Comfort With Telehealth Among Residents of an Underserved Urban Area.

BACKGROUND: Deployment of telehealth has been touted as a means of reducing health disparities in underserved groups. However, efforts to reduce regulatory barriers have not been associated with greater telehealth uptake. The goal of this study was to examine engagement with technology among low-income people of color living in Newark, New Jersey. METHODS: Using surveys and focus groups, we examined study participants' daily use of technology (eg, Internet) and comfort with telehealth services (eg, use of teleconferencing for medication refills) before and after COVID-related social distancing mandates went into effect. RESULTS: Use of technology was significantly lower in the pre-COVID period. However, prior months' use of technology had a weak but significant correlation with comfort with telehealth (r = .243, P = .005) in bivariate analyses and was the only significant predictor in multivariate analyses. Analyses of focus group discussions confirmed that lack of experience with technology and distrust of the security and privacy of digital systems were the most important barriers to comfort with telehealth in our sample. CONCLUSION: Our study found that approximately 20% of people in this under-resourced community lacked access to basic technologies necessary for successful deployment of telehealth services. The study's timing provided an unexpected opportunity to compare experiences and attitudes relating to telehealth in 2 regulatory environments. Although uptake of telehealth services increased with the Federal governments' relaxation of regulatory barriers, there was not a similar increase in comfort with telehealth use. Investments in broadband access and equipment should be accompanied by educational programs to increase day-to-day use of and comfort with associated technologies which would improve consumer confidence in telehealth.

Assessing Health Issues in States with Large Minority Populations.

Health care spending is often addressed in discussions of budgeting and deficits in the United States. It is important to many Americans that funds allocated for health care spending be allocated and spent in the most efficient and effective manner, leading to improved health outcomes, particularly for underserved populations. Many studies address health care spending, but few address the issue of spending as it relates to societal well-being, or certain health outcomes that adversely impact communities. This study seeks to expand the available literature by analyzing data from national sources at the state level.

Obesity in America.

Recent data indicate that Americans are gaining weight at an alarming rate. In fact, data from the CDC indicate that the U.S. obesity average was 12% in 1990 and had grown to 23% by 2005. In recent years, this problem appears to be more prominent in some southern states than in other states. The purpose of this study was to determine what factors were associated with increased levels of obesity. Do demographic, educational, healthcare, or economic factors correlate with this trend? Using state level data in a fixed effects regression model we examined obesity rates for the period 1990-2003. We also used cross tabulation tables to compare obesity rates to several independent variables. Our analysis revealed that obesity was related to several health, demographic, and economic factors. As a result, we argue that policy makers as well as health officials should take a comprehensive look at obesity as well as other social ills, health care conditions, and related issues prior to creating a plan to improve health in this country.

Infant mortality in southern states: a bureaucratic nightmare.

Despite numerous advances in technology, medicine, and health care, infant mortality continues to reach very high levels in southern states. The purpose of this paper is to examine demographic, economic, and health care factors that are likely to affect infant mortality. In so doing, we first compare infant mortality and other critical factors in southern states to other regions of the country. Second, we use cross tabulation tables to determine if there is a correlation between infant mortality and several independent variables. Third, we use regression analysis to determine how each of these variables affects the change in infant mortality for the 1990-2003 periods. The results of the cross tabulation tables indicate relationships between infant mortality and each of the independent variables. When these variables were placed in a regression model, high school graduation rates, race, geographic region, unemployment rates, uninsured rates, teenage pregnancy rates, single parent families, and the number of doctors and hospitals were significant.

Disparities in health care: minority elders at risk.

Minority elders are at great risk for missed diagnoses, greater disabilities, and higher death rates unless health care providers acknowledge that disparities in healthcare do exist and adjust their way of providing care. In the next 30 years, the current elderly population of 35 million is predicted to increase to 72 million. Minority elders are expected to account for 50% of this population. Research has shown that minority elders have a higher incidence of certain diseases but do not receive the same care as their white counterparts (Baldwin, 2003). Differences in the incidence, prevalence, mortality, and burden of disease among minority elders indicate that disparities in healthcare are consistently found in a variety of settings (Jett, 2006). Poor communication and distrust in the health care system have been found to be major factors affecting the quality of healthcare for these individuals. This article discusses healthcare disparities experienced by minority elders and suggests ways to curtail this problem. Culturally sensitive care is suggested to save lives and improve quality of life for these vulnerable individuals. Understanding the cultural practices of minority elders and negotiating a plan of care that respects their beliefs will increase patient compliance, improve care, improve outcomes, and decrease healthcare disparities among minority elders.

The State Children's Health Insurance Program: has it reduced the percentage of uninsured children?

Recent data indicate that the percentage of children in the United States who are uninsured is declining. Although many factors have contributed to that decline, this study assesses the role of public health insurance, specifically the State Children's Health Insurance Program (SCHIP), in reducing the percentage of uninsured children without health insurance from 1998-2000 and whether Medicaid and SCHIP crowd out exists. While this research confirms a significant decline in the percentage of uninsured children since SCHIP began enrolling children in 1998, other factors, including the poverty rate, the percentage of children on Medicaid, geographic region and race had a greater impact in explaining that result than SCHIP. Lastly, the data findings are consistent with research suggesting crowd out does exist.