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PURPOSE: The purpose of this study is to examine the following questions: 1) Do refugees and non-refugees differ in self-rated health? 2) Do refugees and non-refugees differ in cancer risk awareness? and 3) Are lifestyle factors such as diet, physical activity participation, and weight status risk or protective factors of cancer risk awareness? METHODS: A self-administered or interviewer-administered survey were collected from adults with a refugee background from spring to fall in 2017 in Salt Lake County, Utah. Free clinic data (a non-refugee comparison group) were collected using a self-administered survey from May to June in 2017 from a free clinic in Salt Lake County, Utah. RESULTS: Refugees reported better self-rated health and were less likely to be obese/overweight, have family history of cancer, and have healthy diet. Refugees reported lower levels of cancer risk awareness than free clinic non-refugee patients. Having a healthy diet was associated with higher levels of cancer risk awareness. CONCLUSION: Future studies should examine cultural differences related to cancer risk awareness among refugee populations.

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BACKGROUND: Immigration stress includes acculturation stress and the stress related to language barriers, discrimination, occupational challenges, and feelings of isolation from society and a sense of newness or loss. AIMS: The purpose of this study was to examine immigration stress among refugees resettled in the United States. METHODS: A self-administered or interviewer-administered survey was collected from individuals with a refugee background in Utah from summer through fall in 2017 (N = 190). RESULTS: Older age was associated with higher levels of financial stress and homesickness. Poorer levels of self-rated health and fewer somatic symptoms were related to higher levels of homesickness and language barriers. Higher educational attainment was associated with higher levels of financial stress. CONCLUSION: Refugees are a vulnerable population due to being displaced to a foreign country and having to quickly learn a new language and different culture. It is imperative to gain more knowledge on diverse refugee groups and ways in which they can maintain optimum quality of life through and after the resettlement process.

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The annual number of opioid prescriptions for pain relief has been increasing in the United States. This increase has raised concerns about prescription opioid abuse and overdose. The purpose of this study was to examine opioid risks (risk factors that increase the chance of opioid abuse) among uninsured primary care patients utilizing a free clinic. Data were collected using a self-administered paper survey in the waiting room of the free clinic from May to July 2017 (N = 506). Higher levels of somatic symptoms were associated with higher levels of opioid risks. U.S.-born English speakers had higher levels of opioid risk than non-U.S.-born English speakers and Spanish speakers. Being employed was associated with higher levels of opioid risk while attending college or being postcollegiate was related to lower levels of opioid risk. Research surrounding best practices, prescription trends, and population risk is vital in driving health and social policy. Further research would benefit from examining where people are obtaining opioids. In addition, further research on opioid abuse among Hispanic populations would be beneficial. Finally, future studies should examine how prescribing practices are different among free clinic health professionals in comparison to health care professionals working in-patient or at for-profit clinics.

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The purpose of this study was to describe the use of opioids and complementary and alternative medicine (CAM) among uninsured free clinic patients. A self-administered paper survey was collected to describe the use of opioids, complementary, and alternative medicine, and other pain relievers from 877 free clinic patients from January to April 2018. The US born English speakers are more likely to use CAM, nonprescription pain relievers, and prescription opioids, and to be more knowledgeable about opioids compared to non-US born English speakers and Spanish speakers. The main source of opioids for free clinic patients is a health care facility other than a free clinic as well as friends. Although nonprescription pain relievers are commonly used among free clinic patients, CAM is less common to use for pain control. More health education programs are needed to increase the knowledge of opioid risks among free clinic patients as well as other underserved population.

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BACKGROUND: Continuity of care is vital to the success of a health-care system because it improves patient satisfaction and health outcomes, and reduces hospitalizations and emergency room visits. OBJECTIVE: The purpose of this study was to examine free clinic patients' perspectives of continuity of care in the United States. METHOD: A convenience sample of free clinic patients who were the age of 18 or older and spoke English or Spanish participated in a self-administered survey from January to April in 2017 (N = 580). RESULTS: Better instructions from providers were associated with higher levels of continuity of care (P < .01). Higher levels of stress and worse self-rated general health were related to lower levels of continuity of care (P < .05 for stress, P < .01 for general health). Being employed was associated with lower levels of continuity of care (P < .05). Non-US born English speakers and Spanish speakers rated continuity of care higher than US born English speakers (P < .01). CONCLUSION: Even if a patient is unable to see the same physician over time, quality instructions from a well-coordinated provider team may enhance continuity of care from patient perspectives. The social context of patients such as working poor individuals is very important for providers to understand in order to identify barriers to continuity of care.

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Volunteering at a free clinic may influence career choice amongst health profession students. The purpose of this research is to explore knowledge, skill, attitudes, self-efficacy, interest in future work with the underserved, and interest in primary care amongst physician assistant (PA) students through the analysis of demographic characteristics of PA students at a student-run free clinic in the United States. Data were collected from 56 PA students with a quantitative survey collection in October 2018 after their participation at a student-run free clinic in Intermountain West, Salt Lake City, Utah, USA. Out of three sub-scales i. e. attitudes, effect, and readiness, students responded most positively to effect of experience of participating in free clinic. Students who spoke Spanish showed higher levels of self-efficacy and readiness for a future career in comparison to non-Spanish speakers.

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OBJECTIVES: Underserved populations are at risk of low cancer risk awareness. The purpose of this study was to examine cancer risk awareness and lifestyle issues among uninsured primary care patients in the United States. METHODS: Data were collected using a self-administered survey from May to July 2017 of adult free clinic patients (N = 506) who spoke English or Spanish. RESULTS: The following factors were associated with higher levels of cancer risk awareness: higher educational attainment, better self-perceived health, and having a family history of cancer. More than 40% of free clinic patients reported a family history of cancer. Contradictory findings existed between perceived diet quality and perceived weight. CONCLUSIONS: The intersection of cancer risk awareness and lifestyle issues among underserved populations is a vital topic to improve cancer prevention and promote screening uptake. Continued research is needed to understand which types of cancer underserved populations are cognizant of developing. In addition, because community-level interventions are effective in increasing cancer risk awareness, 3 research is needed to determine ways in which health education programs focused at cancer risk awareness directed to underserved populations can be effectively implemented and evaluated.

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Any sexually active person has the possibility of contracting the human papillomavirus (HPV) sometime in their lifetime. HPV vaccines are effective in preventing HPV if obtained prior to viral exposure. Research on knowledge and beliefs of HPV and HPV vaccination among college students in Vietnam is significantly scarce. The purpose of this study is to examine the knowledge and beliefs about HPV among college students in Vietnam compared to college students in the US. This cross-cultural comparison will fill a void in current research on this subject. Over 900 college students (N=932: n=495 in Vietnam and n=437 in the US) participated in a self-administered survey on the knowledge and beliefs about HPV in September and October 2016. Vietnamese participants reported lower levels of knowledge and experiences with the HPV virus and vaccines (p<0.01). Additionally, Vietnamese participants also exhibited more barriers in obtaining the vaccination, as well as, HPV risk denial (p<0.01). The level of knowledge is an important predictor of barriers (p<0.01; ηp2=0.022) and risk denial (p<0.01; ηp2=0.116). On average, both Vietnamese and US participants could correctly answer less than half of the survey questions regarding HPV knowledge. Additionally, provider recommendations are potentially more important than informal connections (e.g. friends, family) to reduce barriers to HPV vaccination (p<0.01; ηp2=0.035) and denial of HPV risks (p<0.05; ηp2=0.008). The increase of knowledge about HPV prevention, including and vaccination, has the potential to be improved through provider interventions. Vietnam could take action toward promoting HPV vaccinations not only at an individual level but also at a national or local level. Further research may examine the effects of a lack of knowledge on HPV-related health outcomes.

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OBJECTIVES: Influenza is a significant worldwide public health issue. Knowledge and perceptions regarding the flu vaccination are associated with whether individuals obtain the vaccination. The purpose of this study was to examine how such perceptions were related to knowledge and self-efficacy regarding influenza and the flu vaccination in Vietnam and the US. METHODS: College students (n=932) in Vietnam (n=495) and the US (n=437) completed a self-administered survey regarding knowledge and perceptions of influenza vaccinations in September and October 2016. RESULTS: Vietnamese participants reported significantly lower levels of awareness about flu risk, higher levels of negative attitudes toward flu vaccination, lower levels of knowledge about the flu and vaccination, and lower levels of self-efficacy than US participants. Higher levels of flu and flu vaccination knowledge and self-efficacy regarding general responsible health practices were associated with lower levels of negative perceptions of flu risk and attitudes toward vaccination. At the same time, self-efficacy regarding responsible health practices was associated with higher levels of awareness of flu risk and lower levels of negative attitudes toward vaccination. Self-efficacy regarding exercise was associated with lower levels of perceptions of flu risk and higher levels of negative attitudes toward vaccination. CONCLUSIONS: Vietnam could benefit from influenza education based on this comparison with the US. In both countries, knowledge and self-efficacy were found to be important factors influencing perceptions of influenza risk and vaccination.

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INTRODUCTION: The purpose of this study is to examine self-reported diagnosis of type 1 and type 2 diabetes and lifestyle change among uninsured primary care patients utilizing a free clinic. METHODS: Free clinic patients participated in a self-administered survey in May and June 2016. Patients with the following self-reported diagnoses were analyzed: type 2 diabetes only (n = 84), and type 1 diabetes only or both (n = 43). RESULTS: Participants who reported having type 2 diabetes only and/or were patients of the diabetes clinic were less likely to have modified diet and/or physical activity to manage diabetes compared to those with type 1 diabetes and/or those who were not patients of the diabetes clinic. Participants with hypertension were more likely to have changed diet and/or physical activity compared to those without hypertension. CONCLUSION: Uninsured primary care patients may not know whether they have type 1 or type 2 diabetes. This is problematic as type 1 and type 2 diabetes require different prevention and self-management strategies. Future studies should examine the impact of misunderstanding the 2 types of diabetes on health behaviors and outcomes and explore the context of the misunderstanding.

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OBJECTIVES: Oral health-related quality of life (OHRQoL) is an important health indicator not only for individuals but also for oral health care providers to treat a person holistically. Previous studies focused on OHRQoL do not provide comprehensive knowledge regarding low-income patients in the United States, many of whom have chronic health conditions that can affect their oral health. The purpose of this study is to examine factors associated with OHRQoL among low-income, uninsured patients of safety-net providers, which provide free or reduced fee medical and/or dental care to underserved populations. METHODS: Uninsured patients (N = 584) participated in a self-administered survey in May and June 2016 at a safety-net clinic in the United States serving a low-income uninsured population, which provides limited oral health care services. This study used cross-sectional design and a nonprobability sample. The dependent variable was OHRQoL measured using the Oral Health Impact Profile-14. Chi square tests, Analysis of Variance tests, and multiple regression were used for statistical analysis. RESULTS: Higher levels of dental care neglect and lower frequency of oral hygiene practice were associated with lower levels of OHRQoL (P < 0.01). Participants utilizing a diabetes clinic reported better OHRQoL than those who were not patients of a diabetes clinic (P < 0.05). US born English speakers had worse general health and OHRQoL compared to non-US born English speakers and Spanish speakers (P < 0.01). CONCLUSIONS: An intervention to remedy dental neglect is recommended to improve OHRQoL among uninsured safety-net patients.

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INTRODUCTION: The collaborations between dental care providers and other health care providers are especially needed for underserved populations. There is a deficit of research focused on underserved populations who utilize a safety net facility such as a free clinic in the United States. The purpose of this study is to examine the association between health-related beliefs and oral health behaviors among uninsured adults utilizing a primary care free clinic providing oral health care. METHODS: Uninsured primary care patients utilizing a free clinic (N = 585) participated in a self-administered paper survey in May and June, 2016. RESULTS: More than 60% of free clinic patients reported a perceived need for dental treatment. Free clinic patients who brush their teeth more than once a day reported better perceived general health compared with those who do not brush their teeth more than once a day. Free clinic patients who had perceived a need for dental treatment reported worse perceived general health compared to those who did not report dental needs. CONCLUSIONS: The results of this study indicate a pressing need for the further development of dental care services at safety-net clinics. By including dental care in health promotion programs, it will have positive impacts not only on oral health but also on a healthy lifestyle and the general health of underserved populations utilizing a safety-net clinic. The implementation and evaluation of the integrated health programs, which include primary care and oral health care together, would be beneficial to reduce oral health disparities.

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