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Background:
Since the enactment of the Affordable Care Act (ACA), the rate of uninsured in the United States has declined significantly. However, not all legal residents have benefited equally. As part of a community-based participatory research (CBPR) partnership with the Marshallese community, an interpretative policy analysis research project w...
Contexts in source publication
Context 1
... quotations se- lected were obtained from 21 separate participants from all five of the focus groups and three individual interviews. Table 1 presents the information related to participants' ages, income, and health insurance coverage; percent- ages reported below are based upon the number of par- ticipants who responded to each item. The majority of the 48 participants (89.1 %) reported income at or less than $30,000. ...
Context 2
... of the primary limitations of the study is that the qualitative data was collected from a convenience sam- ple and is limited to participants in Arkansas. As Table 1 shows, we achieved a diverse sample within the Mar- shallese community. Participants included a range of ages, with approximately half insured and half unin- sured. ...
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Citations
... Furthermore, our study only examined the experiences of CHamoru and Sāmoan QTPI. Future studies should also explore other QTPI communities as PI experiences vary greatly along dimensions of citizenship, political status, and racialization (Arvin 2019;Diaz et al. 2020;McElfish et al. 2016;Morey et al. 2020Morey et al. , 2022Na'puti and Bevacqua 2015). We hope that this study is transferable to the experiences of QTPI more broadly and encourage other QTPI communities to draw from this model and build upon it from their epistemologies. ...
(1) Background: Although culturally grounded health interventions (CGHI) have shown efficacy in improving Indigenous health, few CGHI for Queer and Transgender Pacific Islander (QTPI) communities exist to address their health promotion. This study explores QTPI experiences of health for cultural mechanisms to develop CGHI for QTPI health promotion. (2) Methods: Using Indigenist community-engaged research methodologies, we collaborated with the United Territories of Pacific Islanders Alliance of Washington and Guma’ Gela’ to conduct 11 exploratory semi-structured interviews with QTPI community members living in the Puget Sound area of Washington state. These interviews were analyzed using thematic analysis. (3) Results: QTPI well-being was greatly influenced by how settler colonialism impacted their connectedness to their families, communities, and cultures. We also found that inágofli’e’ and alofa, relational values in CHamoru and Sāmoan culture, played essential roles in facilitating QTPI health. Many participants fostered these values through chosen family, community care, and Indigenous mobilities. (4) Conclusions: Our findings indicate a need for CGHI that facilitate inágofli’e’ and alofa for QTPI to combat settler colonialism’s impacts on QTPI well-being. Finally, we present a community-centered conceptual model for culturally grounded health promotion in QTPI communities.
... Many Marshallese adults work in low paying, blue-collar jobs, such as in food processing, machine, and manufacturing plants, and in the service industry in hotels and restaurants, typically without health or retirement benefits [7][8][9]. For example, 12,000 Marshallese reside in Springdale where the Tyson chicken processing plant is located, and 30 % of Tyson's Springdale workforce is Marshallese [2,9,10]. ...
Objective
Create a longitudinal, multi-modal and multi-level surveillance cohort that targets early detection of symptomatic and asymptomatic COVID-19 cases among Native Hawaiian and Pacific Islander adults in the Continental US and identify effective modalities for participatory disease surveillance and sustainably integrate them into ongoing COVID-19 and other public health surveillance efforts.
Materials and methods
We recruited cohorts from three sites: Federal Way, WA; Springdale, AR; and remotely. Participants received a survey that included demographic characteristics and questions regarding COVID-19. Participants completed symptom checks via text message every month and recorded their temperature daily using a Kinsa smart thermometer.
Results
Recruitment and data collection is ongoing. Presently, 441 adults have consented to participate. One-third of participants were classified as essential workers during the pandemic.
Discussion
Over the past 18 months, we have improved our strategies to elicit better data from participants and have learned from some of the weaknesses in our initial deployment of this type of surveillance system. Other limitations stem from historic inequities and barriers which limited Native Hawaiian and Pacific Island representation in academic and clinical environments. One manifestation of this was the limited ability to provide study materials and support in multiple languages. We hope that continued partnership with the community will allow further opportunities to help restore trust in academic and medical institutions, thus generating knowledge to advance health equity.
Conclusion
This participatory disease surveillance mechanism complements traditional surveillance systems by engaging underserved communities. We may also gain insights generalizable to other pathogens of concern.
... Importantly, this study is the only one of its kind to have a high proportion of American Indian or Alaska Native and Native Hawaiian or Pacific Islander respondents. These groups have suffered historical trauma [60][61][62][63][64][65][66], and the findings of this study are reflective of the impact of that trauma on vaccine hesitancy. The literature shows that outreach and connection in the community by healthcare providers correlates to vaccine uptake [67][68][69][70]. ...
The literature regarding vaccine hesitancy is limited to specific vaccines rather than general vaccine hesitancy. No studies have examined the relationship of general vaccine hesitancy to healthcare access and experiences of racial discrimination. This study fills gaps by examining: (1) socio-demographic factors; (2) associations between healthcare access; and (3) experiences with racial discrimination and general vaccine hesitancy. Survey data were obtained from 2022 US adults from 7 September to 3 October 2021. Racial and ethnic minority populations were oversampled. Age, gender, race, and education were predictors of vaccine hesitancy. Asian respondents had less than two-thirds the odds of being vaccine hesitant. Healthcare access was associated with vaccine hesitancy. Not having health insurance coverage, not having a primary care provider, and not seeing a provider for a routine check-up in the past two years were associated with higher vaccine hesitancy. For every one-point increase in racial discrimination score (0–45), the odds of being more vaccine hesitant increased by a factor of 1.03. The findings demonstrate that policy, systems, and environmental factors are critical to addressing vaccine hesitancy. Given the associations between vaccine hesitancy and racial discrimination and healthcare access, more attention should be given to inequities in the healthcare systems in order to address vaccine hesitancy.
... Many Marshallese adults work in low paying, blue-collar jobs, such as in food processing, machine, and manufacturing plants, and in the service industry in hotels and restaurants, typically without health or retirement benefits [7][8][9]. For example, 12,000 Marshallese reside in Springdale where the Tyson chicken processing plant is located, and 30 % of Tyson's Springdale workforce is Marshallese [2,9,10]. ...
... Our findings are stories of damage and trauma that result from the colonization and the nuclear bombing in the Marshall Islands and subsequent broken treaties and promises of the United States. 6 We wrestle with what Indigenous scholar Eve Tuck calls "damagecentered research," which produces "damage narratives of tribalized and detribalized peoples," although the goal is to " [correct] oppression." 7(p414) Knowing the unvarnished historical context first is essential to be able to move beyond it. ...
The Ri Majel (Marshallese) migrants of Washington State have endured health inequities and unique laws dictating their access to health care once they arrive to the United States. These health inequities can be seen to be a result of historical trauma and militarization of their islands. The research question was an inquiry regarding access to health care for the Ri Majel in Washington State. We first provide detailed historical data in the background to contextualize our research inquiry. We interviewed 12 people and using manifest content analysis found 2 main themes regarding the health of the Ri Majel: (1) health care access and inequity and (2) historical trauma and embodiment. Health care access was impeded by (1) ongoing effects of radiation, (2) repeated denial of services, (3) lack of health care and insurance, (4) lack of language interpretation during health care visits, and (5) poverty. Historical trauma and embodiment were evidenced by these findings: (1) illness and early mortality; (2) provider lack of knowledge and understanding of the Ri Majel; (3) structural discrimination; (4) feelings of sadness and despair; (5) shyness and humility; and (6) a sense of "cannot/will not" and fatalism. Our findings demonstrate the need to examine structural factors when assessing health inequities and a need to understand and mitigate the effects of historical trauma enacted by structural racism, violence, and colonialism. Strategies to mitigate the embodiment of historical trauma require further investigation.
... Militourism-the exploitation of Indigenous land, people, and resources through the synergistic relationship between US military expansion and the tourism industry-and other settler colonial systems [1][2][3][4][5][6][7] have historically produced negative outcomes for the peoples and lands of the Pacific, including inequities in health outcomes, displacement of Pasifika from their homelands, and persistent poverty and homelessness. 2,4,6,[8][9][10][11][12][13][14][15] However, while there is a shared history among Pasifika, the racialization of Pasifika in the US is complex in that the definition of indigeneity varies between Pasifika communities depending on their political relationship with the US government. ...
Introduction: Pasifika (Native Hawaiian and Pacific Islander) people living in the United States experience health, economic, and social inequities, and a disproportionate burden of COVID-19 cases and deaths. This study examines employment among Pasifika living in the 10 US states with the largest Pasifika populations during the COVID-19 pandemic.
Methods: We use the Current Population Survey to examine racial differences in employment status, paid work from home (PWFH), and industry telework friendliness. We use data from the Washington Office of Fiscal Management and the Washington State (WA) Employment Security Department to examine county-level unemployment claims.
Results: Nationally, Pasifika did not self-report unemployment significantly more than Black, Latino, Asian, and American Indian/Alaska Native respondents, but in WA counties with high Pasifika concentrations, unemployment insurance claim rates were higher compared with all other racial groups, particularly Whites and Asians. Surprisingly, Pasifika had more PWFH opportunities, but worked in less telework-friendly industries nationally.
Discussion: This study demonstrates the complexity of employment among Pasifika during the COVID-19 pandemic. The findings correspond with national reports of racialized communities impacted by unemployment, including Pasifika. Marginally significant differences in unemployment nationally may be due to Pasifika working largely in essential industries requiring workplace attendance.
Health Equity Implications: Although overlooked or overshadowed by size, our findings highlight the need for continued advocacy to support data disaggregation and Pasifika data sovereignty. This can be achieved through collaborations between researchers as well as local and community organizations to address data needs of Pasifika communities.
... Further, participants explained that due to their unique status as COFA migrants, they were not able to sign up for an Affordable Care Act plan at the time they lost employer-based insurance. Instead, they had to wait for the annual open enrollment period, typically a six-week period during November-December (McElfish et al., 2016;Halliday & Akee, 2020). As one woman who works with Marshallese patients explained: ...
This article explores the experiences of Marshallese diasporic migrants in the United States (U.S.) during the COVID-19 pandemic in relation to material hardship and community-led relief efforts. Focus groups with 53 Marshallese migrants in three states revealed that material hardship, including food and housing insecurity, inadequate healthcare, and difficulty paying bills, intensified among their communities during the pandemic. In response, Marshallese community-based groups provided relief to their fellow community members, including food, cash assistance, and personal protective equipment. The findings fit a pattern of intensified hardship and community-led relief among marginalized communities in the U.S. during the COVID-19 pandemic.
... The nuclear testing and subsequent research has created significant distrust between the Marshallese community and the US health care system and US researchers (41,42). In addition to historical trauma, several studies have documented ongoing distrust, exclusion, and discrimination within the US healthcare system (39,43). ...
COVID-19 has disproportionally burdened racial and ethnic minorities. Minority populations report greater COVID-19 vaccine hesitancy; however, no studies document COVID-19 vaccine willingness among Marshallese or any Pacific Islander group, who are often underrepresented in research. This study documents United States (US) Marshallese Pacific Islanders’: willingness to get the COVID-19 vaccine, willingness to participate in vaccine trials, and sociodemographic factors associated with willingness. From July 27, 2020-November 22, 2020, a convenience sample of US Marshallese adults were recruited through e-mail, phone calls, and a Marshallese community Facebook page to participate in an online survey. Of those surveyed (n = 120), 32.5% were extremely likely to get the COVID-19 vaccine; 20.8% were somewhat likely; 14.2% were unlikely or very unlikely; and 26.7% stated they did not know or were not sure. Only 16.7% stated they were willing to participate in a COVID-19 vaccine trial. Vaccine willingness was positively associated with older age, higher income, and longer US residence. Health insurance status and having a primary care provider were positively associated with vaccine willingness. Findings demonstrate within-group variation in COVID-19 vaccine willingness.
... A qualitative study of Marshallese migrants revealed that some had a nuanced understanding of the ACA and the steps required to enrol, while others remained uncertain of their eligibility and reported receiving conflicting information from officials. 16 To improve access to necessary information and prevent discrimination against those with LEP in accordance with Section 1557 of the ACA, a 2016 rule mandated that no-cost language services be provided to those seeking and using health insurance. In 2020, the Republican administration reversed this interpretation, removing the requirement for individual language assistance and the obligation to notify individuals of the availability of this assistance. ...
... In one study, Marshallese migrants expressed frustration and anger that after decades of paying taxes and contributing to the economy, they were ineligible for Medicaid. 16 Many gave up trying to apply for health insurance entirely. 23 Second, the compliance cost demands that individuals prove eligibility for the programme via proof of identity and residence, income level and other necessary criteria. ...
The Patient Protection and Affordable Care Act (ACA) was passed in 2010 to expand access to health insurance in the USA and promote innovation in health care delivery. While the law significantly reduced the proportion of uninsured, the market-based protection it provides for poor and vulnerable US residents is an imperfect substitute for government programs such as Medicaid. In 2015, residents of Hawaii from three Compact of Free Association nations (the Federated States of Micronesia, Palau and Marshall Islands) lost their eligibility for the state’s Medicaid program and were instructed to enrol in coverage via the ACA marketplace. This transition resulted in worsened access to health care and ultimately increased mortality in this group. We explain these changes via four mechanisms: difficulty communicating the policy change to affected individuals, administrative barriers to coverage under the ACA, increased out of pocket health care costs and short enrolment windows. To achieve universal health coverage in the USA, these challenges must be addressed by policy-makers.
... This was seen by many as the United States failing to meet obligations of support outlined in COFA. 5 The state of Hawaii rescinding health care coverage to COFA migrants in 2015 led to a 43% increase in mortality within 3 years. 6 ...
By August 2020, non-Hawaiian Pacific Islanders—4% of Hawaii’s population—accounted for 30% of the cumulative COVID-19 cases in the state. Micronesians, mostly Chuukese and Marshallese, were the most severely affected. Disproportionate COVID-19 infection in racial or ethnic groups in the US occur because of socioeconomic factors. The COVID-19 pandemic can be thought of as a syndemic–where cases cluster “on a background of social and economic disparity”. In this brief report, we describe factors that put Chuukese and Marshallese at increased risk for COVID-19 in Hawaii. We show that Micronesians had increased risk for COVID-19 due to limited employment opportunities, housing insecurity, and underlying comorbid conditions in the context of rescinded federal health insurance and broken government promises. We also highlight the resiliency that many community members demonstrated in preventing new infections and supporting those infected. We conclude that COVID-19 in Hawaii should be understood as a syndemic, where Micronesians were disproportionately affected due to disparities in housing, employment, and health access. Our work supports efforts to continue addressing underlying socioeconomic disparities in creating a more equitable future for our Micronesian community in Hawaii.
