Partnering With Community Health Workers to Address COVID-19 Health Inequities: Experiences of the California Alliance Against COVID-19.

With funding from the National Institutes of Health's Community Engagement Alliance, starting in fall 2020, 11 academic medical centers and 75 community partners came together as the California Alliance Against COVID-19 to address COVID-19 inequities in California. Using data from focus groups, statewide meetings, and a statewide partner survey, we describe how promotoras and community health workers (P/CHWs; n = 540) helped to promote access to COVID-19 information, testing, and vaccination. We highlight opportunities to promote health equity among other public health collaborators with a P/CHW model. (Am J Public Health. 2024;114(S1):S45-S49. https://doi.org/10.2105/AJPH.2023.307471).

Social determinants of health among noncitizen deported US veterans: A participatory action study.

This qualitative study examines the social determinants of health among noncitizen deported United States veterans. We utilized Photovoice, a participatory action research method used to inform structural level change, with 12 veterans. Audio-recorded semi-structured interviews explored photos and discussed deportation's effects on veteran health. We performed rapid template and matrix analysis of interview transcripts. Interviews were conducted in Tijuana, Mexico from December 2018 to January 2019. Study findings show that veterans prioritize returning to the United States to improve their quality of life. Analysis of photos and narrative text indicated that deportation caused social, economic, and political insecurities. Veterans struggled to maintain access to necessities post-deportation. Disrupted social networks compounded their situation, resulting in chronic stress and poor health outcomes. The findings from this study offer insight into the ways deportation acts as a social determinant of health. The findings suggest modifying veteran reintegration programs, as well as reforming criminal justice and immigration laws, such as creating more Veteran Treatment Courts and allowing immigration judges to consider military history during deportation proceedings involving noncitizen veterans.

Latinx and Indigenous Mexican Caregivers' Perspectives of the Salton Sea Environment on Children's Asthma, Respiratory Health, and Co-Presenting Health Conditions.

This research investigated Latinx and Indigenous Mexican caregivers' perspectives of the Salton Sea's environment (e.g., dust concentrations and other toxins) on child health conditions. The Salton Sea is a highly saline drying lakebed located in the Inland Southern California desert borderland region and is surrounded by agricultural fields. Children of Latinx and Indigenous Mexican immigrant families are especially vulnerable to the Salton Sea's environmental impact on chronic health conditions due to their proximity to the Salton Sea and structural vulnerability. From September 2020 to February 2021, we conducted semi-structured interviews and focus groups with a total of 36 Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress living along the Salton Sea. A community investigator trained in qualitative research conducted interviews in Spanish or Purépecha, an indigenous language spoken by immigrants from Michoacán, Mexico. Template and matrix analysis was used to identify themes and patterns across interviews and focus groups. Participants characterized the Salton Sea's environment as toxic, marked by exposure to sulfuric smells, dust storms, chemicals, and fires, all of which contribute to children's chronic health conditions (e.g., respiratory illnesses such as asthma, bronchitis, and pneumonia, co-presenting with allergies and nosebleeds). The findings have important environmental public health significance for structurally vulnerable child populations in the United States and globally.

"Ancestral recipes": a mixed-methods analysis of MyPlate-based recipe dissemination for Latinos in rural communities.

BACKGROUND: The Latinx population experiences some of the highest rates of chronic disease, including obesity and type II diabetes. Such conditions may be especially burdensome in rural Latinx communities that often face barriers to accessing disease prevention resources and public health programs. METHODS: Diverse stakeholders (i.e., patients, community members, system of healthcare clinics, community food bank) tailored an existing cookbook, based on the U.S. Department of Agriculture MyPlate healthy eating and dietary guidelines, for local ingredients, health literacy, and language for rural Latinx and Indigenous Latin Americans. The cookbook recipes were disseminated widely via virtual cooking demonstrations, food distribution events, and social media. Pre- and posttest surveys were used to assess changes in diabetes knowledge measured by the 24-item American Diabetes Association Diabetic Knowledge Questionnaire and confidence in dietary behavior change over time measured by 4 questions of the 17-item Mediterranean Diet Index. A mixed effects, repeated measures analysis was conducted with gender ID, age range and educational attainment included as covariates and assessment interval as the predictor (pretest vs posttest) and change in confidence about adhering to four specific components of the Mediterranean diet. Focus groups elicited information on participants' motivation and ability to use the recipes and eat healthy foods following the virtual cooking demonstration participation. RESULTS: A total of 20 virtual cooking demonstrations were conducted and 60 participants completed a pretest survey and 54 a posttest survey, a subsample (n = 19) participated in one of three focus groups. Most participants were female, identified as Latinx/Hispanic, were between the ages of 40-49, and spoke Spanish. 17% identified as Indigenous Latin American specifically as Purépecha, an indigenous group from Michoacán, Mexico. Survey and focus group findings indicated at posttest an increase in diabetes knowledge among participants with no prior diagnosis of chronic health conditions and more confidence in limiting sugary beverages and refined wheat pasta/white rice among indigenous participants. Focus group discussions explicated the quantitative findings. CONCLUSION: This study brought together patients and key stakeholders committed to addressing the social determinants of health and it mobilized the community to develop culturally vetted health education materials. The findings indicate the need for increased access to evidence-based nutrition education and to culturally appropriate food products that can be easily incorporated into daily food preparation.

Creating Cultures of Health in the Academy: Bringing Together Top-Down and Ground-Up Approaches.

This article reports on a 3-year longitudinal study focused on the impact of cross-sector, collective impact approaches to creating cultures of campus health. The study sought to understand the integration of health and well-being concepts into university operations, including business practices and policies, as well as the contribution of public health initiatives focused on health-promoting universities to creating cultures of campus health for students, staff, and faculty. Research was carried out from spring 2018 to spring 2020 via focus group data collection and rapid qualitative analysis involving template and matrix analysis. A total of 18 focus groups were conducted across the 3-year study, six with students, eight with staff, and four with faculty. The initial cohort included 70 participants: 26 students, 31 staff, and 13 faculty. Qualitative analysis findings indicate a general pattern of change over time from a primary focus on well-being characterized by programs and services (e.g., fitness classes) to policy and structural-level interventions (e.g., stairwell beautification and hydration stations) promoting well-being for all. Grass-top and grassroots leadership and action were instrumental to changes in working and learning environments, policies, and campus environment/infrastructure. This work contributes to the growing literature on health-promoting universities and colleges and demonstrates the critical role of both top-down and ground-up approaches and leadership efforts to create more equitable and sustainable cultures of campus health and well-being.

The Intersection of Workplace and Environmental Exposure on Health in Latinx Farm Working Communities in Rural Inland Southern California.

Workplace and environmental exposures pose health risks for racial/ethnic minorities in rural agricultural communities, placing them at a disadvantage in accessing needed health care. Over three fourths (76%) of the 2.4 million farmworkers in the United States are immigrants, mostly from Mexico. However, little is known of the community health concerns and barriers to care of Latinx farmworkers in inland southern California. This qualitative study used a community-based participatory research approach, conducting nine in-home meetings to obtain meaningful community input on health concerns and barriers to access healthcare services among rural residents of the Eastern Coachella Valley, who are also located near the desert-bound Salton Sea of inland southern California. All interviews were audio-recorded and analyzed via listening to the audio recordings and summarizing data in templates and matrices. Participants discussed health concerns related to agricultural labor, including heat-related illness, musculoskeletal ailments and injuries, skin disorders, respiratory illness, and trauma. Participants raised concerns about environmental exposures related to agriculture and the nearby Salton Sea, a highly saline lakebed, and proposed solutions to improve the health of their communities. The findings from this study suggest farmworkers are aware of the health risks posed by living and working in rural farmlands but lack resources and information to act upon and advocate for improved public health.

COVID-19 Testing and Vaccine Hesitancy in Latinx Farm-Working Communities in The Eastern Coachella Valley.

Background: A novel coronavirus, SARS-CoV-2 (known as COVID-19), spread rapidly around the world, affecting all and creating an ongoing global pandemic. In the United States, Latinx, African American, and Indigenous populations across the country have been disproportionately affected by COVID-19 cases and death rates. An examination of the perceptions and beliefs about the spread of the virus, COVID-19 testing, and vaccination amongst racial/ethnic minority groups is needed in order to alleviate the widespread disparity in new cases and deaths. Methods: From November to December 2020 the research team conducted focus groups with members of Latinx farm-working communities in the Eastern Coachella Valley, located in the inland southern California desert region. A total of seven focus groups, six in Spanish and one in Purepecha, with a total of 55 participants were conducted. Topics covered include knowledge of the coronavirus, COVID-19 testing and vaccination. Results: Using theme identification techniques, the findings identify structural factors that underly perceptions held by immigrant, migrant, and indigenous Latinx community members about COVID-19, which, in turn, shape attitudes and behaviors related to COVID-19 testing and vaccination. Common themes that emerged across focus groups include misinformation, lack of trust in institutions, and insecurity around employment and residency. Conclusions: This racial/ethnic minority population is structurally vulnerable to historical and present-day inequalities that put them at increased risk of COVID-19 exposure, morbidity, and mortality. Findings from the focus groups indicate a significant need for interventions that decrease structural vulnerabilities by addressing issues of (dis)trust in government and public health among this population.