A majority of individuals with limited English proficiency (LEP) in the U.S. are foreign-born, creating a complex intersection of language, socio-economic, and policy barriers to healthcare access and achieving good outcomes. Mapping the research literature is key to addressing how LEP intersects with healthcare. This scoping review followed PRISMA-ScR guidelines and included PubMed/MEDLINE, CINAHL, Sociological Abstracts, EconLit, and Academic Search Premier. Study selection included quantitative studies since 2000 with outcomes specified for adults with LEP residing in the U.S. related to healthcare service access or defined health outcomes, including healthcare costs. A total of 137 articles met the inclusion criteria. Major outcomes included ambulatory care, hospitalization, screening, specific conditions, and general health. Overall, the literature identified differential access to and utilization of healthcare across multiple modalities with poorer outcomes among LEP populations compared with English-proficient populations. Current research includes inconsistent definitions for LEP populations, primarily cross-sectional studies, small sample sizes, and homogeneous language and regional samples. Current regulations and practices are insufficient to address the barriers that LEP individuals face to healthcare access and outcomes. Changes to EMRs and other data collection to consistently include LEP status and more methodologically rigorous studies are needed to address healthcare disparities for LEP individuals.

This study focuses on stigma communication about COVID-19 on Twitter in the early stage of the outbreak, given the lack of information and rapid global expansion of new cases during this period. Guided by the model of stigma communication, we examine four types of message content, namely mark, group labeling, responsibility, and peril, that are instrumental in forming stigma beliefs and sharing stigma messages. We also explore whether the presence of misinformation and conspiracy theories in COVID-19-related tweets is associated with the presence of COVID-19 stigma content. A total of 155,353 unique COVID-19-related tweets posted between December 31, 2019, and March 13, 2020, were identified, from which 7000 tweets were randomly selected for manual coding. Results showed that the peril of COVID-19 was mentioned the most often, followed by mark, responsibility, and group labeling content. Tweets with conspiracy theories were more likely to include group labeling and responsibility information, but less likely to mention COVID-19 peril. Public health agencies should be aware of the unintentional stigmatization of COVID-19 in public health messages and the urgency to engage and educate the public about the facts of COVID-19.

This paper examines whether a chilling effect of restrictive state laws aimed at immigrants creates a barrier to enrollment in the food stamp program (now called the Supplemental Nutrition Assistance Program or SNAP) for U.S. citizen children in low-income immigrant families. This analysis looks at 20 states in the continental United States from 2000 to 2008 that were either at or above the U.S. average for percentage of foreign-born population, or states that ranked in the top 10 percent in terms of change in foreign-born population for that time period. To examine this issue, a multivariate, regression-based difference-in-differences (DD) analysis was applied. The “treatment” group is immigrant families with a U.S. citizen child that is 130% of the federal poverty level or below in states with restrictive immigrant related legislation and the “control” group is native families meeting the same federal poverty level guidelines as well as low-income immigrant families in states without the restrictive legislation. The research findings show that there does not appear to be a chilling effect associated with restrictive state laws on participation in the food stamp program. Food insecurity is an immediate need that may override the impediments to enrollment due to immigration status, causing families to apply despite a negative climate toward immigrants. For policy makers and immigrant advocates it is important to know where chilling effects might not occur in order to work with politicians and federal agencies on crafting sound evidence-based policy. Independent of any chilling effect, the model shows that immigrant families are less likely to enroll in food stamp benefits, consistent with other literature. In addition, independent of the effects of restrictive immigration legislation, both non-citizen and naturalized mothers were less likely to be in a family with food stamp benefits compared to similar native-born mothers. This indicates that all states have a gap in food stamp program enrollment that merits further attention and research.

Increases in life expectancy mean that an unprecedented number of individuals are reaching centenarian status, often with complex health concerns. We analyzed nationally representative hospital admissions data (2000–2009) from the National Inpatient Study (NIS) for 52,618 centenarians (aged 100–115 years, mean age 101.4). We predicted length of stay (LOS) via negative binomial models and total inflation adjusted costs via fixed effects regression analysis informed by descriptive data. We also identified hospitalizations due to ambulatory care-sensitive conditions defined by AHRQ Prevention Quality Indicators. Mean LOS decreased from 6.1 to 5.1 days, while over the same time period the mean total adjusted charges rose from USD 13,373 to USD 25,026 in 2009 dollars. Black, Hispanic, Asian, or other race centenarians had higher cost stays compared to White, but only Black and Hispanic centenarians had significantly greater mean length of stay. Comorbidities predicted greater length of stay and higher costs. Centenarians admitted on weekends had higher costs but shorter length of stay. In total, 29.4% of total costs were due to potentially preventable hospitalizations for total charges (2000–2009) of USD 341.8M in 2009 dollars. Centenarian hospitalizations cost significantly more than hospitalization for any other group of elderly in the U.S.

Background: Restrictive state laws aimed at immigrants can have unintended consequences for health insurance coverage of United States citizens in immigrant families due to both actual barriers created by the laws and perceived barriers among immigrants. Increasing numbers of children in the U.S. are part of immigrant families, and these children are more likely to be living in poverty than their counterparts in native families. Immigrant restrictive policies could lead to reduced access to Medicaid and CHIP even for citizen children in immigrant families.Methods: Using data from the Current Population Survey's (CPS) March Supplement, linear probability models with difference-in-differences (DD) estimates compare probability of enrollment in Medicaid/CHIP among low-income U.S. citizen children in immigrant families and low-income children in native families and U.S. citizen children in immigrant families in states that did not adopt restrictive legislation, in order to estimate the impact of restrictive state laws aimed at immigrants. An additional model explores the effect of mother’s citizenship on enrollment among all immigrant families in states with and without restrictive legislation.Results: Results suggest a significant chilling effect where the magnitude of the effect varies according to family demographics and by the types of laws being passed. Immigrant restrictive social welfare laws being adopted have a strong negative effect on U.S. citizen children in immigrant families’ enrollment in Medicaid/CHIP, a 5.5 percentage point reduction in coverage. Among the subsample of only immigrant families, results point toward a global chilling effect created by an overall restrictive policy environment. All immigrant restrictive related laws, including those aimed at education, job restriction, identification access, and social welfare restrictions have a significant and negative impact on access to public insurance for U.S. citizen children with non-citizen mothers.Conclusions: This research shows that the unintended consequence of restrictive state legislation aimed at immigrants is the reduction in access to Medicaid and CHIP by low-income U.S. citizen children living in immigrant families. Reduced access to health insurance can increase unmet medical needs for an already vulnerable group.

As demand increases for well-trained public health professionals, academic leaders of universities and colleges must tailor their curricula to prepare students to be ready for the public health workplace, while also providing critical thinking and awareness skills through a liberal arts course context. Temple University’s undergraduate public health program has created a capstone experience that bridges these two priorities. Using public health community-based program planning and evaluation as its content, this two-semester (32 weeks) writing-intensive course provides training for students in writing a grant proposal, including conducting a needs assessment, devising evaluable program goals and objectives, creating an intervention and planning its implementation and evaluation, and developing budgeting and marketing plans. Students also complete related assignments that help develop the critical thinking skills they need to understand the context of public health within the larger society. Utilizing the LEAP Essential Learning Outcomes, we infuse integrative, interdisciplinary, and applied knowledge with the concept of civic responsibility as pathways for ensuring learning, while still providing concrete skills related to public health practice. We discuss how the course is implemented and how public health practice and liberal arts learning objectives are emphasized to ensure an “educated citizenry.” Universities and colleges that offer an undergraduate degree in public health can use this framework to implement a capstone experience that bridges both public health and liberal arts skills.