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Ratnapradipa KL, Napit K, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Rohde J, Schabloske L, Tchouankam T, Watanabe-Galloway S. African American and Hispanic Cancer Survivors' and Caregivers' Experiences in Nebraska. J Immigr Minor Health 2024:10.1007/s10903-023-01570-6. [PMID: 38180583 DOI: 10.1007/s10903-023-01570-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 01/06/2024]
Abstract
Racial and ethnic minority populations experience poorer cancer outcomes compared to non-Hispanic White populations, but qualitative studies have typically focused on single subpopulations. We explored experiences, perceptions, and attitudes toward cancer care services across the care continuum from screening through treatment among African American and Hispanic residents of Nebraska to identify unique needs for education, community outreach, and quality improvement. We conducted four focus groups (N = 19), April-August 2021 with people who were aged 30 or older and who self-identified as African American or Hispanic and as cancer survivors or caregivers. Sessions followed a structured facilitation guide, were audio recorded and transcribed, and were analyzed with a directed content analysis approach. Historical, cultural, and socioeconomic factors often led to delayed cancer care, such as general disuse of healthcare until symptoms were severe due to mistrust and cost of missing work. Obstacles to care included financial barriers, transportation, lack of support groups, and language-appropriate services (for Hispanic groups). Knowledge of cancer and cancer prevention varied widely; we identified a need for better community education about cancer within the urban Hispanic community. Participants had positive experiences and a sense of hope from the cancer care team. African American and Hispanic participants shared many similar perspectives about cancer care. Our results are being used in collaboration with national and regional cancer support organizations to expand their reach in communities of color, but structural and cultural barriers still need to be addressed.
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Affiliation(s)
- Kendra L Ratnapradipa
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
| | - Krishtee Napit
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
| | - Keyonna M King
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | - Jolene Rohde
- Nebraska Comprehensive Cancer Control Program, Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | | | - Tatiana Tchouankam
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, University of Nebraska Medical Center College of Public Health, 984395 Nebraska Medical Center, Omaha, NE, 68198-4395, USA
- Office of Community Outreach and Engagement, Fred and Pamela Buffett Cancer Center, Omaha, NE, USA
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Ramos AK, Dinkel D, Trinidad N, Carvajal-Suarez M, Schmeits K, Molina D, Boron JB. Acceptability of Intergenerational Physical Activity Programming: A Mixed Methods Study of Latino Aging Adults in Nebraska. J Aging Health 2024; 36:14-24. [PMID: 36961752 DOI: 10.1177/08982643231166167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Abstract
Objective: This study explored Hispanic/Latino aging adults' interest in and preferences for intergenerational physical activity programming. Methods: We used an exploratory sequential (Qual-QUAN) mixed methods design consisting of three focus groups (N = 13 participants; M age = 62.5 years old) and a quantitative survey (N = 105 participants; M age = 57.3 years old). Results: We found that most participants were interested in intergenerational physical activity programs: (1) to promote overall health and well-being, (2) increase opportunities for socialization and relationships, and (3) foster motivation and energy. Preferences for programming included cultural tailoring, bilingual and Spanish-language offerings, and being conducted in-person. Barriers to physical activity included cost, scheduling, transportation, and limited awareness of community resources. Discussion: Innovative public health initiatives incorporating an intergenerational approach may promote physical activity among aging adults. This study has implications for developing and refining intergenerational programming with Hispanic/Latino communities.
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marcela Carvajal-Suarez
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Karen Schmeits
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Diana Molina
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Julie B Boron
- Department of Gerontology, College of Public Affairs and Community Service, University of Nebraska, Omaha, NE, USA
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Ramos AK, Rech JP, Schmeits K, Carvajal M, Trinidad N, Blaskewicz Boron J, Dinkel D. Exploring the Benefits, Barriers, and Facilitators of Physical Activity and Interest in Intergenerational Physical Activity Programming Within a Hispanic/Latino Community in the Midwest. Health Promot Pract 2023:15248399231216728. [PMID: 38102812 DOI: 10.1177/15248399231216728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Hispanic/Latino individuals across the lifespan generally do not engage in enough physical activity. Intergenerational programming is an innovative solution that could improve opportunities for physical activity across the lifespan in a culturally relevant manner; however, few studies have explored perceptions of intergenerational physical activity programming among Hispanic/Latino communities. This pre-implementation study aimed to: (a) explore the perceived benefits, barriers, and facilitators of physical activity among an intergenerational sample of Hispanic/Latino community members and stakeholders and (b) assess interest in intergenerational physical activity programming. This qualitative study consisted of a total of eight focus groups (N = 45 participants): Hispanic/Latino youth (2 groups), their parents (2 groups), older Hispanic/Latino adults (3 groups), and community stakeholders who work with older adults (1 group). We used thematic analysis techniques integrating the Framework Method to compare and contrast perspectives between participant groups. We found that all groups identified physical, mental, and/or social benefits to physical activity. Primary barriers included limited physical accessibility, environmental considerations, and time constraints. Primary facilitators included physical accessibility, programming format, environmental supports, and social support. Overall, there was general interest in intergenerational physical activity programming across all groups. Practitioners are encouraged to: (a) be aware of how different age groups may view and respond to program context, fit, and communications; (b) reflect on their capacity for high-quality implementation, and (c) weigh the costs and benefits of various programming decisions. Findings can be used to design culturally, linguistically, and contextually relevant intergenerational physical activity programming and to promote health equity.
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA
| | - John P Rech
- University of Nebraska Omaha, Omaha, NE, USA
| | - Karen Schmeits
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marcela Carvajal
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Correction to: Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. J Cancer Educ 2023; 38:1777. [PMID: 37552463 DOI: 10.1007/s13187-023-02353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
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Napit K, Ratnapradipa KL, King KM, Ramos AK, Luma LBL, Dinkel D, Robinson T, Schabloske L, Tchouankam T, Watanabe-Galloway S. Qualitative Analysis of Colorectal Cancer Screening for African American and Hispanic Populations in Nebraska: an Application of the PRECEDE Framework. J Cancer Educ 2023; 38:1767-1776. [PMID: 37466902 DOI: 10.1007/s13187-023-02343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 07/20/2023]
Abstract
Nationally and in Nebraska, African Americans (AA) and Hispanics have lower colorectal cancer (CRC) screening rates compared to non-Hispanic Whites. We aimed to obtain perspectives from AA and Hispanic cancer survivors and caregivers in Nebraska about CRC screening to improve outreach efforts. Data from four virtual focus groups (AA female, AA male, Hispanic rural, and Hispanic urban) conducted between April-August 2021 were analyzed using a directed content approach based on the Predisposing, Reinforcing, and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model. Most of the 19 participants were female (84%) and survivors (58%). Across groups, awareness of colonoscopy was high, but awareness of fecal testing needed to be higher, with confusion about different types of fecal tests. Predisposing factors were trust in the health system; awareness of CRC screening; machismo; fear of cancer; embarrassment with screening methods; and negative perceptions of CRC screening. Enabling factors included provider recommendations, healthcare access, and insurance. Reinforcing factors included prioritizing personal health and having a support system. Suggestions to improve screening included increasing healthcare access (free or low-cost care), increasing provider diversity, health education using various methods and media, and enhancing grassroots health promotion efforts. Lack of awareness, accessibility issues, attitudes and perceptions of CRC and CRC screening, trust, and cultural and linguistic concerns are major issues that need to be addressed to reduce CRC screening disparities among AA and Hispanic adults.
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Affiliation(s)
- Krishtee Napit
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Kendra L Ratnapradipa
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lady Beverly L Luma
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
| | - Danae Dinkel
- School of Health & Kinesiology, University of Nebraska at Omaha, Omaha, NE, USA
| | | | | | - Tatiana Tchouankam
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shinobu Watanabe-Galloway
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
- Office of Community Outreach and Engagement, Fred & Pamela Buffett Cancer Center, Omaha, NE, USA
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Woolsey S, Ramos AK, Samson K, Catley D, King KM, Crane R, Dai HD. Strengthening Tobacco 21 implementation and enforcement to reduce tobacco-related health disparities: A stakeholder engagement project. Tob Prev Cessat 2023; 9:20. [PMID: 37342229 PMCID: PMC10277890 DOI: 10.18332/tpc/163299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION As a part of a priority-setting stakeholder engagement project to strengthen the impact of the federal Tobacco 21 (T21) law, we conducted a qualitative study to solicit input from a nationwide sample of tobacco control stakeholders regarding the implementation, enforcement, and equity implications of the T21 law. METHODS Following the T21 policy evaluation guidance developed by the Centers for Disease Control (CDC), we identified T21 experts in four domains: policy, evaluation, subject matter, and implementation from a national search of stakeholders (invitations, n=1279) to account for geographical variation. This study presents results from five focus groups conducted in December 2021 among stakeholders (n=31) with experience in T21 policy, evaluation, subject matter, and implementation. RESULTS Participating T21 stakeholders reported on eight themes from four main topic areas: 1) Implementation, 2) Enforcement, 3) Equity outcomes, and 4) Recommended changes from stakeholders. Stakeholders shared insights on both passive and active implementation methods used in their communities, and highlighted major barriers such as the absence of a standardized tobacco retail licensing mandate and insufficient resources. Regarding T21 enforcement, stakeholders believed that current deterrents for retail violations might not be effective. They noted that vape and tobacco shops and online sales of tobacco products are emerging major challenges in T21 enforcement. Stakeholders also discussed possible health inequities that may be exacerbated by heterogenous implementation of the T21 law. CONCLUSIONS To strengthen T21 and mitigate potential exacerbation of existing health inequities, greater alignment of federal, state, and local efforts to reduce heterogeneity of implementation and enforcement of the T21 law is recommended.
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Affiliation(s)
- Summer Woolsey
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Kaeli Samson
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Delwyn Catley
- The Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Hospital, Kansas City, Missouri
| | - Keyonna M King
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
| | - Rob Crane
- Preventing Tobacco Addiction Foundation, Dublin, Ohio
| | - Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, United States
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Rowland SA, Ramos AK, Maiya S, Carlo G. Health Status, Health Care Access, and Health Information Sources Among Latino Immigrant Cattle Feedyard Workers in the Midwest. Workplace Health Saf 2023; 71:296-303. [PMID: 37073976 DOI: 10.1177/21650799231163134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Cattle production in the United States is heavily supported by Latino/a workers. Beyond injury rates, our understanding of the health status of cattle feedyard workers is limited. The purpose of this study was to describe the health status and health care access among Latino immigrant cattle feedyard workers in the Midwest. METHODS A cross-sectional design using face-to-face structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska was conducted between May 2017 and February 2020. FINDINGS A total of 243 workers completed interviews; 91% were men. Over half (58%) had health insurance but few (36%) had a regular health care provider. Few chronic health conditions were reported despite most being overweight (53%) or obese (37%). The sample mean of sleep hours/24 hours was 7.1 ± 1.1. Problem drinking was moderate (42%), cigarette smoking was low (14%), and drug use was extremely low (<1%). Receiving health information from work was associated with less problem drinking, less obesity, lower blood pressure, and better sleep. CONCLUSIONS Although few workers reported having a chronic health condition, most workers had chronic disease risk (i.e., elevated body mass index, problem drinking) and few had a regular health care provider. Receiving health information at work may have protective health effects. APPLICATIONS TO PRACTICE Occupational health professionals can partner with feedyard employers to expand current health and safety training programs beyond injury prevention to focus on health more broadly and to connect workers with local health care resources.
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Affiliation(s)
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
| | - Sahitya Maiya
- Department of Human Development and Family Studies, University of New Hampshire
| | - Gustavo Carlo
- School of Education, University of California, Irvine
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Ramos AK, Deal A, Quintero SA, Wilson FA. Immigrant-focused Medical Legal Partnerships: A Practical Innovation to Improve Immigrant Health and Social Well-being. Prog Community Health Partnersh 2023. [DOI: 10.1353/cpr.2023.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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Carlo G, McGinley M, Maiya S, Ramos AK. Associations of Work-Related Injuries and Stress to Family and Youth Wellbeing among U.S. Latino/a Immigrant Cattle Feedyard Workers. Int J Environ Res Public Health 2023; 20:3361. [PMID: 36834054 PMCID: PMC9962635 DOI: 10.3390/ijerph20043361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
Based on the Ecological Stress-Based Model of Immigrant Worker Safety and Health, we hypothesized that occupational stress and physical safety would be negatively linked to workers' depression, which in turn, would increase family conflict and decrease youth prosocial behaviors. A total of 242 Latino immigrant cattle feedyard workers from Nebraska and Kansas (90.9% male; M age = 37.7 years) answered questions assessing depression, occupational stress, whether they had ever been injured at work, familial conflict, and youth prosocial behaviors. All four indirect relations among occupational stress and injury and the outcomes (family conflict and youth prosocial behaviors) via depressive symptomatology were significant. Additionally, ever injured was negatively related to youth prosocial behaviors and occupational stress was positively related to youth prosocial behaviors. The findings support our model and suggest that increased stress and work-related injuries on cattle feedyards are linked to mental health problems, which in turn, is linked to more conflict experienced at home and less youth prosocial behaviors. Feedyard employers should focus on improving safety culture including providing robust training in the workplace. Practical implications to improve availability and access to mental and behavioral health resources to mitigate negative family outcomes are provided.
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Affiliation(s)
- Gustavo Carlo
- School of Education, University of California, Irvine, CA 92697, USA
| | - Meredith McGinley
- Department of Psychology, University of Wisconsin, Parkside, Kenosha, WI 53144, USA
| | - Sahitya Maiya
- Department of Human Development and Family Studies, University of New Hampshire, Durham, NH 03824, USA
| | - Athena K. Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Ramos AK, Su D, Correa A, Trinidad N. A Concurrent Mixed-Methods Study of Midwestern Latino Parents Participation and Preferences for Parenting Education Programs. J Child Fam Stud 2023; 32:530-543. [PMID: 36788948 PMCID: PMC9910248 DOI: 10.1007/s10826-023-02547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Parenting programs are an important tool that can provide support for parents and families and improve family functioning. This concurrent nested QUANT + qual mixed methods study sought to better understand parenting education program participation and examine format, delivery, and content preferences for parenting programs among Latino parents in Nebraska. Results from a statewide survey (N = 173) indicated that 31.4% of parents in the sample had participated in a parenting program. Significant predictors of participation in parenting education programs included being unmarried, not working full-time, having a higher income, and having excellent or very good health. Major barriers to participation included lack of information about available programs and logistical concerns. Focus group participants discussed key program design concerns which included: (1) cultural clashes related to acculturation gaps between parents and children; (2) cultural relevance of programming; (3) logistical considerations; and (4) the inclusion of technology to enhance parenting. Overall, participants were particularly interested in group-based learning, flexible scheduling, and improving the cultural relevance of programs. Implications for program design and outreach to improve Latino parents' access and willingness to participate in parenting education programs are presented. Future research should explore the effectiveness of parenting program implementation and dissemination with Latino parents in rural communities, if there are differences in the benefits of parenting programs by Latino subgroup or level of acculturation, and assess the impact of near-peers in the delivery of parenting programs with Latinos.
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Affiliation(s)
- Athena K. Ramos
- University of Nebraska Medical Center, Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340 USA
| | - Dejun Su
- University of Nebraska Medical Center, Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340 USA
| | - Antonia Correa
- University of Nebraska Medical Center, Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340 USA
| | - Natalia Trinidad
- University of Nebraska Medical Center, Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, Omaha, NE 68198-4340 USA
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Dai HD, Pierce J, Beseler C, Abadi A, Zoucha K, Johnson R, Buckley J, Ramos AK. Hierarchical Modeling of Psychosocial, Parental, and Environmental Factors for Susceptibility to Tobacco Product Use in 9-10-Year-Old Children. J Adolesc Health 2023; 72:267-276. [PMID: 36424333 PMCID: PMC10917612 DOI: 10.1016/j.jadohealth.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Tobacco use during early adolescence can harm brain development and cause adverse health outcomes. Identifying susceptibility in early adolescence before initiation presents an opportunity for tobacco use prevention. METHODS Data were drawn from the Adolescent Brain and Cognitive Development study that enrolled 9-10-year-old children in 21 US cities between 2016 and 2018 at baseline. Separate nested hierarchical models were performed to incrementally examine the associations of sociodemographic factors, psychosocial influences, parental substance use, immediate social contacts, and perceived neighborhood safety with tobacco use susceptibility among never tobacco users (n = 10,449), overall and stratified by gender. RESULTS A total of 16.6% of youths who have never used tobacco reported susceptibility to tobacco. Females (vs. males, adjusted odds ratio [AOR] [95% confidence interval {CI}] = 0.80 [0.70-0.91]), positive parental monitoring (AOR [95% CI] = 0.76 [0.66-0.87]) and positive school environment (AOR [95% CI] = 0.95 [0.93-0.98]) were associated with reduced susceptibility to tobacco use. Parental education level (high school, AOR [95% CI] = 1.52 [1.02-2.28]; bachelor's degree, AOR [95% CI] = 1.53 [1.03-2.28]; or postgraduate degree, AOR [95% CI] = 1.54 [1.03-2.3] vs. less than high school), youth substance ever use (AOR [95% CI] = 2.24 [1.95-2.58]), internalizing problems (AOR [95% CI] = 1.03 [1-1.06]), and high scores on negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency-impulsive behavior scale were associated with increased susceptibility to tobacco use. Stratified analysis showed that parent-perceived neighborhood safety was associated with reduced susceptibility to tobacco use among males but not among females (AOR [95% CI] = 0.89 [0.81-0.99]) vs. (AOR [95% CI] = 1.01 [0.9-1.13]). A positive school environment was associated with lower susceptibility to tobacco use among females but not among males. DISCUSSION Parental, environmental, and psychosocial factors influence early childhood tobacco susceptibility. Family and school-based tobacco prevention programs should consider integrating these factors into primary school curricula to reduce youth tobacco susceptibility and later initiation.
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Affiliation(s)
- Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska.
| | - John Pierce
- Department of Family Medicine & Public Health, University of California-San Diego, San Diego, California
| | - Cheryl Beseler
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Azar Abadi
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kenneth Zoucha
- Department of Psychiatry, University of Nebraska Medical Center, Omaha, Nebraska
| | - Rachel Johnson
- Division of Internal Medicine/Pediatrics, Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - James Buckley
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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Ramos AK, Reynaga D. The TN Visa: The Future of Foreign Workers in Livestock Production. J Agromedicine 2023; 28:81-85. [PMID: 36284467 DOI: 10.1080/1059924x.2022.2140734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Agricultural employers have faced extreme challenges in recruiting and retaining an adequate workforce. Various societal changes have made hiring local workers into agricultural jobs difficult. Therefore, there is a growing reliance on foreign workers and visa programs to meet labor demands. One such program, the TN visa, can be an effective and useful tool for recruiting professional labor for livestock operations, and many agricultural employers have already seen its value. It is likely that the use of the TN program will continue to grow in the future. However, there is opportunity for misuse and abuse of the TN program because there are few administrative rules and limited oversight. We offer recommendations to improve the TN program and the well-being of TN professionals including additional oversight of the program, transparency in recruiting and contracting workers, educating TN workers about U.S. labor rights, ensuring fair pay, and allowing a path to work authorization for TN workers' spouses and children who accompany them in the U.S. Clearly, sustainable solutions to the farm labor shortage are needed. As a field, we need to better understand workforce recruitment and retention concerns as well as mechanisms being used to address such concerns and their impact on workers' health, safety, and well-being.
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center 68198-4340, Omaha, Nebraska, USA
| | - Danny Reynaga
- Managing Attorney, Agricultural Worker Rights Program, Legal Aid of Nebraska, 1423 First Avenue 69361, Scottsbluff, Nebraska, USA
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Bendixsen CG, Ramos AK, Holmes SM. Structural Competency and Agricultural Health and Safety: An Opportunity to Foster Equity within Agriculture. J Agromedicine 2023; 28:45-52. [PMID: 36420522 PMCID: PMC11034733 DOI: 10.1080/1059924x.2022.2148148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The future of agricultural work in the United States (U.S.) must account for at least two important trends: 1) the persistence of the industry being riddled with high rates of injury and illness and 2) the growing proportion of hired farmworkers compared to family farmworkers working in these dangerous environments. These workers confront structural disadvantages that impede social justice and prosperity. Social structures like policies, economic systems, institutions, and social hierarchies create health disparities, often along the lines of social categories. The result is an already dangerous industry with vulnerable workers facing unjust risks, especially those that are undocumented. Agricultural health and safety professionals and other stakeholders should engage structural competency curricula in order to increase awareness of impact of structures and be better positioned to improve farmworker health and wellbeing. Similar work has been successful in the training healthcare professionals, e.g. the Structural Competency Working Group (SCWG). New strategies are needed to improve farmworker wellbeing and retain an adequate agricultural workforce. A greater understanding of the social and structural concerns that farmworkers face is an important step towards occupational and social justice. It is also clear that it will require collaboration and community-based efforts creating a larger team of people using similar concepts related to the structural influences on whether health and wellbeing are distributed equitably. This work is being moved forward in healthcare, social work, worker organizations, and community-based initiatives. Agricultural health and safety professionals have a vital contribution to make if they join the ranks.
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Affiliation(s)
- Casper G. Bendixsen
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Athena K. Ramos
- Central States Agricultural Safety and Health Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Seth M. Holmes
- Division of Society and Environment, University of California Berkeley, Berkeley, California, USA
- Deprtment of Anthropology, University of Barcelona, Barcelona, Spain
- Catalan Institute for Research and Advanced Study, Barcelona, Spain
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Mavragani A, Ramos AK, Trinidad N, Quintero S, Johnson Beller R, Struwe L, Pozehl B. Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study. JMIR Form Res 2022; 6:e40379. [PMID: 36563025 PMCID: PMC9823566 DOI: 10.2196/40379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/07/2022] [Accepted: 11/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technology using apps or devices to self-manage health behaviors is an effective strategy to improve lifestyle-related health problems such as hypertension, obesity, and diabetes. However, few studies have tested an mHealth intervention with Hispanic/Latino adults, and no studies were found testing mHealth with rural Hispanic/Latino adults, the fastest-growing population in rural areas. OBJECTIVE The purpose of this study was to evaluate the feasibility, usability, and acceptability of an mHealth cardiovascular risk self-management intervention with rural Hispanic/Latino adults. METHODS A descriptive study using quantitative and qualitative methods was used to evaluate the feasibility, usability, and acceptability of delivering a 12-week mHealth self-management intervention to reduce cardiovascular risk with rural Hispanic/Latino adults who were randomized to 1 of 2 groups. Both groups were asked to use MyFitnessPal to self-monitor daily steps, weight, and calories. The intervention group received support to download, initiate, and troubleshoot technology challenges with MyFitnessPal (Under Armour) and a smart scale, while the enhanced usual care group received only a general recommendation to use MyFitnessPal to support healthy behaviors. The usability of MyFitnessPal and the smart scale was measured using an adapted Health Information Technology Usability EvaluationScale (Health-ITUES). Adherence data in the intervention group (daily steps, weight, and calories) were downloaded from MyFitnessPal. Acceptability was evaluated using semistructured interviews in a subsample (n=5) of intervention group participants. RESULTS A sample of 70 eligible participants (enhanced usual care group n=34; intervention group n=36) were enrolled between May and December 2019. The overall attrition was 28% at 12 weeks and 54% at 24 weeks. mHealth usability in the intervention group increased at each time point (6, 12, and 24 weeks). Adherence to self-monitoring using mHealth in the intervention group after week 1 was 55% for steps, 39% for calories, and 35% for weights; at the end of the 12-week intervention, the adherence to self-monitoring was 31% for steps, 11% for weight, and 8% for calories. Spikes in adherence coincided with scheduled in-person study visits. Structured interviews identified common technology challenges including scale and steps not syncing with the app and the need for additional technology support for those with limited mHealth experience. CONCLUSIONS Recruitment of rural Hispanic/Latino adults into the mHealth study was feasible using provider and participant referrals. The use of MyFitnessPal, the smart scale, and SMS text messages to self-monitor daily steps, weights, and calories was acceptable and feasible if technology support was provided. Future research should evaluate and support participants' baseline technology skill level, provide training if needed, and use a phone call or SMS text message follow-ups as a strategy to minimize attrition. A wearable device, separate from the smartphone app, is recommended for activity tracking.
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Affiliation(s)
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Natalia Trinidad
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sophia Quintero
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | | | - Leeza Struwe
- College of Nursing, University of Nebraska Medical Center, Lincoln, NE, United States
| | - Bunny Pozehl
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
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15
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Elliott KC, Lincoln JM, Flynn MA, Levin JL, Smidt M, Dzugan J, Ramos AK. Working hours, sleep, and fatigue in the agriculture, forestry, and fishing sector: A scoping review. Am J Ind Med 2022; 65:898-912. [PMID: 35880742 DOI: 10.1002/ajim.23418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 06/06/2022] [Accepted: 07/13/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Agriculture, forestry, and fishing industry (AgFF) workers often work extremely long hours during peak production seasons, resulting in sleep deprivation and fatigue. The National Occupational Research Agenda has classified fatigue as a "significant safety issue" and area of concern for many industry sectors, including AgFF. This review explores current research and practice in AgFF and proposes next steps. METHODS We conducted a scoping literature review to examine the extent and nature of research in this area. Article inclusion criteria included peer-reviewed journal articles written in English; published after 1989; covering AgFF workers in high-income countries; with data on working hours/schedules and sleep related to safety and health. RESULTS Limited research has addressed long hours and sleep deprivation among AgFF workers. We identified 8350 articles for title and abstract review. Among those, 407 underwent full-text review and 96 met all inclusion criteria (67% agriculture, 25% fishing/seafood processing, 8% forestry). The literature provided some evidence fatigue contributes to fatalities, injuries, and illnesses in AgFF. Older, new, young, foreign-born, and female workers, as well as those who work in small organizations or longer hours (40+) may be at higher risk for fatigue-related injury and illness. Few studies have developed or evaluated interventions to control risks. DISCUSSION Given that fatigue is a factor in injury and illness for this sector, future AgFF surveillance and research should increase efforts to capture fatigue and sleep data, directly investigate the role of long hours and nonstandard work schedules in the sector, and most importantly, create practical interventions to manage fatigue.
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Affiliation(s)
- K C Elliott
- Office of Agriculture Safety and Health, Office of the Director, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - Jennifer M Lincoln
- Office of Agriculture Safety and Health, Office of the Director, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, Ohio, USA
| | - Michael A Flynn
- Division of Science Integration, NIOSH, Cincinnati, Ohio, USA
| | - Jeffrey L Levin
- Department of Occupational and Environmental Medicine, The University of Texas at Tyler Health Science Center, Tyler, Texas, USA
| | - Mathew Smidt
- Southern Research Station, USDA Forest Service, Auburn, Alabama, USA
| | - Jerry Dzugan
- Alaska Marine Safety Education Association, Sitka, Alaska, USA
| | - Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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16
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Beseler CL, Crawford KJ, Charlier DE, Ramos AK. The NIOSH Agricultural Centers' YouTube Channel: Time Series Modeling of Viewership of Agricultural Health and Safety Videos. J Agromedicine 2022; 27:368-377. [PMID: 34719344 PMCID: PMC9072590 DOI: 10.1080/1059924x.2021.2000907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We sought to understand the mechanism underlying the growth trajectory in the United States Agricultural Safety and Health Centers YouTube channel. We also explored the benefits and limitations of using YouTube analytics to evaluate the impacts of public health interventions involving YouTube. Time series analysis of total views, total watch hours, average duration of watch time, and number of subscribers were assessed to determine the monthly patterns of non-seasonal and seasonal components in the data from 2013 to 2020. Health, safety, and animal handling video views were summarized descriptively across time and season. Lastly, time series regressions were used to determine the type of video that best predicted growth in the channel viewership metrics. The time series were not random but could be explained by autoregressive and moving average correlation structures. Health videos were the strongest predictors of future growth but were not the most watched type of video. Strong seasonality components indicated that videos were most watched during periods of high agricultural activity, but less so during the winter months. Generally, growth in YouTube viewership metrics was explained by past month viewership predicting future viewership. Outreach and media content may produce spikes of increased interest, but in order to sustainably grow the channel over time, Ag Centers and other agricultural stakeholders should continue to focus on the value of particular content to potential viewers, how and when content is released, and strategic promotion of the channel and its videos.
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Affiliation(s)
- Cheryl L. Beseler
- 984388 Nebraska Medical Center, Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, College of Public Health, Central States Center for Agricultural Safety and Health, Omaha NE 68198-4388 USA
| | - Kathryn J. Crawford
- Department of Occupational and Environmental Health, University of Iowa, College of Public Health, Great Plains Center for Agricultural Health, Iowa City USA
| | - Devon E. Charlier
- School of Public Health, University of Minnesota, Upper Midwest Agricultural Safety and Health Center, Minneapolis USA
| | - Athena K. Ramos
- University of Nebraska Medical Center, College of Public Health, Central States Center for Agricultural Safety and Health. Omaha USA
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17
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Su D, Alshehri K, Ern J, Chen B, Chen L, Chen Z, Han X, King KM, Li H, Li J, Li Y, Michaud T, Shi L, Ramos AK, Wen M, Zhang D. Racism Experience Among American Adults During COVID-19: A Mixed-Methods Study. Health Equity 2022; 6:554-563. [PMID: 36081888 PMCID: PMC9448514 DOI: 10.1089/heq.2022.0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dejun Su
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Khalid Alshehri
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jessica Ern
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Baojiang Chen
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Austin, Texas, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Zhuo Chen
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Keyonna M. King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hongmei Li
- Department of Media, Journalism and Film, Miami University, Oxford, Ohio, USA
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tzeyu Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lu Shi
- Department of Public Health Sciences, Clemson University, Clemson, South Carolina, USA
| | - Athena K. Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ming Wen
- Department of Sociology, University of Utah, Salt Lake City, Utah, USA
| | - Donglan Zhang
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, New York, USA
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Dineen KK, Lowe A, Kass NE, Lee LM, Wynia MK, Voo TC, Mohapatra S, Lookadoo R, Ramos AK, Herstein JJ, Donovan S, Lawler JV, Lowe JJ, Schwedhelm S, Sederstrom NO. Treating Workers as Essential Too: An Ethical Framework for Public Health Interventions to Prevent and Control COVID-19 Infections among Meat-processing Facility Workers and Their Communities in the United States. J Bioeth Inq 2022; 19:301-314. [PMID: 35522376 PMCID: PMC9073494 DOI: 10.1007/s11673-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep this "essential industry" producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry's implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities.
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Affiliation(s)
- Kelly K. Dineen
- School of Law, School of Medicine (secondary), Creighton University, 2500 California Plaza, Omaha, NE 68178 USA
| | - Abigail Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Nancy E. Kass
- Berman Institute of Bioethics & Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Lisa M. Lee
- Office of the Vice President for Research and Innovation & Department of Population Health Sciences, Virginia Tech, Blacksburg, VA USA
| | - Matthew K. Wynia
- Center for Bioethics and Humanities & Internal Medicine University of Colorado School of Medicine, Aurora, CO USA
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel Lookadoo
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Athena K. Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Jocelyn J. Herstein
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Sara Donovan
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE USA
| | - James V. Lawler
- Global Center for Health Security & Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE USA
| | - John J. Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center & Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE USA
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Reyes S, Acosta LM, Domínguez V, Ramos AK, Andrews AR. Immigrant and U.S.-born migrant farmworkers: Dual paths to discrimination-related health outcomes. Am J Orthopsychiatry 2022; 92:452-462. [PMID: 35617245 DOI: 10.1037/ort0000625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research with immigrant Latino populations often point to findings that immigrants tend to evidence better health outcomes than nonimmigrants. When exploring differences based on nativity, comparisons often end with just comparing these two groups. Exploring these variables alone may oversimplify the shared and unique paths of risk and resilience between these groups. Experimental research shows that discrimination is often directed toward immigrants, but U.S.-born Latinos report more frequent exposure. We sought to address this by examining two distinct pathways by which discrimination leads to negative health. A sample of 240 Latino migrant farmworkers completed questionnaires regarding immigration-related fears, discrimination, physical and mental health, demographics, and other outcomes. While U.S.-born participants reported similar or worse outcomes across health measures, the pathways to these outcomes appeared to differ between the two groups, with immigration-related fears accounting for substantial portions of these health outcomes, especially in the dual paths with discrimination (p values < .05). Simply comparing Latino groups across U.S. nativity may paper over important differences in how they arrive at those health outcomes, including that immigration-related concerns may exacerbate exposure to and severity of discrimination, which in turn leads to negative health outcomes. On the other hand, discrimination itself may account for numerous negative health outcomes more directly for U.S.-born Latinos. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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20
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King KM, Key-Hagan M, Desai A, Mundy T, Shittu AK, Roberts LR, Montgomery S, Clarke M, Idoate R, Michaud TL, Ramos AK, Strong S, Thorpe RJ, Montgomery SB. Stress Correlates Related to Depressive Symptoms Among Young Black Men in Southern California. Am J Mens Health 2022; 16:15579883221097801. [PMID: 35549937 PMCID: PMC9112424 DOI: 10.1177/15579883221097801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Black men experience higher levels of chronic stress, life stressors, and discrimination due to oppressive social and economic conditions. Black men are at greater risk of depression, but most published research on stress and depression has focused on Black people in general, Black women, or older Black men. We sought to determine whether discrimination, perceived stress, major life stress, daily hassles, and social capital were associated with depressive symptoms in young Black men. Survey data were collected from April 2010 to March 2012 in Southern California from a convenience sample of Black men (N = 201). We used two-sample t tests and one-way analysis of variance (ANOVA) to examine the association of stress correlates with depressive symptoms. Logistic regression was conducted to estimate the likelihood of reporting depressive symptoms for each significant correlate. Over half of the sample reported depressive symptoms. Health status, perceived discrimination, urban hassles, perceived stress, and neighborhood trust and safety were significantly related to depressive symptoms. Those who reported higher perceived stress had higher odds of reporting depressive symptoms, whereas lower everyday discrimination experiences were associated with lower odds of depressive symptoms. Future studies should consider examining the effectiveness of embedding coping mechanisms for stress, including perceived discrimination, in health interventions for young Black men to prevent or reduce depression.
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Affiliation(s)
- Keyonna M King
- Loma Linda University, Loma Linda, CA, USA.,University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Avni Desai
- Loma Linda University, Loma Linda, CA, USA
| | | | | | | | | | | | - Regina Idoate
- University of Nebraska Medical Center, Omaha, NE, USA
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Haws JK, Andrews AR, Acosta Canchila MN, Ramos AK. Refining the Migrant Farmworker Stress Inventory among Latino migrant farmworkers in rural Nebraska. Journal of Rural Mental Health 2022; 46:100-116. [PMID: 35814869 PMCID: PMC9267916 DOI: 10.1037/rmh0000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Migrant Farmworker Stress Inventory (MFWSI) was developed to measure the distinct stressors faced by migrant farmworkers. The most appropriate measurement and factor structure, however, has been primarily examined with exploratory methods with no studies of confirmatory factor analyses to date. The current study built on prior exploratory factor analytic approaches using the MFWSI by applying confirmatory factor analyses and other tests of validity to better delineate the component parts of migrant farmworker stress that contribute to anxiety and depression. Participants were 241 Latino migrant farmworkers recruited from rural farmworker campsites in Nebraska. Neither of the previously identified factor structures fit the data well initially. Following model respecification, only three factors remained from the original exploratory approaches. These models produced both common and unique factors, which were combined to produce a four-factor model. Results suggest that rural migrant farmworker stress may operate with at least four distinct domains: 1) economic difficulties, 2) immigration and legal status, 3) parenting and child difficulties, and 4) social isolation and related challenges. Finally, only economic difficulties predicted depression and anxiety scores, such that those reporting more stress around economic difficulties reported higher depression and anxiety symptoms. Results point to the need for additional measurement and construct refinement to inform empirical, clinical, policy, and social advocacy work.
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Affiliation(s)
- J. Kyle Haws
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Arthur R. Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | | | - Athena K. Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
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22
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Ramos AK, Carvajal-Suarez M, Trinidad N, Quintero SA, Molina D, Johnson-Beller R, Rowland SA. Health and Well-Being of Hispanic/Latino Meatpacking Workers in Nebraska: An Application of the Health Belief Model. Workplace Health Saf 2021; 69:564-572. [PMID: 34167388 DOI: 10.1177/21650799211016907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meatpacking is dirty, dangerous, and demanding work. In the United States, the industry predominately employs people from racial/ethnic minority backgrounds and immigrants, with 45% of the workforce identifying as Hispanic/Latino. Little is known about how the work environment affects worker engagement in health-promoting activities; however, occupational health professionals are uniquely positioned to advance worker health, safety, and general well-being. METHODS Hispanic/Latino meatpacking workers with work-related musculoskeletal pain and active health concerns were recruited to participate in a study to explore health, health behaviors, and the work environment. Five focus groups (N = 28) were conducted in Nebraska between March 2019 and February 2020. Thematic analysis using the Health Belief Model constructs was used to explain workers' health behaviors including utilization of occupational health services at their workplace. FINDINGS Workers believed that there was little they could do to prevent and treat health problems. They understood the perceived threat of health problems and the benefits of self-care, but the perceived barriers often outweighed the benefits. The workplace had few prompts to motivate or incentivize self-care both in and outside of work. In addition, workers did not trust the occupational health office and saw few benefits to accessing services. Together, these conditions resulted in low self-efficacy and limited engagement in health-promoting behaviors. CONCLUSION/APPLICATION TO PRACTICE Occupational health professionals should promote Total Worker Health and foster trust by providing culturally, linguistically, and literacy appropriate services and by identifying opportunities and reducing barriers for workers to engage in activities to promote their health, safety, and well-being.
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Rowland SA, Ramos AK, Carvajal-Suarez M, Trinidad N, Johnson-Beller R, Struwe L, Quintero SA, Pozehl B. Musculoskeletal Pain and Cardiovascular Risk in Hispanic/Latino Meatpacking Workers. Workplace Health Saf 2021; 69:556-563. [PMID: 34425720 DOI: 10.1177/21650799211016908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most meatpacking workers have pain affecting their back, arms, and/or wrists from work-related repetitive motions, forceful exertion, and awkward positioning. Chronic musculoskeletal pain is associated with obesity, hypertension, type II diabetes, heart attack, and stroke. Hispanic/Latino workers in the meatpacking industry are a vulnerable population; limited English, lack of health insurance, and fear of deportation often deter them from seeking care where preventable cardiovascular risks might be detected. The purpose of this study was to examine perceived health and actual cardiovascular risk among Hispanic/Latino meatpacking workers with musculoskeletal pain in Nebraska. METHODS Structured interviews were used to examine perceived health, awareness of cardiometabolic risk, and capacity for health self-management. Body mass index (BMI), lipids, blood pressure, Hemoglobin A1c (HbA1c), and cardiorespiratory fitness (step test) were used to examine cardiovascular risk. FINDINGS Of those interviewed (n = 39), musculoskeletal pain affected usual life activities in 64% (n = 25) of participants. Of those tested (n = 30), 93% (n = 28) had a BMI > 30 kg/m2, 86% (n = 26) had at least one lipid abnormality, 50% (n = 15) had blood pressure > 120/80 mm Hg, and 43% (n = 13) had an HbA1c > 5.7%. Males had greater fitness than females (p = .03), but also greater lifetime risk of heart attack or stroke compared with females (p = .02). CONCLUSION/APPLICATION TO PRACTICE In this sample, cardiovascular risk exceeded that found in the general Hispanic population in the United States. Occupational health nurses can assist workers to be aware of their risk by measuring and providing culturally and linguistically appropriate education on blood pressure, BMI, cholesterol, and HbA1c.
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Affiliation(s)
| | | | | | | | | | - Leeza Struwe
- University of Nebraska Medical Center College of Nursing
| | | | - Bunny Pozehl
- University of Nebraska Medical Center College of Nursing
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Abstract
Objectives To evaluate disparities in youth e-cigarette use patterns and flavor use by race/ethnicity over time. Methods We used data from the US 2014-2019 National Youth Tobacco Survey (NYTS) to examine trends in dual use (co-use of e-cigarettes and cigarettes or other tobacco products), occasional (≤ 5 days) versus frequent use (≥ 20 days) in the past 30 days, and flavor use among current (past-30-day) e-cigarette users (n = 13 178) across racial/ethnic groups (non-Hispanic Whites, non-Hispanic Blacks, Hispanics/Latinos, and non-Hispanic others). Results Among current e-cigarette users, dual use and occasional use decreased significantly from 2014 to 2019 across racial and ethnic groups except for non-Hispanic Blacks; frequent use and flavored e-cigarette use increased among non-Hispanic Whites, Hispanics/Latinos, and non-Hispanic others but not among non-Hispanic Blacks. In 2019, non-Hispanic Black e-cigarette users were more likely to report dual use (adjusted odds ratio [AOR] = 2.2; 95% confidence interval [CI] = 1.5, 3.2; P < .001) and occasional use of e-cigarettes (AOR = 3.7; 95% CI = 2.3, 5.9; P < .001) but less likely to report frequent use (AOR = 0.2; 95% CI = 0.1, 0.4; P < .001) and flavored e-cigarette use (AOR = 0.4; 95% CI = 0.3, 0.5; P < .001) than their White peers. Conclusions Youth e-cigarette use patterns differed considerably across racial/ethnic groups, and tailored strategies to address disparities in e-cigarette use are needed. (Am J Public Health. 2021;111(11):2050-2058. https://doi.org/10.2105/AJPH.2021.306448).
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Affiliation(s)
- Hongying Dai
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Athena K Ramos
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Babalola Faseru
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Jennie L Hill
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
| | - Steven Y Sussman
- Hongying Dai is with the Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha. Athena K. Ramos is with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center. Babalola Faseru is with the Department of Population Health, University of Kansas Medical Center, Kansas City. Jennie L. Hill is with the Department of Epidemiology, College of Public Health, University of Nebraska Medical Center. Steven Y. Sussman is with the Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles
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Idoate R, Gilbert M, King KM, Spellman L, McWilliams B, Strong B, Bronner L, Siahpush M, Ramos AK, Clarke M, Michaud T, Godfrey M, Solheim J. Urban American Indian Community Health Beliefs Associated with Addressing Cancer in the Northern Plains Region. J Cancer Educ 2021; 36:996-1004. [PMID: 32162283 PMCID: PMC7523620 DOI: 10.1007/s13187-020-01727-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
American Indians residing in the Northern Plains region of the Indian Health Service experience some of the most severe cancer-related health disparities. We investigated ways in which the community climate among an American Indian population in an urban community in the Northern Plains region influences community readiness to address cancer. A Community Readiness Assessment, following the Community Readiness Model, conducted semi-structured interviews with eight educators, eight students, and eight community leaders from the American Indian community in Omaha's urban American Indian population and established the Northern Plains region community at a low level of readiness to address cancer. This study reports on a subsequent qualitative study that analyzed all 24 interview transcriptions for emergent themes to help understand the prevailing attitude of the community toward cancer. A synthesis of six emergent themes revealed that the community's perceptions of high levels of severity and barriers, paired with perceptions of low levels of susceptibility and benefits, lead to low levels of self-efficacy, all of which are reflected in minimal cues to action and little effort to address cancer. These findings, interpreted through the lens of the Health Belief Model, can inform the development of more community-based, comprehensive, and culturally appropriate approaches to address the multilevel determinants of health behaviors in relation to cancer among American Indians in the Northern Plains region.
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Affiliation(s)
- Regina Idoate
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
| | - Mark Gilbert
- Faculty of Medicine, Medical Humanities (HEALS) program, Medical Division of Medical Education, Dalhousie University, B3H4R2, Halifax, NS, Canada
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, Center for Reducing Health Disparities, University of Nebraska Medical Center, 5050 Ames Avenue, Omaha, NE, 68104, USA
| | - Lisa Spellman
- UNMC Public Relations, University of Nebraska Medical Center, 985230 Nebraska Medical Center, Omaha, NE, 68198-5230, USA
| | - Bobbie McWilliams
- University of Nebraska Medical Center, Youth Enjoy Science Program, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Brittany Strong
- Omaha Public Schools, Native Indigenous Centered Education Program, 3215 Cuming Street, Omaha, NE, 68131, USA
| | - Liliana Bronner
- Department of Family Medicine, Primary Care Center for Education, Research, & Healthcare Design, University of Nebraska Medical Center, 983075 Nebraska Medical Center, Omaha, NE, 68198-3075, USA
| | - Mohammad Siahpush
- College of Public Health, Department of Health Services Research and Administration, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Martina Clarke
- Department of Internal Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198-2265, USA
| | - Tzeyu Michaud
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Maurice Godfrey
- Munroe-Meyer Institute, University of Nebraska Medical Center, 985450 Nebraska Medical Center, Omaha, NE, 68198-5450, USA
| | - Joyce Solheim
- Department of Biochemistry & Molecular Biology/Pathology & Microbiology, Eppley Institute, Cancer Research Doctoral Program, University of Nebraska Medical Center, 985950 Nebraska Medical Center, Omaha, NE, 68198-5950, USA
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Kellstedt DK, Schenkelberg MA, Essay AM, Welk GJ, Rosenkranz RR, Idoate R, Ramos AK, Grimm B, Dzewaltowski DA. Rural community systems: Youth physical activity promotion through community collaboration. Prev Med Rep 2021; 23:101486. [PMID: 34458077 PMCID: PMC8378795 DOI: 10.1016/j.pmedr.2021.101486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 01/28/2023] Open
Abstract
A community systems approach is important to
identify social and geographic health impacts. Community stakeholders residing within the city had
higher trust and collective efficacy scores. These stakeholders had roles directly leading
physical activity opportunities for youth. Youth physical activity was greater in the community
with stakeholders in administrative roles. Unique community variables should be studied to
elucidate system drivers of physical activity.
A common way to address rural population health issues
is through community stakeholders working together. Youth physical activity (PA)
happens in adult-led in-school and out-of-school group opportunities that vary
across communities and generally occur in isolated settings. This study explores
similarities and differences in rural community system structure and
collaborative process variables that help to conceptualize the collaborative
impact influencing population youth PA outcomes. Stakeholders (Community 1,
n = 23; Community 2, n = 26)
and youth (Community 1, n = 205; Community 2,
n = 213) were recruited in 2018–2019 as part of
Wellscapes, a hybrid implementation-effectiveness community randomized trial. A
stakeholder survey (n = 49) measured community system
structures and collaboration processes. Youth completed the Youth Activity
Profile to measure PA levels. More Community 1 respondents than Community 2
resided within city limits (73.9% vs. 34.6%). Collective efficacy was
significantly greater in Community 1 (M = 4.0,
SD = 0.5) than in 2 (M = 3.2,
SD = 0.4), p < 0.05.
Perceptions of trust scored significantly greater in Community 1
(M = 4.1, SD = 0.3) than in 2
(M = 3.3, SD = 0.5),
p < 0.05. Though both communities met rural
definitions and had stakeholder investment, Community 1 had a greater proportion
of PA-implementing stakeholders and more residing within city limits which may
have influenced that community’s higher scores in collective efficacy and trust.
Community 2 had more stakeholders in administrator roles and yielded greater
youth PA levels. Unique and common variables of rural communities should be
considered in understanding system factors that impact youth
PA.
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Affiliation(s)
- Debra K Kellstedt
- Family & Community Health, Texas A&M AgriLife Extension, College Station, TX 77843, USA
| | | | - Ann M Essay
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Gregory J Welk
- College of Human Sciences, Iowa State University, Ames, IA 50011, USA
| | - Richard R Rosenkranz
- College of Health & Human Sciences, Kansas State University, Manhattan, KS 66506, USA
| | - Regina Idoate
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Athena K Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Brandon Grimm
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - David A Dzewaltowski
- College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
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27
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Ramos AK, Adhikari S, Yoder AM, Rautiainen RH. Occupational Injuries among Latino/a Immigrant Cattle Feedyard Workers in the Central States Region of the United States. Int J Environ Res Public Health 2021; 18:ijerph18168821. [PMID: 34444570 PMCID: PMC8392181 DOI: 10.3390/ijerph18168821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 11/18/2022]
Abstract
Agriculture is a dangerous industry with high rates of occupational injuries. Immigrants comprise the majority of the hired agricultural workforce in the United States, and these workers may be at a higher risk for job-related injuries. This study addressed the frequency, characteristics, and risk factors of occupational injuries among Latino immigrant cattle feedyard workers. Data were collected through structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska (n = 243; 90.9% male). Descriptive statistics and logistic regression were used to identify risk factors for injury. Nearly three-fourths of participants (71.2%) reported having experienced one or more injuries in the past while working on a cattle feedyard. The most frequent types of reported injuries, including those not requiring medical care, were bruises/contusions (40%), cuts/lacerations (21%), and sprains/strains (12%). These injuries were mainly caused by animals/livestock (33%), chemicals (23%), falls (12%), and tools (9%). Significant risk factors for injury included male gender (OR 5.9), being over age 35 (OR 2.6), working on a large or an extra-large feedyard (OR 5.4), having 11 or more employees on the feedyard (OR 3.6), and working more than eight hours a day (OR 4.7). Having received safety training was also associated with greater risk of injury in a univariable model (OR 2.6). Cattle feedyard workers are at high risk for injury and require more effective preventive measures.
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Affiliation(s)
- Athena K. Ramos
- Center for Reducing Health Disparities, Department of Health Promotion, University of Nebraska Medical Center, Omaha, NE 68198-4340, USA
- Correspondence: ; Tel.: +1-402-559-2095
| | - Suraj Adhikari
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198-4388, USA; (S.A.); (A.M.Y.); (R.H.R.)
| | - Aaron M. Yoder
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198-4388, USA; (S.A.); (A.M.Y.); (R.H.R.)
| | - Risto H. Rautiainen
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE 68198-4388, USA; (S.A.); (A.M.Y.); (R.H.R.)
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Grimm B, Ramos AK, Maloney S, Abresch C, Tibbits M, Lyons K, Palm D. The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes. J Community Health 2021; 47:79-86. [PMID: 34387813 PMCID: PMC8361828 DOI: 10.1007/s10900-021-01020-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 10/24/2022]
Abstract
In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community's needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent's capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.
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Affiliation(s)
- Brandon Grimm
- Office of Public Health Practice, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4335, USA.
| | - Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, Central States Center for Agricultural Safety and Health (CS-CASH), Office of Latino Latin American Studies (UNO OLLAS), College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Shannon Maloney
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4340, USA
| | - Chad Abresch
- Department of Pediatrics, CityMatCH, Division of Child Health Policy, University of Nebraska Medical Center, Omaha, NE, 68198-2155, USA
| | - Melissa Tibbits
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Kiara Lyons
- Department of Pediatrics, CityMatCH, Division of Child Health Policy, University of Nebraska Medical Center, Omaha, NE, 68198-2170, USA
| | - David Palm
- Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4350, USA
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29
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Ramos AK, Girdžiūtė L, Starič J, Rautianinen RH. Identifying "Vulnerable Agricultural Populations" at Risk for Occupational Injuries and Illnesses: A European Perspective. J Agromedicine 2021; 26:340-345. [PMID: 32458756 DOI: 10.1080/1059924x.2020.1771498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: A common understanding of the term "vulnerable populations" in the European agricultural context is needed. Therefore, the purpose of this paper was to identify vulnerable populations working in European agriculture. Methods: Participatory dialogue with members of the Safety Culture and Risk Management in Agriculture (SACURIMA) network was used to identify and build consensus on the major vulnerable groups of people who work in European agriculture. Results: Five groups of vulnerable people were identified, which included: (1) foreign-born farmworkers (including both immigrants and refugees); (2) migrant and seasonal farmworkers; (3) beginning farmers (those with <5 years of experience); (4) farm families (including women, children, and older adults), and (5) farmers and farmworkers who have physical, mental health, or intellectual disabilities. Conclusion: By developing a consistent understanding of vulnerable populations working in European agriculture, we can promote consistency in health and safety messaging, measurement of health and safety constructs, and implementation and dissemination of health and safety programs and information.
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura Girdžiūtė
- Faculty of Bioeconomy Development, Vytautas Magnus University, Akademija, Kaunor, Lithuania
| | - Jože Starič
- Veterinary Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Risto H Rautianinen
- Natural Resources Institute, Helsinki, Finland and University of Nebraska Medical Center, Central States Center for Agricultural Safety and Health, Department of Environmental, Agricultural & Occupational Health, College of Public Health, 984395 Nebraska Medical Center Omaha, Omaha, Nebraska, USA
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Herstein JJ, Degarege A, Stover D, Austin C, Schwedhelm MM, Lawler JV, Lowe JJ, Ramos AK, Donahue M. Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures. Emerg Infect Dis 2021. [DOI: 10.3201/204800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Herstein JJ, Degarege A, Stover D, Austin C, Schwedhelm MM, Lawler JV, Lowe JJ, Ramos AK, Donahue M. Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures. Emerg Infect Dis 2021; 27:1032-1038. [PMID: 33591249 PMCID: PMC8007314 DOI: 10.3201/eid2704.204800] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.
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Ramos AK, Carvajal-Suarez M, Trinidad N, Quintero S, Molina D, Rowland SA. "No somos máquinas" (We are not machines): Worker perspectives of safety culture in meatpacking plants in the Midwest. Am J Ind Med 2021; 64:84-96. [PMID: 33284493 DOI: 10.1002/ajim.23206] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Meatpacking is dangerous, dirty, and demanding (3-D) work-much of which is done by immigrant workers. It is characterized by high rates of occupational injuries and illnesses due to the speed of the production line, repetitive motions, and other inherent exposures. The purpose of this qualitative study was to explore perceptions of safety culture among Hispanic/Latino meatpacking workers in the Midwest. METHODS Five focus groups with a total of 28 participants were conducted between March 2019 and February 2020 with Hispanic/Latino meatpacking workers in Nebraska. Workers were asked about the type of work performed, how the work was physically done, and perceptions of health risks and exposures. Thematic analysis was used to build a description of safety culture within the meatpacking industry. RESULTS Three main themes were found: (1) workers depicted a culture where companies cared more about production than people; (2) workers felt powerless in improving their situation; and (3) workers noted that the work was precarious, both dangerous and one where much of the responsibility for safety was shifted to the individual workers. CONCLUSIONS The meatpacking industry has a poor safety culture. Safety culture within the industry may be improved by ensuring that organizational values and artifacts are aligned with safety by addressing the critical role of supervisors, providing culturally and linguistically appropriate consistent safety training and messaging to the workforce, and enforcing and strengthening safety regulations.
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Marcela Carvajal-Suarez
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sophia Quintero
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Diana Molina
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sheri A Rowland
- College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska, USA
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Abstract
Cattle feedyards are animal feeding operations where beef cattle are finished to market weight on grain. Cattle feeding can be dirty, demanding, and dangerous work. This study sought to assess the predictors of fatigue and the need for recovery among Latino/a immigrant cattle feedyard workers in the United States. A path model was examined to explore direct and indirect relations among physical fatigue, mental fatigue, need for recovery, job characteristics, and health and sociodemographic covariates. Lower self-reported health, experiencing physical pain, not handling animals, and decreased decision latitude were directly related to increased physical fatigue. Shorter tenure working on cattle feedyards, lower educational level, experiencing physical pain, and increased job demands were directly related to heightened mental fatigue. Being female, experiencing physical pain, an elevated average of hours worked per day, increased job demands, and less decision latitude were directly related to an increased need for recovery and indirectly related to both physical and mental fatigue. Physical and mental fatigue have specific correlates, but job characteristics, including job demands and decision latitude, can directly and indirectly impact workers' levels of physical and mental fatigue and their need for recovery. Both preventive measures and restructuring work operations may reduce the risk for fatigue and the need for recovery. Implications for cattle feedyard workers, supervisors, and employers are discussed. Finding ways to balance productivity and the well-being of workers should be a high priority for cattle feedyards across the country.
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, Department of Health Promotion, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, USA
| | - Meredith McGinley
- Department of Psychology, University of Wisconsin-Parkside, Kenosha, WI, USA
| | - Gustavo Carlo
- Department of Human Development and Family Science, University of Missouri, Columbia, MO, USA
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, Department of Health Promotion at the University of Nebraska Medical Center and the Central States Center for Agricultural Safety and Health
| | - Marc B Schenker
- Western Center for Agricultural Health and Safety and the Migration and Health Research Center at the University of California at Davis
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Ramos AK, Duysen E, Carvajal-Suarez M, Trinidad N. Virtual Outreach: Using Social Media to Reach Spanish-speaking Agricultural Workers during the COVID-19 Pandemic. J Agromedicine 2020; 25:353-356. [PMID: 32921289 DOI: 10.1080/1059924x.2020.1814919] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Face-to-face outreach and in-person training have traditionally been key strategies in reaching agricultural producers, workers, and communities with safety and health information, but the COVID-19 pandemic has forced outreach educators to be creative and find alternative ways to reach, communicate, and share such information. In this commentary, we describe our use of social media to reach Latino/a cattle feedyard workers with COVID-19 related information. As a result of our effort, we reached over 54,000 people and demonstrated there is an audience for Spanish-language agricultural safety and health information. Social media can be a cost-effective method for virtual outreach in this new normal. We should look at this time as an opportunity to learn more about how our stakeholders obtain information and about how best we can connect with them. Although our outreach methods may be changing, our goal is not - we will continue to work to improve the safety and health of those who work in agriculture.
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center , Omaha, NE, USA
| | - Ellen Duysen
- Central States Center for Agricultural Safety and Health, College of Public Health, University of Nebraska Medical Center, 984388 Nebraska Medical Center , Omaha, NE, USA
| | - Marcela Carvajal-Suarez
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center Omaha, NE, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center Omaha, NE, USA
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Abstract
From the farms to the packing plants, essential workers in critical food production industries keep food on our tables while risking their and their families' health and well-being to bring home a paycheck. They work in essential industries but are often invisible. The disparities illuminated by COVID-19 are not new. Instead, they are the result of years of inequities built into practices, policies, and systems that reinforce societal power structures. As a society, we are now at an antagonizing moment where we can change our collective trajectory to focus forward and promote equity and justice for workers in agriculture and food-related industries. To that end, we describe our experience and approach in addressing COVID-19 outbreaks in meat processing facilities, which included three pillars of action based on public health ethics and international human rights: (1) worksite prevention and control, (2) community-based prevention and control, and (3) treatment. Our approach can be translated to promote the health, safety, and well-being of the broader agricultural workforce.
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Affiliation(s)
- Athena K Ramos
- Assistant Professor, Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center , Omaha, Nebraska
| | - Abigail E Lowe
- Ethics and Public Health Preparedness, Center for Preparedness Education, College of Public Health, University of Nebraska Medical Center , Omaha, NE, USA
| | - Jocelyn J Herstein
- Sub-Saharan Africa Region, Global Center for Health Security, College of Public Health, University of Nebraska Medical Center , Omaha, NE, USA
| | - Shelly Schwedhelm
- Emergency Management & Biopreparedness, Nebraska Medicine & Global Center for Health Securitu, Nebraska Medical Center , Omaha, Nebraska, USA
| | - Kelly K Dineen
- Health Law Program, Creighton University , Omaha, Nebraska, USA
| | - John J Lowe
- Department of Environmental, Agricultural and Occupational Health, College of Public Health and Executive Director, Global Center for Health Security, University of Nebraska Medical Center , Omaha, Nebraska, USA
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Andrews AR, Haws JK, Acosta LM, Acosta Canchila MN, Carlo G, Grant KM, Ramos AK. Combinatorial Effects of Discrimination, Legal Status Fears, Adverse Childhood Experiences, and Harsh Working Conditions among Latino Migrant Farmworkers: Testing Learned Helplessness Hypotheses. J Lat Psychol 2020; 8:179-201. [PMID: 33511335 PMCID: PMC7837582 DOI: 10.1037/lat0000141] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Migrant farmwork is often characterized by harsh working conditions that carry significant physical and mental health consequences. Using a learned helplessness framework, the current study examined the extent to which discrimination, immigration legal status difficulties, and adverse childhood experiences moderated the effects of harsh working conditions on depression and anxiety. The study also examined the extent to which harsh working conditions mediated the effects of discrimination, immigration legal status difficulties, and adverse childhood experiences on depression and anxiety. Participants were 241 migrant farmworkers recruited in the Midwest. Participants completed interviews consisting of the Migrant Farmworker Stress Index (MFWSI), Adverse Childhood Events scale (ACEs), Everyday Discrimination Scale, the Centers for Epidemiology Scale for Depression (CES-D), and the seven item Generalized Anxiety Disorder scale (GAD-7). Tests of indirect effects suggested, working conditions mediated the effects of ACEs, immigration legal status fears, and discrimination on CES-D and GAD-7 scores (p-values < .05). Higher ACEs and discrimination also appeared to be associated with larger effects of harsh working conditions on depression and anxiety (p-values < .05), while legal status fears did not significantly moderate the effect of harsh working conditions on either outcome (p-values > .05). Likely through different mechanisms, adverse childhood experiences, discrimination and immigration legal status are associated with higher risk of harsh working conditions and subsequently these conditions account for much of the relations between these three stressors with depression and anxiety. Additionally, discrimination and adverse childhood experiences appear to then enhance the effects of working conditions.
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Affiliation(s)
| | - James K. Haws
- Department of Psychology, University of Nebraska-Lincoln
| | | | | | - Gustavo Carlo
- Human Development and Family Science, University of Missouri, Columbia
| | - Kathleen M. Grant
- VA Nebraska-Western Iowa Health Care System,,Department of Internal Medicine, University of Nebraska Medical Center
| | - Athena K. Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center
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Ramos AK, Carvajal-Suarez M, Trinidad N, Michaud TL, Grimm B, LeVan T, Siahpush M. A Cross-sectional Study of Gender-related Differences in Reporting Fatigue and Pain among Latino/A Migrant Farmworkers. J Agromedicine 2020; 25:319-329. [PMID: 31941431 DOI: 10.1080/1059924x.2020.1713272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Migrant farmworkers face many hardships in both their working and living environments including dangerous and demanding tasks, long hours, and inadequate rest. This study sought to explore gender differences in the reporting of fatigue and pain and to identify predictors of fatigue and pain among migrant farmworkers in Nebraska (n = 241). Methods: Bivariate tests were used to assess associations among study variables. Linear and generalized linear mixed effect models were used to assess gender as a predictor of fatigue and pain respectively while controlling for covariates. Results: Females reported significantly higher levels of fatigue (M score = 15.5, SD = 6.1 compared to M score = 12.8, SD = 4.3) than their male counterparts. Females were also more likely to report pain (56.9% of females compared to 36.3% of males). Being female, pain, hours of sleep, and job demands were significant predictors of fatigue. Fatigue and job-related injury were the only significant predictors of pain. Conclusions: There are gender-related disparities in the reporting of fatigue and pain among Latino/a migrant farmworkers. Extra precautions need to be taken to protect worker health and safety and reduce fatigue, particularly for female workers. Implications for employers, supervisors, and healthcare providers are discussed.
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center , Omaha, NE, USA
| | - Marcela Carvajal-Suarez
- Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
| | - Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, 984340 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
| | - Brandon Grimm
- Department of Health Promotion, College of Public Health, 984365 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
| | - Tricia LeVan
- Department of Epidemiology, College of Public Health, 984395 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, 984365 Nebraska Medical Center, University of Nebraska Medical Center , Omaha, NE, USA
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Michaud TL, Siahpush M, Estabrooks P, Schwab RJ, LeVan TD, Grimm B, Ramos AK, Johansson P, Scoggins D, Su D. Association Between Weight Loss and Glycemic Outcomes: A Post Hoc Analysis of a Remote Patient Monitoring Program for Diabetes Management. Telemed J E Health 2020; 26:621-628. [DOI: 10.1089/tmj.2019.0030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Tzeyu L. Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paul Estabrooks
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Robert J. Schwab
- Division of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tricia D. LeVan
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Internal Medicine and Veterans Nebraska Western Iowa Healthcare System, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Brandon Grimm
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Athena K. Ramos
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Patrik Johansson
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dylan Scoggins
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Acosta LM, Andrews AR, Acosta Canchila MN, Ramos AK. Testing Traditional Machismo and the Gender Role Strain Theory With Mexican Migrant Farmworkers. Hispanic Journal of Behavioral Sciences 2020. [DOI: 10.1177/0739986320915649] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The current study examines the moderating role of traditional machismo on mental health outcomes. We hypothesized that machismo would enhance the effects of stressors that are incongruent with traditional machismo beliefs (discrimination, adverse childhood experiences [ACEs], and fear of deportation) on depression and anxiety outcomes but would not enhance stressors that are congruent (harsh working conditions and poverty) on depression and anxiety. Participants were 190 male Mexican migrant farmworkers. As hypothesized, endorsing high traditional machismo was associated with stronger effects of fear of deportation and discrimination on depression outcomes compared with low traditional machismo. The interaction of machismo and ACEs was not significant in predicting depression or anxiety. Moreover, machismo did not moderate the effects of poverty or harsh working conditions on depression or anxiety outcomes. Results partially supported our hypotheses and suggested that the effect of machismo on depression may be better understood in the context of value-incongruent stressors.
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Hudson-Flege MD, Grover HM, Meçe MH, Ramos AK, Thompson MP. Empathy as a moderator of sexual violence perpetration risk factors among college men. J Am Coll Health 2020; 68:139-147. [PMID: 30570441 DOI: 10.1080/07448481.2018.1536055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 08/15/2018] [Accepted: 10/09/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examined if empathy was a significant moderator of several empirically established risk factors for sexual violence perpetration among college men. Participants: Data are from 544 college men who participated in a longitudinal study from 2008 to 2011 at a large, public university. Methods: Participants completed a self-report survey in their first through fourth years in college. A series of generalized linear models were conducted using sexual violence risk factors and empathy during the sophomore year as predictors of sexual violence perpetration frequency during junior year. Results: Empathy was found to be a significant moderator of six out of the 10 sexual violence risk factors tested, such that high levels of empathy were associated with lower sexual violence perpetration rates among high-risk males. Conclusion: Additional research, including the measurement and evaluation of empathy in implementation of college sexual violence prevention and intervention efforts, should be undertaken.
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Affiliation(s)
- Matthew D Hudson-Flege
- Institute on Family & Neighborhood Life, Clemson University, Clemson, South Carolina, USA
| | - Holly M Grover
- Institute on Family & Neighborhood Life, Clemson University, Clemson, South Carolina, USA
| | - Merita H Meçe
- Institute on Family & Neighborhood Life, Clemson University, Clemson, South Carolina, USA
| | - Athena K Ramos
- Institute on Family & Neighborhood Life, Clemson University, Clemson, South Carolina, USA
- College of Public Health, Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Martie P Thompson
- Institute on Family & Neighborhood Life, Clemson University, Clemson, South Carolina, USA
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Michaud TL, Siahpush M, King KM, Ramos AK, Robbins RE, Schwab RJ, Clarke MA, Su D. Program completion and glycemic control in a remote patient monitoring program for diabetes management: Does gender matter? Diabetes Res Clin Pract 2020; 159:107944. [PMID: 31765684 DOI: 10.1016/j.diabres.2019.107944] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/13/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023]
Abstract
AIMS To examine gender differences in program completion and glycemic outcomes for patients with type 2 diabetes (T2D) in a remote patient monitoring (RPM) program for diabetes management. METHODS Based on data from an RPM program that enrolled post-discharge T2D patients (n = 1645) in 2014-2017, logistic regression models were estimated to assess gender difference in the likelihood of completing the three-month RPM program; whereas ordinary least squares (OLS) regression models were used to examine gender difference in post-RPM hemoglobin A1c (HbA1c), controlling for demographics, baseline health status, including HbA1c, patient activation scores, and physiological data upload frequency for patients who had completed the program. RESULTS Among enrolled participants, men had lower odds of completing the three-month RPM program than women (adjusted odds ratio, 0.61; 95% confidence interval [CI], 0.39-0.95). However, among those who completed the program, men had lower post-RPM HbA1c than women (-0.18; 95% CI, -0.33, -0.03) after controlling for baseline HbA1c and other covariates. CONCLUSIONS While female patients with T2D were more likely to complete the RPM program, they showed a higher glycemic level at the end of the program compared to male patients. To close gender disparities in health, interventions through telemedicine tailored towards women's diabetes outcomes and men's engagement level are warranted.
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Affiliation(s)
- Tzeyu L Michaud
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keyonna M King
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Athena K Ramos
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Regina E Robbins
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert J Schwab
- Division of General Internal Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Martina A Clarke
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
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Siahpush M, Robbins RE, Ramos AK, Michaud TL, Clarke MA, King KM. Does Difference in Physical Activity Between Blacks and Whites Vary by Sex, Income, Education, and Region of Residence? Results from 2008 to 2017 National Health Interview Surveys. J Racial Ethn Health Disparities 2019; 6:883-891. [PMID: 31004290 DOI: 10.1007/s40615-019-00586-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/21/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To examine how the effect of race (Black versus White) on meeting physical activity (PA) guidelines varies by sex, income, education, and region of residence. METHODS We pooled data from 10 consecutive years (2008 to 2017) of the National Health Interview Survey. We used logistic regression to assess the extent to which the effect of race on meeting the U.S. federal guidelines for PA varies by sex, income, education, and region, after controlling for several health-related variables. The analysis sample size was 225,600 (102,348 men and 123,252 women). RESULTS Race and most of the other covariates interacted with sex in their effect on meeting PA guidelines; therefore, separate models for men and women were estimated. In each model, race interacted with income and region, but not with education. Among men, Blacks were more likely to meet PA guidelines than Whites in nearly all income categories and regions. The race effect was weakest among the poor and in the Northeast region. Among women, Blacks were generally less likely than Whites to meet the guidelines and the race effect was largest among the poor and in the Northeast region. CONCLUSION This study showed that the difference between Blacks and Whites in the extent to which they adhere to federal PA guidelines varies by sex, income, and region of residence. Black women whole live below the poverty threshold are less likely than other demographic groups to meet the PA guidelines. Targeted interventions to promote PA among this population group are warranted.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center; 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
| | - Regina E Robbins
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center; 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center; 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Tzeyu L Michaud
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center; 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
| | - Martina A Clarke
- Department of Internal Medicine, College of Medicine, University of Nebraska Medical Center; 982265 Nebraska Medical Center, Omaha, NE, 68198-2265, USA
| | - Keyonna M King
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center; 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA
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Abstract
Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers' right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.
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Affiliation(s)
- Athena K Ramos
- a Center for Reducing Health Disparities , University of Nebraska Medical Center , Omaha , Nebraska , USA
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Ramos AK, Trinidad N, Correa A, Carlo G. Correlates and predictors of alcohol consumption and negative consequences of alcohol use among Latino migrant farmworkers in Nebraska. Am J Orthopsychiatry 2019; 89:559-568. [PMID: 30676052 DOI: 10.1037/ort0000401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol is a significant issue among the Latino farmworker population. This study used cross-sectional data from the Nebraska Migrant Farmworker Health Study, 2016 (N = 241) to (1) describe drinking behavior, (2) evaluate associations between alcohol consumption and negative consequences from alcohol use and various social and demographic variables, and (3) assess contextual and interpersonal predictors of alcohol consumption and negative consequences from alcohol use. Descriptive, bivariate statistics and hierarchical multiple regression were used. Results indicated that over 30% of participants had engaged in heavy drinking in the last year. Alcohol consumption was significantly positively associated with negative consequences of alcohol use and significantly negatively associated with work safety climate and age. Negative consequences from alcohol use was significantly negatively associated with work safety climate. Significant predictors of alcohol consumption included work safety climate and age. Being married or in a relationship, alcohol consumption, and work safety climate were significant predictors of negative consequences from alcohol use. This study highlights the potential positive spillover effect of work safety climate on worker drinking behaviors. Implications and recommendations for agricultural employers, farmworker health advocates, and social service agencies are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Athena K Ramos
- Department of Health Promotion, University of Nebraska Medical Center
| | - Natalia Trinidad
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Antonia Correa
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center
| | - Gustavo Carlo
- Department of Human Development and Family Science, University of Missouri
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Ramos AK. Child Labor in Global Tobacco Production: A Human Rights Approach to an Enduring Dilemma. Health Hum Rights 2018; 20:235-248. [PMID: 30568417 PMCID: PMC6293346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Tobacco production is a multi-billion-dollar global industry. Unfortunately, the cultivation of tobacco engages the labor of children throughout the world in extremely dangerous environments, which has both immediate and long-term consequences for children and society. This paper explores the human rights concerns associated with child labor in tobacco production by highlighting three countries-the United States, Kazakhstan, and Malawi-and examines the impact that the United Nations Convention on the Rights of the Child, the International Labour Organization's (ILO) Worst Forms of Child Labour Convention, and the ILO's Safety and Health in Agriculture Convention have on child labor practices in tobacco production. It also proposes general actions to address the human rights concerns related to child labor practices in tobacco production, as well as specific actions for selected countries. A human rights-based approach to reducing child labor in agriculture could create meaningful changes that improve lives and opportunities for health, education, and economic stability among children and families across the globe.
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Affiliation(s)
- Athena K Ramos
- Assistant professor in the Department of Health Promotion, Center for Reducing Health Disparities at the University of Nebraska Medical Center, Omaha, NE, USA, and a faculty fellow with the Rural Futures Institute at the University of Nebraska
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LeVan TD, Romberger DJ, Siahpush M, Grimm BL, Ramos AK, Johansson PL, Michaud TL, Heires AJ, Wyatt TA, Poole JA. Relationship of systemic IL-10 levels with proinflammatory cytokine responsiveness and lung function in agriculture workers. Respir Res 2018; 19:166. [PMID: 30176916 PMCID: PMC6122449 DOI: 10.1186/s12931-018-0875-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/27/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Agriculture workers are exposed to microbial component- and particulate matter-enriched organic dust aerosols. Whereas it is clear that exposure to these aerosols can lead to lung inflammation, it is not known how inflammatory responses are resolved in some individuals while others develop chronic lung disease. Interleukin (IL)-10 is an immunomodulatory cytokine that is recognized as a potent anti-inflammatory and pro-resolving factor. The objective of this study was to determine whether there is a relationship of systemic IL-10 and proinflammatory responses and/or respiratory health effects in humans with prior agriculture exposure. METHODS This is a cross sectional study of 625 veterans with > 2 years of farming experience. Whole blood was stimulated with or without organic dust and measured for IL-6, TNFα and IL-10. Participants underwent spirometry and respiratory symptoms were assessed by questionnaire. RESULTS We found that baseline IL-10 concentration from the whole blood assay was inversely associated with ΔTNF-α (r = - 0.63) and ΔIL-6 (r = - 0.37) levels. Results remained highly significant in the linear regression model after adjusting for age, sex, BMI, race, education, smoking status, and white blood cell count (ΔTNF-α, p < 0.0001; ΔIL-6, p < 0.0001). We found no association between chronic cough (p = 0.18), chronic phlegm (p = 0.31) and chronic bronchitis (p = 0.06) and baseline IL-10 levels using univariate logistic regression models. However, we did find that higher FEV1/FVC was significantly associated with increased baseline IL-10 concentration. CONCLUSIONS Collectively, these studies support a potential role for IL-10 in modulating an inflammatory response and lung function in agriculture-exposed persons.
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Affiliation(s)
- Tricia D. LeVan
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
- Veterans Affairs Nebraska Western Iowa Healthcare System, Omaha, NE USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE USA
| | - Debra J. Romberger
- Veterans Affairs Nebraska Western Iowa Healthcare System, Omaha, NE USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Brandon L. Grimm
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Athena K. Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Patrik L. Johansson
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Tzeyu L. Michaud
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Art J. Heires
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Todd A. Wyatt
- Veterans Affairs Nebraska Western Iowa Healthcare System, Omaha, NE USA
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Jill A. Poole
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE USA
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Abstract
Ensuring the health and well-being of Latinas is critical given the size of the population and its rapid growth across the United States. Social capital may be a tool for alleviating some of the individual, neighborhood, and societal challenges that Latina immigrants face. This study uses bivariate tests and multivariate regression to assess the association between social capital and self-efficacy among Latina immigrants in the Midwest (N = 94). Self-efficacy was positively correlated with bonding and bridging social capital. Findings from a multiple regression model indicate that bonding and bridging social capital are significantly associated with self-efficacy after adjusting for the effect of related covariates. Public health interventions may benefit from building and fostering bonding and bridging social capital among immigrants as way to improve self-efficacy, promote health, and enhance public health practice.
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Affiliation(s)
- Athena K Ramos
- a Center for Reducing Health Disparities, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Dejun Su
- a Center for Reducing Health Disparities, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Antonia Correa
- a Center for Reducing Health Disparities, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
| | - Natalia Trinidad
- a Center for Reducing Health Disparities, College of Public Health , University of Nebraska Medical Center , Omaha , Nebraska , USA
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Abstract
Migrant farmworkers represent a structurally vulnerable population coming to rural communities to work, but often are economically disadvantaged and socially isolated. Based on survey data from 200 migrant farmworkers in rural Nebraska in 2013, this study seeks to identify and categorize major stressors that have contributed to depression among farmworkers. Over 30% of respondents were identified to have high stress levels as indicated by the Migrant Farmworker Stress Inventory (MFWSI). The MFWSI was categorized into eight domains: economics and logistics; acculturation and social isolation; relationship with partner; health; entertainment; concerns for children; and substance use by others. Nearly half (45.8%) of respondents were depressed. Correlations between the principal component scores of the eight stressor domains and the cumulative depression score were significant for the domains: (1) economics and logistics and (2) health (r = 0.22, p < 0.01). Findings highlight the importance of improving economic and living conditions as well as addressing social and cultural needs by creating more welcoming receiving communities.
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Affiliation(s)
- Athena K Ramos
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
| | - Dejun Su
- Center for Reducing Health Disparities, College of Public Health, University of Nebraska Medical Center, 984340 Nebraska Medical Center, Omaha, NE, 68198-4340, USA.
| | - Lina Lander
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198-4395, USA.
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Siahpush M, Tibbits M, Soliman GA, Grimm B, Shaikh RA, McCarthy M, Wan N, Ramos AK, Correa A. Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study. Tob Control 2017; 26:703-708. [PMID: 28119499 DOI: 10.1136/tobaccocontrol-2016-053339] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 12/21/2016] [Accepted: 12/29/2016] [Indexed: 11/04/2022]
Abstract
AIM To examine the association between neighbourhood exposure to point-of-sale (POS) cigarette price promotions and financial stress among smokers in a Midwestern metropolitan area in the USA. METHODS Survey data from 888 smokers provided information on sociodemographic and smoking related variables. Financial stress was measured with the question: 'In the last six months, because of lack of money, was there a time when you were unable to buy food or pay any important bills on time, such as electricity, telephone, credit card, rent or your mortgage? (Yes/No).' Using audit data from 504 tobacco retailers, we estimated a score of POS price promotions for each respondent by summing the different types of promotion in each store in their neighbourhood, as defined by a 1-km roadway buffer. RESULTS Adjusted results provided strong support for an association between higher scores of neighbourhood POS cigarette price promotions and a higher probability of financial stress (p=0.007). CONCLUSION Exposure to POS cigarette price promotions is associated with financial stress. This finding, coupled with previous reports that smokers with financial stress are less likely to attempt to quit or succeed in quitting smoking, suggests that POS cigarette price promotions may act as an impediment to smoking cessation.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Melissa Tibbits
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ghada A Soliman
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Brandon Grimm
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Raees A Shaikh
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Molly McCarthy
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Neng Wan
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - Athena K Ramos
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Antonia Correa
- Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
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