A regional approach to health care reform: the Texas border.

The purpose of this article is to analyze health insurance disparities related to labor environment factors in the Texas-Mexico border region. A logistic regression model was performed using microdata from the 2010 American Community Survey to estimate the probability of having employer-based insurance, controlling labor environment factors such as hours worked, occupation industry, and the choice of private, nonprofit or public sector jobs. Industries primarily employing the Mexican American population are less likely to offer employer-based health insurance. These industries have the North American Industry Classification System (NAICS) code 770 construction, including cleaning, and NAICS code 8680, restaurants and other food services. Although it was found that working in public sector industries such as code 9470, administration of justice, public order, and safety, or NAICS code 7860, elementary and secondary schools, improved by 60% the probability of the Mexican American population having employer-based health insurance, these occupations ranked at the bottom of the main occupation list for Mexican Americans. These findings provide evidence that the labor environment plays an important role in understanding current health insurance access limitations within the Mexican American community under 2010 Patient Protection and Affordable Care Act provisions, which are directed to small business and lower-income individuals.

Does injury prevention education initiate household changes in a Spanish-speaking minority population?

Young children from low income families are among the most affected population of unintentional injury. This non-randomized longitudinal study examined knowledge for home and child safety with an injury prevention training offered to parents of children who reside in the Rio Grande Valley of Texas. Eighty eight parents received the training and pre-and post-test surveys were used to measure knowledge outcomes. A follow-up survey was conducted 2 months after the educational intervention to identify how many parents reported household and safety behavior changes as a result of the training. The most significant change in behavior, as it pertains to the household, was related to locking and storage of dangerous cleaning chemicals. Other significant changes in behavior were in areas that directly related to the child such as learning how to swim, use of sun block and fire safety in the home. This study suggests that tailored trainings can improve parent knowledge and change in behaviors for the promotion of safety activities to avoid risks for unintentional injuries. Further, the study identified certain at-risk areas that need to be addressed from an educational perspective. These areas include bicycle and water safety; specifically, the use of protective gear when bicycling; understanding and adhering to traffic rules when bicycling; and, the dangers of drowning in small quantities of water.

Progression in understanding and implementing the cultural and linguistic appropriate services standards: five-year follow-up at an academic center.

In 2001, 14 national standards on Culturally and Linguistically Appropriate Services (CLAS) in health care were issued by the US Department of Health and Human Services Office of Minority Health to guide outcomes specific to disparities affecting patients with limited English proficiency. Additionally, demographic changes are rapidly occurring throughout the United States leading to more culturally and racially diverse communities, which have increased language barriers in the health care environment. This nonrandomized, cross-sectional study assessed changes and attitudes and applications of CLAS in an academic health care setting over a 5-year period (2006 to 2011). Results indicated that, in 2006, 72.6% participants reported they were "not at all familiar with CLAS" in comparison with 28.8% in 2011. In 2006, 16.5% participants strongly agreed to the question, "I know how to work with medical interpreters" compared with 24.9% in 2011. The same trend is seen with the question, "I use medical interpreters when I have a Spanish-speaking patient," in 2006, 25.5% strongly agreed in comparison with 35.4% in 2011. This study suggests that significant improvements occurred in the use of medical interpreters and understanding of CLAS as a result of educational activities implemented from 2006 to 2011.

Incorporating what promotoras learn: becoming role models to effect positive change.

Promotoras (community health workers) play an important health promotion role and must be continuously trained, but little is known about how much of their learning they actually put into practice. This non-randomized, longitudinal study examined knowledge and home environmental outcomes of an asthma and healthy homes training offered to promotoras using a train-the-trainer model. Eighty-five promotoras received the training and pre- and post-test surveys were used to measure training outcomes. Results showed a statistically significant increase in asthma and healthy home-related knowledge (P < .001). At 12-months post-intervention, a majority of the promotoras (69%) reported they made household changes to improve their indoor environment as a result of the training. This study suggests that effective trainings can improve promotoras knowledge and behaviors for the promotion of healthy homes in the community. Further evaluation is needed to investigate whether these trainings allow promotoras to serve as role models within their communities "by educating through example" and thereby enhance their credibility as health educators.