The Latino Health Insurance Program: a pilot intervention for enrolling Latino families in health insurance programs, East Boston, Massachusetts, 2006-2007.

BACKGROUND: Thirteen percent of Latinos in Massachusetts lack health insurance, the highest rate of any ethnic or racial group. Families without health insurance are more likely to be in poor or fair health, to lack a regular medical provider, and to not have visited a medical provider in the past year. CONTEXT: The Latino Health Insurance Program is designed as a response both to the high rate of uninsurance among Latinos in Boston and to the multiple obstacles that keep Latino parents from applying for insurance for their families. METHODS: In 2006, we designed and implemented a culturally competent model of health insurance outreach, education, enrollment and maintenance, and referral for primary care and social services for Latino families. CONSEQUENCES: Year 1 results of the Latino Health Insurance Program are promising. Six community members were hired and trained as case managers. A total of 230 children and adults were enrolled or re-enrolled in health insurance programs and received other needed services. Retention was near 100% after 1 year. INTERPRETATION: The Latino Health Insurance Program may serve as a model health insurance access program that can be adapted by community-based organizations and also can be incorporated into public agency programs for Latinos and other immigrant and minority groups. The program continues to serve East Boston residents and was expanded in 2008.

Obesity, physical activity, and the urban environment: public health research needs.

Persistent trends in overweight and obesity have resulted in a rapid research effort focused on built environment, physical activity, and overweight. Much of the focus of this research has been on the design and form of suburbs. It suggests that several features of the suburban built environment such as low densities, poor street connectivity and the lack of sidewalks are associated with decreased physical activity and an increased risk of being overweight. But compared to suburban residents, inner city populations have higher rates of obesity and inactivity despite living in neighborhoods that are dense, have excellent street connectivity and who's streets are almost universally lined with sidewalks. We suggest that the reasons for this apparent paradox are rooted in the complex interaction of land use, infrastructure and social factors affecting inner city populations. Sometimes seemingly similar features are the result of very different processes, necessitating different policy responses to meet these challenges. For example, in suburbs, lower densities can result from government decision making that leads to restrictive zoning and land use issues. In the inner city, densities may be lowered because of abandonment and disinvestment. In the suburbs, changes in land use regulations could result in a healthier built environment. In inner cities, increasing densities will depend on reversing economic trends and investment decisions that have systematically resulted in distressed housing, abandoned buildings and vacant lots. These varying issues need to be further studied in the context of the totality of urban environments, incorporating what has been learned from other disciplines, such as economics and sociology, as well as highlighting some of the more successful inner city policy interventions, which may provide examples for communities working to improve their health. Certain disparities among urban and suburban populations in obesity and overweight, physical activity and research focus have emerged that are timely to address. Comparable research on the relationship of built environment and health is needed for urban, especially inner city, neighborhoods.

"Where does the damp come from?" Investigations into the indoor environment and respiratory health in Boston public housing.

The self-reported prevalence of asthma increased by 75% from 1980 to 1994, a trend found to be significant and evident in every region of the country. The increase has been most marked in children 0-14 years of age, and there is evidence that, as with lead poisoning, inner-city and urban populations are most at risk. Attention has turned to the role of indoor environment risk factors, especially in homes and schools. Such factors include moisture and mold growth, pest infestation, dust mites, the building envelope, heating systems, inadequate ventilation, NO2, and environmental tobacco smoke. The Healthy Public Housing Initiative (HPHI) is a Boston-based community-centered research and intervention project designed to engage Boston Housing Authority residents in a collaborative process to improve respiratory health, quality of life, building conditions, and building maintenance in public housing. This article summarizes the significant research findings from four pilot studies in housing developments that lay the foundation for the larger HPHI asthma-related environmental intervention study. The research design for the pilot projects is informed by principles of community-collaborative research. The strengths of this model of research to our work are also discussed.