Immigrant-focused Medical Legal Partnerships: A Practical Innovation to Improve Immigrant Health and Social Well-being.

THE PROBLEM: Immigration status is an important social determinant of health that can limit access to health care and related services. Few medical legal partnerships (MLPs) address immigration-related legal needs of patients. PURPOSE OF ARTICLE: An immigrant-focused MLP (IMLP) addresses immigration legal needs and provides advice to vulnerable patient-clients and their families regarding potential legal consequences of accessing health care and other public benefits. In this article, we outline the core elements of an IMLP and provide case examples from our ongoing IMLPs. KEY POINTS: Although many of the core elements of an IMLP are similar to those of an MLP, an IMLP focuses specifically on immigration-related legal needs of patient-clients. IMLPs can complement and extend MLP services by providing legal assistance to non-citizen immigrant individuals and mixed status families. CONCLUSIONS: IMLPs may improve immigrant patient-clients' health and social well-being and create eligibility for public benefits. An IMLP can be a scalable innovation to improve access to health and legal services. Challenges to institutionalizing an IMLP may include limited sustainable funding, few legal service providers with immigration expertise and capacity, patient-client identification, and the politicized nature of immigration.

Effectiveness of a community-driven, asthma intervention: project asthma in-home response.

Objectives: Project Asthma In-home Response (AIR) is a multilevel, home-based intervention to address childhood asthma. This study aims to assess the effectiveness of the community-driven, multilevel Project AIR intervention. We hypothesize that children participating in the Project AIR intervention will have reduced asthma-related emergency room visits, hospitalizations, and asthma exacerbations. Methods: Seventy-Five participants of an in-home asthma intervention were surveyed at the onset of intervention and six months after the intervention. Results: The mean age of clients in the sample population was ten years. Most clients in the sample population were 11-15 years old (34.7%), followed by 6-10 years old (29.3%) and 3-5 years (26.0%). Participation in the Project AIR intervention resulted in significant reductions in asthma attacks (p-value 0.0003), asthma-related emergency room visits (p-value > 0.0001), and asthma-related hospitalizations (p-value 0.008).Conclusion: The results of this study support that in-home environmental asthma programs are an efficient method of treating asthma in a smaller metro area. Our findings reinforce prior studies in larger metropolitan areas such as New York and Boston.

Feasibility, Usability and Acceptability of a mHealth Intervention to Reduce Cardiovascular Risk in Rural Hispanic Adults: Descriptive Study.

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.

Lead Toxicity and Environmental Health Justice Stories in Black and White Woodcut Portraits.

Background: Omaha, Nebraska, has a lead-contaminated superfund site and substandard housing that pose risks for childhood lead exposure. Healthy Housing Omaha (formerly, Omaha Healthy Kids Alliance), an environmental health nonprofit, partnered with the fourth author, an artist, and a newspaper to raise awareness about lead poisoning by publishing portraits and stories of affected community members. Methods: The authors analyzed an interview with the artist, photographs of portraits published in a local newspaper, and quotations from portrait sitters. Results: Shared stories of lead exposure and poisoning conveyed in the portraiture and printmaking processes revealed structural racism as an emergent theme. Conclusions: Arts-based research methods, such as portraiture, can be scaled and applied to support national and international community engagement efforts to advocate for environmental justice and public health.

mHealth Intervention to Improve Cardiometabolic Health in Rural Hispanic Adults: A Pilot Study.

BACKGROUND: Hispanic/Latino adults have high rates of hypertension, obesity, and type II diabetes. Mobile health technologies (mHealth) are effective in supporting self-management of lifestyle behaviors; however, the effectiveness in rural Hispanic/Latino adults is unclear. OBJECTIVE: A pilot 12-week self-management mHealth intervention in rural Hispanic/Latino adults with cardiometabolic risk was conducted. METHODS: A randomized, 2-group (intervention and enhanced usual care) design was used to test the use of the MyFitnessPal app, a smart scale, and text messages to support daily self-monitoring of weight, food intake, and steps. RESULTS: Seventy participants enrolled. The intervention group had greater improvement in body mass index ( P = .052) and waist circumference ( P = .043) at 12 weeks and a trend toward greater fitness at 12 and 24 weeks. Both groups improved hemoglobin A 1c level at 12 and 24 weeks. CONCLUSIONS: mHealth using MyFitnessPal, smart scale, and text messages may be effective for improving aspects of cardiometabolic health in rural Hispanic/Latino adults.

Musculoskeletal Pain and Cardiovascular Risk in Hispanic/Latino Meatpacking Workers.

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.

Health and Well-Being of Hispanic/Latino Meatpacking Workers in Nebraska: An Application of the Health Belief Model.

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.

"No somos máquinas" (We are not machines): Worker perspectives of safety culture in meatpacking plants in the Midwest.

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.