Athena K. Ramos

Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study

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.

Perception of Job-Related Risk, Training, and Use of Personal Protective Equipment (PPE) among Latino Immigrant Hog CAFO Workers in Missouri: A Pilot Study

Hog production in the United States is a large industry that has seen dramatic changes over the last few decades. Concentrated animal feeding operations (CAFOs) are growing in number throughout the country. This pilot study explores the perception of risk, receipt of work-related training, provision and usage of personal protective equipment (PPE), and prevention preferences of Latino immigrant hog CAFO workers in Missouri. Forty workers (M age = 36.08 years, SD = 10.04; 92.5% male; 70.0% Mexican) were interviewed. Results indicate that most workers did not perceive their job as dangerous. Limited English proficient workers were significantly less likely to report receiving any work-related training. Although most workers had access to employer provided PPE, usage was inconsistent. As the demographic composition of the farmworker population in the Midwest becomes increasingly comprised of hired immigrant workers, it will be imperative to develop occupational safety and health educational and outreach efforts focused on the needs of these workers.

Partnering for Health with Nebraska's Latina Immigrant Community Using Design Thinking Process

Background: The Center for Reducing Health Disparities at the University of Nebraska Medical Center partnered with El Centro de Las Americas, a community-based organization, and various community members to develop a 1-day Spanish-language health conference entitled El Encuentro de La Mujer Sana (Healthy Woman Summit) for immigrant Latinas in Nebraska during May 2013 as part of National Women’s Health Week.Objective: Design thinking was used to create a meaningful learning experience specifically designed for monolingual Spanish-speaking immigrant Latinas in Nebraska and build a foundation for collaboration between an academic institution, community-based organizational partners, and community members.Methods: We used the design thinking methodology to generate ideas for topics and prototyped agendas with community stakeholders that would be relevant and provide culturally and linguistically appropriate health education.Conclusions: By developing community-based health education programs for Latinas with Latinas through a community-engaged co-creation process, organizations and communities build trust, enhance community capacity, and meet identified needs for education and service. Design thinking is a valuable tool that can be used to develop community health education initiatives and enhance civic participation. This method holds promise for health education and public health in becoming more relevant for traditionally marginalized or disenfranchised populations.

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health

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.

Stress, Depression, and Occupational Injury among Migrant Farmworkers in Nebraska

Agriculture is one of the most dangerous industries in the United States. Farmworkers, including migrant farmworkers, are at risk for work-related injuries. This study explores the association between stress, depression, and occupational injury among migrant farmworkers in Nebraska. Occupational injury was hypothesized to significantly increase the odds of farmworkers being stressed and depressed. Two hundred migrant farmworkers (mean age = 33.5 years, standard deviation (SD) = 12.53; 93.0% men, 92.9% of Mexican descent) were interviewed. In bivariate analyses, results indicated that stress and depression were positively associated with occupational injury. Two logistic regression models were developed. Occupational injury was a significant factor for depression, but not for stress. Participants who had been injured on the job were over seven times more likely to be depressed. These results highlight the interconnection between the work environment and mental health. More must be done to foster well-being in rural, agricultural communities. Improving occupational health and safety information and training, integrating behavioral health services into primary care settings, and strengthening the protections of the Migrant and Seasonal Agricultural Worker Protection Act may improve conditions for migrant farmworkers in the rural Midwest.

Partnering With American Indian Communities in Health Using Methods of Strategic Collaboration

Background: The Association for Prevention Teaching and Research (APTR) sponsored six regional workshops in 2010 on community engagement and community-engaged research. One of the six workshops was a collaborative effort between the Great Plains Tribal Chairman’s Health Board (GPTCHB)–Northern Plains Tribal Epidemiology Center and the College of Public Health at the University of Nebraska Medical Center (UNMC-COPH).Objectives: To create a meaningful and dynamic forum for the exchange of ideas and co-learning between researchers from urban, tribal and nontribal communities and to build the groundwork for development of sustainable partnerships between researchers and American Indian (AI) communities to eliminate health disparities.Methods: To enhance meaningful community engagement, we utilized Methods of Strategic Collaboration using the Appreciative Inquiry, 4D Change Process Model and designed several interactive group activities including Collaborative Learning and Understanding Exercises (CLUE) and the Research Café.Results: The key themes that emerged from the interactive sessions stressed the importance of building relationships and trust; mutual use and sharing of data; and acquiring knowledge, skills, and abilities to enable sustainable research partnerships with AI communitiesConclusions: Innovative, dynamic, and strategic collaborative methods of Appreciative Inquiry and the World Café can served to engage people in a constructive dialogue to create a shared vision and plan for more meaningful research partnerships based on principles of equity and social justice, essential for the elimination of health disparities. These collaborative methods can be replicated and adapted in diverse communities, locally, nationally, and globally.

Self-Reported Occupational Injuries and Perceived Occupational Health Problems among Latino Immigrant Swine Confinement Workers in Missouri

Swine production has changed dramatically, and in the United States production often takes place in concentrated animal feeding operations (CAFOs). Because of the size and density of these types of facilities, workers may be exposed to serious occupational health risks such as noxious gases, agricultural dusts, elevated noise levels, and zoonotic diseases. This descriptive study examines self-reported occupational injuries and perceived occupational health problems among a convenience sample of 40 Latino immigrant swine confinement workers (92.5% male; M age = 36.1 years; SD = 10.0) in Missouri. Results indicated that seventeen workers (42.5%) rated their health as fair or poor, thirteen (32.5%) had experienced an occupational injury, and eleven (28.2%) reported occupational health problems such as burning eyes, muscular pain, headaches, coughing, nausea, nasal congestion, and sneezing. The majority of workers did not perceive their job to be dangerous. Clearly, more must be done to protect workers, especially immigrant workers, who may not have the same access to information, training, or other protections. Health and safety should be a priority for both farmworkers and farm employers. Practical and policy-based implications and recommendations are discussed.

Point-of-Sale E-cigarette Advertising Among Tobacco Stores.

The marketing expenditure and sale of e-cigarettes increased sharply in the United States in recent years. However, little is known about neighborhood characteristics of point-of-sale (POS) e-cigarette advertising among tobacco stores. The purpose of this study was to examine socio-demographic characteristics of POS e-cigarette advertising among tobacco stores in the Omaha metropolitan area of Nebraska, USA. Between April and June 2014, trained fieldworkers completed marketing audits of all stores that sell tobacco (n = 463) in the Omaha metropolitan area and collected comprehensive e-cigarette advertising data of these stores. Based on the auditing information, we categorized tobacco stores based on e-cigarette advertising status. Logistic regression was used to examine the association between neighborhood socio-demographic factors and e-cigarette advertising among tobacco stores. 251 (54.2%) of the 463 tobacco stores had e-cigarette advertisements. We found that neighborhoods of stores with POS e-cigarette advertising had higher per capita income (p < 0.05), higher percentage of non-hispanic whites (p < 0.005), and higher percentage of individuals with high school education (p < 0.005) than neighborhoods of stores without POS e-cigarette advertising. There were negative associations between e-cigarette advertising and number of adolescents or number of middle/high school students. After adjusting for covariates, only percentage of non-Hispanic Whites remained a significant factor for e-cigarette advertising. POS e-cigarette advertising among tobacco stores is related with neighborhood socioeconomic and demographic characteristics. Future studies are needed to understand how these characteristics are related with e-cigarette purchasing and e-cigarette prevalence among social groups.

The Association of Point-of-Sale E-cigarette Advertising with Socio-Demographic Characteristics of Neighborhoods

Electronic cigarettes (e-cigarettes) marketing expenditure is skyrocketing in the United States. However, little is understood about the geographic and socio-demographic patterns of e-cigarette advertising. We examined the associations between point-of-sale (POS) e-cigarette advertising and neighborhood socio-demographic characteristics in the Omaha Metropolitan Area of Nebraska. In 2014, fieldworkers collected comprehensive POS e-cigarette advertising data from all stores that sell tobacco (n = 463) in the Omaha Metropolitan Area. We used Geographic Information Systems to map POS e-cigarette advertisement density for the entire study area. Linear regression was used to examine the association between socio-demographic factors and POS e-cigarette advertising density. E-cigarette advertising density exhibited an obviously uneven geographic pattern in Omaha. Higher level of POS e-cigarette advertising was significantly related to lower median household income, higher percentage of Hispanics, and higher percentage of young adults. However, after adjusting for covariates, only median household income remained significantly associated with POS e-cigarette advertising. We found geographic, socioeconomic, and racial and ethnic disparities in exposure to POS e-cigarette advertising in Omaha, Nebraska. Future studies are needed to understand how these disparities influence e-cigarette adoption by different social groups and how to use such information to inform e-cigarette prevention strategies.

Association between Social Capital and Self-Efficacy among Latinas in Nebraska

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.