The association between housing and food insecurity among medically underserved cancer patients.

PURPOSE: To assess the prevalence of socioeconomic needs and associations between housing characteristics and food insecurity among low-income cancer patients, among whom housing and food insecurity are particularly prevalent. METHODS: Low-income cancer patients in active treatment (N = 1618) were enrolled in a comprehensive patient navigation program. Food insecurity was assessed using the 18-item US Department of Agriculture US Household Food Security Survey Module. Participants self-reported their need for assistance with housing issues/type of assistance needed, perception of overcrowding, satisfaction with living situation, and household density via a cross-sectional survey. Descriptive analyses, cross-tabulations and tests of proportions, and binary logistic regression were used in data analyses. RESULTS: Seventy percent of patients were food insecure. Housing characteristics associated with food insecurity were homelessness or living in sheltered/supportive housing (83.3% food insecure), renting (71.9%), and homeownership (58.1%; p < .001); living situation satisfaction (not satisfied, 79.4%; somewhat satisfied, 25.6%; very satisfied, 66%; p < .001); need of housing assistance (79.2%; p < .001), and feeling crowded in their living unit (77.6%; p < .05). Associations of living unit type with food insecurity were significant in the binary logistic regression model (renters 1.68 OR, homeless/sheltered housing 2.80 OR vs homeowners). CONCLUSION: The vulnerability to food insecurity of patients in this low-income sample was underlined by the high rates found, and clear associations with housing characteristics of homelessness, housing assistance needs, and feeling overcrowded were identified. These results could help shape priorities around screening patients for nutrition and housing needs and developing interventions to address them.

Sleep behavior of New York City taxi drivers compared to the general US population.

Introduction: Taxi drivers are a low income population with long work hours, a high-stress sedentary occupation, and varied work shifts, augmenting their risk for sleep disorders. We evaluated sleep quality among New York City (NYC) taxi drivers, a predominantly immigrant/minority population, for associations with sleep outcomes and examined intervention development and policy implications. Methods: A cross-sectional survey was conducted at driver-frequented locations with 211 consenting NYC taxi drivers and included the 12-item Medical Outcomes Study Sleep Scale and the Perceived Stress Scale-10. For five domains (sleep disturbance, snoring, shortness of breath, sleep adequacy, and somnolence) and Sleep Problems Index-II, self-reported scores were calculated and normed against a nationally representative 2009 US sample to obtain standardized t-test scores. Scores <47 were lower than US averages, indicating worse sleep quality. Results were explored in multivariable linear and logistic regression models. Results: Almost one-half (47%) of drivers had scores indicating sleep quality below US averages for snoring, 36% for shortness of breath/obstruction, and 19% for somnolence. There were significant associations of perceived stress with Sleep Problems Index II (p<0.001), sleep disturbance (p<0.001), somnolence (p<0.001), and sleep adequacy (p<0.05). Stress was predictive of sleep adequacy (p<0.05, bivariate; p<0.05, multivariate) and shortness of breath/obstruction (p<0.01, bivariate; p<0.001, multivariate). Nightshift drivers had significantly worse sleep disturbance scores than dayshift drivers (p<0.05). Taxi drivers were more likely to get an inadequate amount of daily sleep (<7 hours) than the average US male (48.5% vs. 38.3%). Conclusions: Sleep hygiene and stress management interventions could benefit the health of this population and improve driver and public safety. The associations of taxi driver sleep quality and stress indicate an opportunity for targeted intervention. Further research into sleep as an important determinant of taxi driver health is needed, especially in the burgeoning for-hire vehicle (Uber, Lyft, etc) sector.

Food Insecurity among Cancer Patients Enrolled in the Supplemental Nutrition Assistance Program (SNAP).

Purpose: Food insecurity, which leads to adverse health outcomes, has even more severe implications for cancer patients. Yet medically underserved cancer patients are more likely to be food insecure than the general population.Methods: This study is a cross-sectional analysis of intake data from patients who participated in the Integrated Cancer Care Access Network (ICCAN). ICCAN is a specialized program that addresses socioeconomic barriers to cancer care among underserved cancer patients in NYC. This study utilized ICCAN data from 2011 to 2017. The USDA food insecurity score, self-reported SNAP receipt, and SNAP eligibility based on household income were compared between SNAP and non-SNAP recipients.Results: 681 patients were assessed for food insecurity. Sixty-nine percent of participants lived in food insecure households. Despite SNAP assistance, most SNAP recipients (68%) were food insecure; 69% of respondents who did not receive SNAP were also food insecure.Conclusions: Underserved cancer patients who receive SNAP are still food insecure, hence at more significant risk for its associated negative outcomes. Supplemental programs for patients with chronic diseases are needed in clinics with large low income populations. SNAP benefits should account for the additional financial burden posed by treatment costs and exceptional circumstances faced by cancer patients.

Predictors of Health Insurance, Life Insurance, and Retirement Savings Among NYC's Immigrant Taxi and For-Hire Vehicle Drivers.

Taxi and for-hire vehicle (FHV) drivers are a predominantly immigrant population facing a range of occupational stressors, including lack of workplace benefits and increasing financial strain from tumultuous industry changes and now COVID-19's devastating impact. Bilingual research staff surveyed 422 New York City taxi/FHV drivers using a stratified sampling approach in driver-frequented locations to examine drivers' health and financial planning behaviors for the first time. Drivers lacked health insurance at double the NYC rate (20% vs. 10%). Life insurance and retirement savings rates were lower than U.S. averages (20% vs. 60%, 25% vs. 58%, respectively). Vehicle ownership was a significant predictor of health insurance, life insurance, and retirement savings. Compared to South Asian drivers, Sub-Saharan African drivers were significantly less likely to have health insurance and North African, and Middle Eastern drivers were significantly less likely to have retirement savings. Although most drivers indicated the importance of insurance and benefits, < 50% understood how to use them. Drivers felt primary care coverage to be most important followed by other health-related coverage, retirement benefits, and life insurance. Results reveal compelling addressable gaps in insurance and benefits coverage and the need to implement accessible financial literacy with navigation and advising services and programs.

Financial and food security challenges of Egyptian women undergoing breast cancer treatment.

BACKGROUND: Breast cancer treatment is an established cause of financial toxicity, and associated costs may contribute to higher mortality and morbidity rates. In Egypt, breast cancer incidence and mortality rates are among the highest in the Middle East. Late-stage diagnosis is common, and disease occurs at an earlier age than in Europe and North America. Out-of-pocket payments are the primary means of financing healthcare in Egypt, and socioeconomic factors have been shown to significantly impact access to cancer screening and treatment. METHODS: An observational cross-sectional study was conducted among breast cancer patients at Ain Shams University Hospitals in Cairo from 2013 to 2015. RESULTS: One hundred women with breast cancer participated. There was a high need for financial assistance (66.0%) and patients with financial needs had great difficulty affording medications (80.0%). A number of patients had lost their jobs following diagnosis, with 32.7% employed prior to diagnosis and 15.3% afterwards. Nearly one-half of participants were classified as food insecure, and nearly one-third reported difficulty affording transportation costs. CONCLUSIONS: This is the first study to describe socioeconomic needs and financial impact among a cohort of Egyptian women undergoing breast cancer treatment. The findings highlight the financial impact of breast cancer treatment on a cohort of Egyptian breast cancer patients and the need for a multidisciplinary approach to help them access and mitigate the costs of treatment. Recommendations include implementing patient financial navigation services and producing printed materials to inform patients of resources to help mitigate the treatment's financial impact.

Associations with the Receipt of Colon Cancer Screening Among a Diverse Sample of Arab Americans in NYC.

Arab Americans (AA) face increased risk for colorectal cancer (CRC), the third leading cause of cancer-related death in the US, due to low utilization of preventative care and socioeconomic disparities. This study explores associations with the receipt of CRC screening among AA in New York City. A cross-sectional survey was conducted among 100 individuals attending religious and community organizations with interviewer-administered surveys in Arabic and English. Results from 100 participants showed they were more likely to complete CRC screening with a doctor recommendation (74%) and were more likely to get a recommendation with a high school education or higher (86%). Uninsured participants and those with public insurance were the least likely to complete screening. Those with a higher mean score in Spiritual Life/Faith (13.34 vs. 11.67) were less likely to complete screening. Findings suggest the need for culturally sensitive interventions to increase CRC screening rates among AA.

Food Purchasing Behavior of Food Insecure Cancer Patients Receiving Supplemental Food Vouchers.

PURPOSE: Food insecure cancer patients experience worse health outcomes and poorer quality of life than food secure patients. There has been little research in programs to alleviate food insecurity in cancer patients. The objective of this paper is to report on the food purchasing behaviors of cancer patients enrolled in a supplemental food voucher program. METHODS: This paper utilized data from a three-arm randomized controlled trial investigating the impact of food interventions on alleviating food insecurity in cancer patients receiving chemotherapy and/or radiation therapy. In one arm, patients received a monthly $230 voucher with which to purchase food. Receipts were collected for items purchased with the voucher and were coded to analyze purchasing behaviors. RESULTS: Thirty-three patients provided receipts for more than 11,000 individual items. Patients spent 50% of voucher funds on animal protein, fruits, and vegetables. Patients spent, on average, 77% of voucher funds on items categorized as "healthy." CONCLUSIONS: Patients who received a food voucher purchased more fruits and vegetables than national averages would suggest. They also spent less on sweetened beverages than national samples. Patients who were born outside of the United States or who were limited English proficient purchased significantly more healthy foods than English-speaking and American-born study patients. Supplemental food vouchers for food insecure cancer patients resulted in the purchase of healthy food items.

Taxi Drivers at Risk: Tailoring Nutrition and Exercise Materials.

Cognitive interviewing was used to refine nutrition and exercise health education materials for use in the New York City taxi driver community. Cognitive interviews were conducted with taxi drivers at garages and community centers across New York City. Interviews were conducted in five rounds with approximately 10 interviews conducted in each round. Modifications were made to the education materials between rounds based on driver feedback. Interviews were transcribed, coded to identify areas needing improvement, and then used to modify materials. Areas that needed adaptation included colloquialisms, literacy level, complex jargon/terminology, vague/confusing phrasing, driver-specific and ethnic-specific preferences, visual aids, and mathematical calculations. These were organized into four key themes: linguistic responsiveness, occupational and cultural adaptation, visuals, and calculations. Cognitive interviewing is a useful method for refining health education materials in the diverse driver population. Cognitive interviewing revealed a need to reduce literacy level, avoid complex terminology, make further occupational and cultural adaptations, use clear visual aids, and avoid the use of complex calculations. Cognitive interviewing is an effective method for refining health education materials for immigrant and low literacy populations.