Palm Trees y Nopales: The Commodification and Hybridization of the South Texas Borderlands

This dissertation examines social inequalities rooted in capital. Through research conducted in the Lower Rio Grande Valley of South Texas, this project interrogates how social characters use capital to access goods and services. By investigating seasonal migration of US and Canadian retirees into the region, the work highlights the social construction of retirement, the use of state and local governances to establish white only enclaves, and the nation-state’s role in creating marginalized populations in the Texas-Mexico borderlands. Ethnography is the primary research method with demographic and popular culture analysis as secondary modes of collecting data

The relationship of aging, complete tooth loss, and having a dental visit in the last 12 months

OBJECTIVES: To evaluate the extent to which dental health care visits in the past year differed among older adults with and without edentulism. MATERIAL AND METHODS: We conducted a cross-sectional study using the 2017 Medical Expenditure Panel Survey among participants aged \u3e /=50 years (n = 10,480, weighted = 112,116,641). Two self-reported outcome variables were used: loss of all teeth from upper and lower jaws (yes/no) and dental visit in the last 12 months (yes/no). Logistic models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Overall, 11.4% of the non-institutionalized U.S. population aged \u3e /=50 years were edentulous; the prevalence was higher in those with advanced age. Adherence to annual oral health visits was 16% among those with edentulism, 52% among those without. The prevalence of dental care visits in the past year was higher among those with advanced age without edentulism, but for those with edentulism, the odds of visiting a dental care provider was lower in all age groups compared to those 50-59 years ((60-69 years): aOR: 0.58, CI:0.36-0.95; (70-79 years): aOR: 0.51, CI: 0.30-0.88; ( \u3e /= 80 years): aOR: 0.45, CI: 0.26-0.80)). CONCLUSION: Although the prevalence of edentulism was higher in those with advanced age, oral health visits during the last 12 months were less frequent in older adults with edentulism. Interventions to improve adherence to dental care recommendations in the growing aging population are warranted

English language proficiency, complete tooth loss, and recent dental visits among older adults in the United States

Objectives: This study sought to provide population-based estimates of complete tooth loss and recent dental visits among older adults in the United States by English language proficiency. Methods: We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants 50 years of age (n = 10,452, weighted to represent 111,895,290 persons). Five categories of language proficiency were created based on self-reported English language ability and language spoken at home (Spanish, Other). Results: The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%, English only: 12.0%). Complete tooth loss was less common among participants for whom Spanish was their primary language, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42-0.76). Among those without complete tooth loss, dental visits in the past year were less common among participants with primary language other than English as compared to those who only speak English. Conclusions: Complete tooth loss varied by English language proficiency among adults aged 50 years in the United States. Suboptimal adherence to annual dental visits was common, more so in those with complete tooth loss, and varied by English language proficiency

The Role of Limited English Proficiency and Access to Health Insurance and Health Care in the Affordable Care Act Era

Purpose: Limited English proficiency adversely impacts people\u27s ability to access health services. This study examines the association between English language proficiency and insurance access and use of a usual care provider after the implementation of the Affordable Care Act (ACA). Methods: Using cross-sectional data from the 2016 Medical Panel Expenditures Survey, we identified 24,099 adults (weighted n=240,035,048) and categorized them by self-reported English-language proficiency. We classified participants according to responses to: How well do you speak English? Would you say... Very well; well; Not well; Not at all? (having limited English proficiency: not well; not at all, English proficient: well; very well; and English only: not applicable) and What language do you speak at home? Would you say... English, Spanish, Other. Using these two recoded variables, we created a variable with five categories: (1) Spanish speaking, with limited English proficiency, (2) other language speaking, with limited English proficiency, (3) Spanish speaking, English proficient, (4) other language speaking, English proficient, and (5) English only. Health insurance and usual care provider were determined by self-report. Results: Among those \u3c 65 years, the percent covered by public insurance (Spanish: 21%, Other languages: 28%, English only 14%), who were uninsured (Spanish: 46%, Other languages: 17%, English only: 8%), and who lacked a usual care provider (Spanish: 45%, Other languages: 35%, English only: 26%) differed by English language proficiency. Among those \u3e /=65 years, fewer people with limited English proficiency relative to English only were dually covered by Medicare and private insurance (Spanish: 12%, Other languages: 15%, English only: 59%), and a higher percent lacked a usual care provider (Spanish: 15%, Other languages: 11%, English only: 7%). Differences persisted with adjustment for covariates. Conclusion: Post the ACA, persons with limited English proficiency remain at a risk of being uninsured relative to those who only speak English

COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP): A study protocol

BACKGROUND: Healthcare professionals have negative implicit biases toward minority and poor patients. Few communication skills interventions target implicit bias as a factor contributing to disparities in health outcomes. We report the protocol from the COmmuNity-engaged SimULation Training for Blood Pressure Control (CONSULT-BP), a trial evaluating a novel educational and training intervention targeting graduate medical and nursing trainees that is designed to mitigate the effects of implicit bias in clinical encounters. The CONSULT-BP intervention combines knowledge acquisition, bias awareness, and practice of bias mitigating skills in simulation-based communication encounters with racially/ethnically diverse standardized patients. The trial evaluates the effect of this 3-part program on patient BP outcomes, self-reported patient medication adherence, patient-reported quality of provider communication, and trainee bias awareness. METHODS: We are conducting a cluster randomized trial of the intervention among cohorts of internal medicine (IM), family medicine (FM), and nurse practitioner (NP) trainees at a single academic medical center. We are enrolling entire specialty cohorts of IM, FM, and NP trainees over a 3-year period, with each academic year constituting an intervention cycle. There are 3 cycles of implementation corresponding to 3 sequential academic years. Within each academic year, we randomize training times to 1 of 5 start dates using a stepped wedge design. The stepped wedge design compares outcomes within training clusters before and after the intervention, as well as across exposed and unexposed clusters. Primary outcome of blood pressure control is measured at the patient-level for patients clustered within trainees. Eligible patients for outcomes analysis are: English-speaking; non-White racial/ethnic minority; Medicaid recipient (regardless of race/ethnicity); hypertension; not have pregnancy, dementia, schizophrenia, bipolar illness, or other serious comorbidities that would interfere with hypertension self-control; not enrolled in hospice. Secondary outcomes include trainee bias awareness. A unique feature of this trial is the engagement of academic and community stakeholders to design, pilot test and implement a training program addressing healthcare. DISCUSSION: Equipping clinicians with skills to mitigate implicit bias in clinical encounters is crucial to addressing persistent disparities in healthcare outcomes. Our novel, integrated approach may improve patient outcomes. TRIAL REGISTRATION: NCT03375918. PROTOCOL VERSION: 1.0 (November 10, 2020)

English Language Proficiency and Complete Tooth Loss in Older Adults in the United States

Objectives To provide contemporary, national population-based estimates of complete tooth loss of older adults by English language proficiency. Methods We conducted a cross-sectional analysis of the 2017 Medical Expenditure Panel Survey among participants ≥50 years of age (n=10,452, weighted=111,895,290). Results The prevalence of complete tooth loss was higher among those with limited English proficiency (Spanish speaking: 13.7%; Other languages: 16.9%) than those proficient in English (Spanish speaking: 5.0%; Other languages: 6.0%). After adjusting for education, complete tooth loss was less common among participants for whom Spanish was their primary, with limited English proficiency relative to English only (adjusted odds ratio: 0.56; 95% confidence interval: 0.42-0.76). Among those without complete tooth loss, dental visit in the past year were less common among participants with primary languages other than English as compared to those who only speak English. Discussion Research is needed to examine the relationship of aging, oral health, and access to care