandates, "pay-or-play" programs, or Medicaid expansions, can improve coverage, but many Latinos could still remain uninsured.

Measuring functioning and health in the very old.

To assess the validity of brief multidimensional measures of health, we studied 155 new residents of a long-term care institution. We collected self-reported measures of various aspects of health, as well as performance-based measures of physical and cognitive function. For six similar health dimensions measured using two self-reported methods, the average correlation between paired health dimensions was 0.64 (nonpaired correlation = 0.36). When we compared self-reports and performance on three closely paired health concepts, the average correlation of paired concepts was 0.49 (nonpaired correlation = 0.22). In a factor analysis, similar health dimensions measured using different methods tended to load on the same factor. Except for manual performance, performance-based and self-reported measures of physical and role function loaded on one factor. We conclude that brief measures of health and self-reported physical functioning in very old persons have acceptable validity.

Barriers to medical care for homeless families compared with housed poor families.

To evaluate health access and health services utilization of homeless families we selected a systematic sample of 194 homeless families from 10 shelters in Los Angeles and 196 housed poor families from the same geographic regions of Los Angeles selected from welfare offices. Both samples relied primarily on Medicaid for their health insurance (61% and 96%). However, more homeless families than housed poor families were currently uninsured (26% vs 2%), had lost health insurance over the past year (50% vs 21%), and had spent a greater percentage of the past year uncovered by health insurance (22% vs 6%). Homeless families were much less likely to report a regular provider for preventive care (81% vs 94%) or for sick care (72% vs 95%). Moreover, of those reporting a regular provider, homeless families were more likely than housed poor families to use emergency departments or clinics rather than private offices for both preventive care (35% vs 15%) and sick care (37% vs 26%). Barriers to health care more frequently prevented homeless families from obtaining care (38% vs 28%). These findings suggest that homeless families have greater problems of access to health care than other poor families, related to lack of insurance, lack of a regular primary care provider, and other barriers. Programs to address these barriers for homeless families are presented.

Selected measures of health status for Mexican-American, mainland Puerto Rican, and Cuban-American children.

The 1987 National Vital Statistics System and the Hispanic Health and Nutrition Examination Survey (1982 through 1984) were used to assess the health status of Mexican-American, mainland Puerto Rican, and Cuban-American children by examining the prevalences of pregnancy outcomes and chronic medical conditions. The low-birth-weight rate among Hispanics (7.0%) compared favorably with that of non-Hispanic whites (7.1%) despite the greater poverty and lower levels of education among Hispanics. When examined by Hispanic subgroup, however, significant differences were present, with mainland Puerto Ricans having the highest prevalences of low-birth-weight infants. Premature births were more common among all three Hispanic subgroups than among non-Hispanic whites. Mexican-American and Cuban-American children had a similar prevalence of (3.9% and 2.5%, respectively) chronic medical conditions compared with non-Hispanic white children; Puerto Rican children had a higher prevalence of chronic medical conditions (6.2%). When assessed by these health status indicators, Hispanic children seem to have a health status similar to non-Hispanic white children. However, mainland Puerto Rican children seem at greater risk for poor health, reflecting the US Hispanic population's heterogeneity. Health programs targeted at US Hispanics should appropriately consider these group differences.

Health insurance coverage and utilization of health services by Mexican Americans, mainland Puerto Ricans, and Cuban Americans.

This investigation examines data on 13,000 Mexican Americans, Puerto Ricans, and Cuban Americans between 6 months and 74 years of age who were interviewed from 1982 through 1984 in the Hispanic Health and Nutrition Examination Survey. In addition, data from the 1989 Current Population Survey (N = 145,000) conducted by the US Bureau of the Census are presented for the white and black non-Hispanic populations as well as the three Hispanic national origin groups. The study revealed that over one third of the Mexican-American population, one fifth of the Puerto Rican population, and one fourth of the Cuban-American population is uninsured for medical expenditures compared with one fifth of the black, non-Hispanic population and one tenth of the white, non-Hispanic population. Furthermore, compared with Hispanics with private health insurance, uninsured Hispanics are less likely to have a regular source of health care, less likely to have visited a physician in the past year, less likely to have had a routine physical examination, and less likely to rate their health status as excellent or very good.

Health of homeless children and housed, poor children.

Homeless children in families are increasing in numbers across the country and have been noted to have frequent health problems. The health status of homeless children was assessed on multiple dimensions through parental report in a survey conducted with 196 homeless families in 10 shelters in Los Angeles and 194 housed poor families after March 1987 through January 1988. During the month before the survey, the homeless and housed poor children experienced high rates of illness symptoms, disability, and bed days. Homeless and housed poor children were frequently rated by their parents to be in fair or poor health (17% vs 13%, P = .14). Homeless children, however, were reported to have more behavior problems and school failure [30% vs 18%, P = .06] than housed poor children. Homeless children also had high rates of other health problems such as developmental delay (9%) and overweight (13%). The diets of homeless children were frequently imbalanced, dependent on food from "fast-food" restaurants, and characterized by repeated periods of deprivation. Family problems were more common among homeless families, especially among single-parent homeless families compared with single-parent housed families (spousal abuse, 68% vs 41%, P less than .01; parental drug and alcohol abuse, 60% vs 39%, P less than .01). It is concluded that homeless children have significant child behavior and developmental problems and disorders of nutrition and growth, which are associated with multiple risk factors in their environment.

The effects of a prepaid group practice on mental health outcomes.

Does a prepaid group practice relative to comparable fee-for-service plans lead to different mental health outcomes for its beneficiaries? To answer this question, we used data from the RAND Health Insurance Experiment. We observed no statistically significant or clinically meaningful differences in mental health outcomes for families randomly assigned to Group Health Cooperative of Puget Sound or to comparable fee-for-service insurance plans in the Seattle area. We found the same null result for overall mental health status as well as for psychological distress (e.g., anxiety and depression) and psychological well-being, and for the full population as well as the initially sick and poor, although our precision was low for the latter comparisons. Thus, the less intensive style of treatment in the prepaid group practice was not associated with noticeably worse mental health outcomes.

Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family function characteristics.

We studied 196 homeless and 194 housed poor families in Los Angeles, California to gain an understanding of events that precipitate family homelessness. Both homeless and housed poor mothers averaged 29 years old and were accompanied by two or three children. Three-fourths of both the homeless and housed families had income below the poverty level, and both groups expended almost two-thirds of their income on housing. Mothers in homeless families more commonly reported spousal abuse (35 vs 16 percent), child abuse (28 vs 10 percent), drug use (43 vs. 30 percent), or mental health problems (14 vs 6 percent) and weaker support networks. Homeless mothers more commonly came from homes where their parents abused drugs or alcohol (49 vs 34 percent) or more commonly lived outside the home or in foster care (35 vs 25 percent). Homelessness was reported as due primarily to economic pressures of housing costs, but personal and family problems frequently played a contributing role, especially for single parent families. Burdens of increasing housing costs and family dysfunction among housed poor families place many at risk for homelessness.

The effects of insurance generosity on the psychological distress and psychological well-being of a general population.

Reductions in the generosity of fee-for-service insurance lower the use of general medical and mental health services, but do they lead to lower mental health status for the covered population? We addressed this question using data from the RAND Corporation Health Insurance Experiment. Families in six sites in the United States were randomly assigned to one of 14 insurance plans for three- or five-year periods. On average, there were no significant adverse effects of cost-sharing plans, relative to a free-care plan, on either psychological well-being or psychological distress, when the cost-sharing plans included full catastrophic coverage. Those with high mental health status but low income at baseline had significantly more favorable mental health outcomes on the cost-sharing plans than on the free-care plan. We cannot definitively comment on the effects of insurance generosity for the sick poor. Our findings apply in the context of mandated comprehensive mental and general health coverage for a general nonelderly, nondisabled household population.