Eat Well El Paso!: Lessons Learned From a Community-Level Restaurant Initiative to Increase Availability of Healthy Options While Celebrating Local Cuisine.

PURPOSE: Restaurants have the potential to improve nutrition and positively shape social norms. We describe lessons learned and recommended strategies from Eat Well El Paso! (EWEP), a local restaurant initiative. DESIGN: Descriptive case study. SETTING: EWEP partnered with local restaurants from 2012-2017 in El Paso, Texas, along the US/Mexico border. SAMPLE: Our sampling frame included EWEP staff and managers/owners at participating restaurants, of which the majority participated (80% and 85%, respectively). INTERVENTION: EWEP was a local restaurant initiative led by the city public health department. EWEP contracted registered dietitians to assist locally-owned restaurants to increase availability of healthy menu options. MEASURES: Observation, key informant interviews, and document review assessed participation, barriers, and facilitators to restaurant participation and program sustainability. ANALYSIS: Thematic and descriptive analyses. RESULTS: 57% of restaurants completed the full on-boarding process, but long-term retention was low (24% of completers). Restaurant managers/owners perceived value in marketing, nutritional analysis, and menu design. Barriers included scheduling, complexity of restaurant culture, fear of food inspections, restaurant turnover, competing responsibilities, and lack of dedicated funding. CONCLUSION: Although local context and sample size may limit generalizability, lessons learned and recommended strategies are relevant and informative for communities working to increase restaurants' healthy menu options.

Culture and sexuality-related communication as sociocultural precursors of HPV vaccination among mother-daughter dyads of Mexican descent.

U.S. Latinas are the second most affected ethnic group by cervical cancer morbidity and mortality. Cervical cancer is caused by high risk Human Papillomavirus (HPV) strains and HPV vaccines are an effective form of primary prevention. Parents are the primary decision makers of vaccination uptake as vaccination is recommended for children between the ages of 11-12. The purpose of our study is to investigate the influence of sociocultural factors particularly salient to U.S. Latinos and their role in facilitating or hindering communication about sexuality and vaccination uptake. We conducted a mixed methods sequential study with Latina mother-daughter dyads of Mexican descent (50% who had vaccinated). Our study was informed by the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior. We assessed the influence of communication about sexuality on uptake and the influence of relationship factors such as familism, mother-daughter connectedness, and children's autonomy and cultural factors such as acculturation and ethnic identity on sexuality-related communication. Our results indicated that mothers who engaged in conversations about birth control methods with their daughters had 5.69 times the odds of having vaccinated their daughters. Our qualitative data indicated that mothers who had vaccinated communicated about sexuality emphasizing that sexuality is a normal part of life, perceived that their child is likely to be sexually active one day, and viewed themselves as a primary source of sexuality-related information compared to mothers who had not vaccinated. Findings highlighted potential sociocultural approaches to motivate open communication about sexuality and adoption of sexual health preventative measures for children.

Our Homes, Our Health: Strategies, Insight, and Resources to Support Smoke-Free Multiunit Housing.

Tobacco use remains the single most preventable cause of disease, disability, and death in the United States. Almost 500,000 people die every year in the United States because of tobacco use; approximately one in eight of those deaths are attributable to secondhand smoke exposure. Significant disparities exist in terms of which groups bear the greatest burden of tobacco-related illness and mortality. Reducing tobacco use and exposure in groups most affected and most at risk is a national public health priority. Tobacco control advocates can promote health equity by prioritizing policies that are likely to decrease tobacco use and secondhand smoke exposure and improve access to tobacco cessation resources among populations most at risk for tobacco-related disparities, including people who live in subsidized multiunit housing. In this article, we share the context, process, key milestones, and lessons learned as stakeholders in El Paso, Texas explored and implemented smoke-free policy in subsidized public housing. Partners including the local housing authority, a nonprofit health foundation, the local public health department, and a local university facilitated a thoughtful and community-engaged process that acknowledged the right of residents to breathe clean air in their own homes, potential challenges residents who choose to smoke may face in adapting to smoke-free policy, and the need for support for those who choose to quit. We conclude with five key lessons learned and share resources for other communities, health professionals, and coalitions advocating for and supporting smoke-free housing policy in their communities.

Depression, Self-Esteem, and Childhood Abuse Among Hispanic Men Residing in the U.S.-Mexico Border Region.

Hispanics experience health disparities in mental health and HIV infection when compared to non-Hispanic Whites, which may be related to childhood abuse. The purpose of our cross-sectional study was to examine the relationship between childhood abuse and depressive symptoms in a sample of Hispanic men (N = 103) living in a metropolitan U.S.-Mexico border area. Secondarily, we examined the role of self-esteem in mediating this relationship, and the moderating role of sexual orientation. Gay/bisexual men (n = 53) were more likely to report childhood abuse than heterosexual (n = 50) counterparts (47.2% vs. 32%). Self-esteem mediated the relationship between childhood abuse and depression for men who have sex with men, but not heterosexual men. Nurses should increase knowledge of mental health disparities that impact Hispanic men to ensure that appropriate treatment can be provided to reduce the risk of co-occurring health risks to these men, including risk for HIV infection.

Promoting Health Through Policy and Systems Change: Public Health Students and Mentors on the Value of Policy Advocacy Experience in Academic Internships.

Emerging professionals and new Certified Health Education Specialists often lack academic training in and actual experience in National Commission for Health Education Credentialing Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession. For undergraduate and graduate students who have an opportunity to complete an internship or practicum experience, gaining experience in Competencies 7.2: Engage in advocacy for health and health education/promotion and 7.3: Influence policy and/or systems change to promote health and health education can have a profound impact on their career development and their ability to advocate for policies that promote health and health equity. Compelling evidence suggests that interventions that address social determinants of health such as poverty and education and those that change the context through improved policy or healthier environments have the greatest impact on public health, making it vital for emerging public health professionals to gain experience in policy advocacy and systems change. In this commentary, students and faculty from two large universities in the U.S.-Mexico border region reflect on the value of policy advocacy in academic internship/fieldwork experiences. Based on their experiences, they highly recommend that students seek out internship opportunities where they can participate in policy advocacy, and they encourage university faculty and practicum preceptors to provide more opportunities for policy advocacy in both classroom and fieldwork settings.

A Comparison of Sexual Relationships among Hispanic men by Sexual Orientation: Implications for HIV/STI Prevention.

Background: Hispanic men experience high rates of HIV infection and other sexually transmitted infections (STIs) when compared to non-Hispanic whites. Many factors contribute to HIV/STI risk among Hispanic men. Some researchers have suggested that primary relationships may be a source of HIV/STIs because some men engage in sexual relationships outside of the primary relationship. However, little is known about this among Hispanic men, and less is known about how sexual relationships differ by sexual orientation. Purpose: The purpose of this study was two-fold: 1) to determine if Hispanic men engage in sexual relationships outside of primary relationships; and 2) to compare sex outside of primary relationships by sexual orientation. Methods: Data for this study were obtained from a larger study that investigated health risks of Hispanic men residing in the U.S.-Mexico border community. Participants were recruited from agencies that provided services to Hispanic men. Participants completed a structured interview that included questions about primary relationships and sex outside of primary relationships. The sample consisted of 103 Hispanic men (50 heterosexual, 43 gay, and 10 bisexual Hispanic men), but two participants refused to answer relationship questions, resulting in a sample of 101 Hispanic men. Results: About one-third of the participants (n =29) reported sex outside of the primary relationship, but no differences were found between the gay/bisexual and heterosexual men, X 2 (2, N = 101) = 9.91, p = .128. More gay/bisexual men reported sex with the primary partner and another person at the same time than heterosexual men, X 2 (2, N = 101) = 13.32, p = .010. More gay/bisexual men reported open relationships when compared to heterosexual men, X 2 (2, N = 101) = 17.23, p = .008, and more gay/bisexual men reported sex outside the primary relationship without the primary partner's knowledge, X 2 (2, N = 101) = 15.09. p = .020. However, more heterosexual men reported that condoms were not used for sex outside the primary relationship when compared to gay/bisexual men, X 2 (2, N = 101) = 14.01, p = .029. Implications for Practice: Sex outside of primary relationships presents some implications for HIV/STI prevention among Hispanic men. Because gay/bisexual men experience higher rates of HIV/STI, more attention needs to be focused on all forms of relationships to prevent acquisition of HIV/STIs. Among heterosexual Hispanic men more attention needs to be given to reinforcement of safer sex practices both outside the primary relationship, and within the primary relationship if high risk sex is occurring outside the primary relationship. More research is needed on the reasons for sex outside the primary relationship among Hispanic men, as well as research to promote safer sex practices when sex occurs outside of the primary relationship.

Increasing Our Advocacy Capacity Through HIV Community Mobilization: Perspectives From Emerging and Mid-Career Professionals.

In this commentary, six public health practitioners and researchers discuss how their participation in the El Paso HIV Community Mobilization effort has contributed to their professional development and increased their collective capacity to advocate for practice and policy improvements that contribute to health equity in general and within the context of HIV prevention. Like previous commentaries in this department that have highlighted the value of the Certified Health Education Specialist credential ( http://www.nchec.org/health-education-credentialing ) and the importance of gaining experience in policy advocacy, this article is relevant for public health professionals in diverse work settings. The authors hope that their experience will encourage others to participate in community mobilization efforts, and they welcome communication and collaboration with anyone interested in learning more about the HIV Community Mobilization efforts discussed in this commentary.

Depression and Co-Occurring Health Determinants of Hispanic Men with HIV Infection in the U.S.-Mexico Border Region: A Pilot Study.

HIV infection among Hispanic men is a public health concern. Certain factors have been identified that may contribute to the high rates of HIV infection among Hispanic men such as migration, acculturation, poverty, and depression. Hispanic men with HIV infection are at risk for additional co-occurring health issues. Given limited research few studies have focused specifically on Hispanic men with HIV infection residing in a U.S.-Mexico border community. This pilot study surveyed participants (n = 39), to better understand co-occurrence of health determinants, especially depression among Hispanic men with HIV infection. The study's findings indicate that clinicians need to be aware that factors may influence depression among people with Hispanic men with HIV infection. Clinicians also need awareness of the impact of depression on adherence to HIV care and treatment among Hispanic men with HIV infection. More research is needed to explore the relationship of HIV-related stigma, HIV disclosure, social support, and depression among Hispanic men with HIV infection.

Health Risk and Protective Factors Among Hispanic Women Living in the U.S.-Mexico Border Region.

As the Hispanic population continues to flourish in areas such the U.S.-Mexico border region, more attention needs to be focused on health factors among Hispanics. The purpose of this study was (1) to determine what specific health protective and health risk factors exist among Mexican/Mexican American women residing along the U.S.-Mexico border and (2) to determine the relationship between the protective and risk factors among these women. A sample of Mexican/Mexican American women (N = 98) participated in a structured interview that collected data on familism, Hispanic stress, depression, violence, and sexual risk and demographic variables. Religious factors had the largest influence on the health risk behaviors of alcohol intoxication and drug intoxication (p < .05), while familism influenced only condom use (p = .002) and a lifetime history of intimate partner violence (p = .039). Health care access also influenced the health risks of alcohol intoxication (p = .013), drug intoxication (p = .012), and condom use (p = .019). The study's results provide implications for clinical care and directions for future research.

Perspectives From the Field: Certified Health Education Specialists on the Value of Health Education Credentialing.

In this commentary, four Certified Health Education Specialists (CHESs) share their reasons for obtaining national certification as health education specialists, the value of national credentialing to their employers, and the career development benefits of National Commission for Health Education Credentialing certification. CHESs play a vital role in diverse research and practice settings and increasingly contribute to changes in practice and policy that promote health equity. National Commission for Health Education Credentialing certification enhances our individual capacity as public health educators and also enhances our profession through systematic verification of responsibilities, competencies, and subcompetencies. This commentary is particularly timely in light of the Health Education Specialist Practice Analysis 2015, which updated, refined, and validated the model of health education practice.

Professional development through policy advocacy: communicating and advocating for health and health equity.

Communicating and advocating for evidence-based public health policy is a key component of health promotion practice, but public health professionals often lack experience in policy advocacy. This article provides perspectives from public health professionals who participated in successful public health policy advocacy efforts in their community. Their experiences using evidence-based research to advocate for policies that promote health equity contributed significantly to their career development, and also contributed to community capacity to reduce tobacco-related disparities. This article builds on previous work emphasizing the value of career development opportunities that enhance and diversify the public health workforce, and provides practical tips and "lessons learned" that are relevant to a wide range of public health professionals.

Experience preferred: insights from our newest public health professionals on how internships/practicums promote career development.

Universities offering undergraduate degrees in health promotion or health education and/or graduate degrees in public health typically require an internship, practicum, or fieldwork experience. This type of mentored experience is an important aspect of career development for the next generation of public health professionals and benefits not only the students but also the profession and the communities in which they work. This article provides perspectives from four public health professionals who have recently graduated from designated minority-serving institutions and highlights the ways in which internship, practicum, or fieldwork experiences have contributed to their career development. From a career development perspective, internships provide unique opportunities to develop professional networks, practice competencies learned in the classroom, gain experience in different environments, and share lessons learned with others in our field. The diversification of the public health research and practice workforce is increasingly recognized as crucial in building health equity. Internship programs that focus specifically on the academic and professional development of students underrepresented in public health provide experiences that meet or supplement academic requirements, and provide students with real-world experience and an expanded network of mentors and role models.

Health, hope, and human development: building capacity in public housing communities on the U.S.-Mexico border.

In this paper we highlight results from our recent survey of public housing residents living in the U.S.-Mexico border region. Our data inform our interdisciplinary (public health, education, environmental engineering, sociology) efforts to improve health and educational equity in our community, and provide ripe opportunities for policy advocacy.

Career development through local chapter involvement: perspectives from chapter members.

The importance of career development in professional organizations has been noted in the literature. Personal and professional benefits of membership regardless of discipline can be found across the career spectrum from student to executive. The benefits of professional membership with respect to career development in local chapter organizations have seldom been studied. Local chapter participation may offer significant career development opportunities for the practitioner, faculty member, and student. The purpose of this study was to explore the importance of local chapter involvement to the career development of health education practitioners. An 18-item questionnaire was disseminated to the membership of three local SOPHE (Society for Public Health Education) chapters that explored the level of local chapter involvement and the impact of how specific professional development activities impacted career development. The results of the survey highlighted the importance of continuing education programs, networking, and leadership experience in developing one's career that are offered by local SOPHE chapter involvement. Making a positive impact in the community and earning the respect of one's peers were most often reported as indicators of career success. These factors can directly impact local chapter participation. Career development can certainly be enhanced by active participation in the local chapter of a professional association.

Professional development through planning for and/or participating in an accreditation/approval review.

The quality of delivery of health education services is connected to landmark events in the history of health education. Quality assurance is one type of professional development in which practicing health education specialists engage. This article presents the steps of an accreditation/approval process, brief overviews of the major accreditation/approval systems, and the opportunities within the accreditation/approval process for professional development.