Stacked Up Against Us: Using Photovoice and Participatory Methods to Explore Structural Racism's Impact on Adolescent Sexual and Reproductive Health Inequities.

While structural racism has profound impacts on adolescent health, little is known about how youth synthesize racialized experiences and work to dismantle systems of oppression. This article provides an overview of a Youth Participatory Action Research study that used Photovoice and community mapping to explore how structural violence, like racism, impacts the sexual and reproductive health of historically excluded youth as they navigate unjust socio-political landscapes. Youth participants used photography and community maps to identify how the experience of bias, profiling, and tokenism impacted their ability to navigate complex social systems. With youth voices prioritized, participants explored ways to address structural racism in their lives. The importance of co-creating opportunities with and for youth in critical reflection of their lived experience is emphasized. Through an Arts and Cultural in Public Health framework, we provide an analysis of the ways structural racism functions as a gendered racial project and fundamental cause of adolescent sexual and reproductive health inequities, while identifying pathways toward liberation in pursuit of health and well-being.

Comparative Effects of Randomized Second-line Therapy for Type 2 Diabetes on a Composite Outcome Incorporating Glycemic Control, Body Weight, and Hypoglycemia: An Analysis of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE).

OBJECTIVE: In Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE) (5,047 participants, mean follow-up 5.0 years), differences in glycemic control were demonstrated over time among four randomized therapies added to metformin. Weight gain and hypoglycemia are also important outcomes for people with type 2 diabetes. We compared the effects of the four randomized GRADE medications on a composite outcome incorporating glycemic deterioration, weight gain, and hypoglycemia. RESEARCH DESIGN AND METHODS: The composite outcome was time to first occurrence of any of the following: HbA1c >7.5%, confirmed; ≥5% weight gain; or severe or recurrent nonsevere hypoglycemia. Secondary analyses included examination of individual components of the composite outcome, subgroup effects and potential mediators, and treatment satisfaction. Cumulative incidence was estimated with the Kaplan-Meier estimator. Cox proportional hazards models were used to assess pairwise group differences in risk of an outcome. RESULTS: Risk of reaching the composite outcome (events per 100 participants per treatment year [PTYs]) was lowest with liraglutide (19 per 100 PTYs) followed by sitagliptin (26 per 100 PTYs), glargine (29 per 100 PTYs), and glimepiride (40 per 100 PTYs); all pairwise comparisons were statistically significant. The order was the same for risk of weight gain and hypoglycemia, but risk of glycemic deterioration was lowest with glargine, followed by liraglutide, glimepiride, and sitagliptin. No significant heterogeneity in risk of composite outcome was detected across prespecified covariates. Participants who reached the composite outcome had modestly but significantly lower treatment satisfaction. CONCLUSIONS: Among participants treated with common second-line drug classes for type 2 diabetes, the liraglutide group had the lowest and glimepiride the highest risk of reaching a composite outcome encompassing glycemic deterioration, weight gain, and hypoglycemia. These findings may inform decision-making regarding type 2 diabetes therapy.

Participatory Action Research to Explore the Role of Structural Violence on Marginalized and Racialized Young Parents.

Structural inequities influence young parents' access to health care, housing, transportation, social support, education, and income. The current study adds to the extant literature by providing data directly obtained in collaboration with young parents to understand how structural violence affects the health and well-being of their families, ultimately resulting in community-driven policy recommendations developed in collaboration with the state health department. We engaged a diverse sample of young people-considered as community researchers in the project-including Black, Latinx, and/or LGBTQ+ pregnant and parenting young parents in a participatory action research (PAR) project in the spring of 2022 to explore their health and material needs while living in Springfield, Massachusetts. Together with young parents, we used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection (photos), engage in group thematic analysis, and take action at the state policy level. We also conducted individual semi-structured life-history interviews with the young parents. Participatory community-led findings indicate an urgent need for systemic change to increase access to safe and affordable housing; living-wage jobs; safe, high-quality, and affordable child care; and to bolster social support and disabilities services for young parents and their families. This participatory study funded by a state health department demonstrates that participatory community-driven data can have the power to mobilize community members and policy makers for social change if prioritized at the state and local levels. Additional practice-based implications include prioritizing participatory mentorship programs intended to aid young parents in navigating the complex systems that are vital to their survival.

US-Mexico Border Stress and Daily Substance Use among Latino Youth: a Cross-Sectional Study.

Background: Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors. Methods: In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support. Results: Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use. Discussion: Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

Does high family support protect against substance use in adolescents who perceive high disordered neighborhood stress, border community and immigration stress or normalization of drug trafficking at the US-Mexico border? Analysis of the BASUS survey.

Background: Adolescent substance use is a significant issue which occurs during a critical period of life of youth. Perceived stress is a risk factor for adolescent substance use, and life events such as low family support, and community and familial turmoil often lead to ongoing feelings of stress and uncertainty. Similarly, structural factors such as poverty, local neighborhood disinvestment and disrepair, and exposure to racism and discrimination are linked to feelings of stress. The US-Mexico border region is favorable for drug smuggling. Such a context exacerbates stressful life events during adolescence and increases the risk of adolescent substance use. This study aims to investigate the impact family support has on substance use in adolescents living on either side of the U.S./Mexico border who self-reported high perceptions of disordered neighborhood stress, border community and immigration stress, or normalization of drug trafficking. Methods: This study used data from the cross-sectional BASUS survey. Logistic regression was used to study the association between family support and past 30-day use of alcohol, tobacco, marijuana, and any substance in a sample restricted to students who self-reported high perceptions of disordered neighborhood stress, border community and immigration stress, or normalization of drug trafficking. Results: Participants with low family support were at higher risk of using any substance compared to participants with high family support (aOR= 1.58, 95% CI: 1.02; 2.45). Similar results were found for alcohol (aOR= 1.79, 95% CI: 1.13, 2.83). While the odds of using tobacco were higher for those with low social support as compared to participants with higher social support, this association was not statistically significant (aOR = 1.74, 95% CI: 0.93, 3.27). Conclusion: Prevention programs tailored to the U.S.-Mexico border region should emphasize strengthening family support as a preventive factor against adolescent substance use. Family support should be considered in school counseling assessments, healthcare screenings and other social services.

Mind the Gaps: The Need for Inclusion of Male-Identified Voices in Adolescent Sexual and Reproductive Health.

Adolescent sexual and reproductive health (ASRH) inequities are well documented for historically excluded youth (i.e., youth of color, LGBTQIA+ youth, youth with disabilities, recently im/migrated youth) living in the U.S. Northeast. However, the lived experience of male-identifying young people from historically excluded backgrounds in ASRH remains largely unexamined. The purpose of this paper is to present findings related to male-identified perspectives on social constructions of sexuality, sexual and reproductive health, and sexuality education. A research team composed of two local youth-serving organizations, eight youth researchers, and university researchers, used Youth Participatory Action Research (YPAR) methods to examine how structural violence contributes to inequitable ASRH outcomes for historically excluded youth. Photovoice and community mapping were used as YPAR methods. We also completed individual interviews on the same topic with the youth and with 17 key stakeholders that either provide services to youth or are emerging adult service recipients. Community-driven data reveal two major themes around the silencing of male-identified voices in ASRH: lack of culture-centered and gender-expansive approaches for ASRH, and the subsequent toll of sexism and (cis)gendered social and educational norms on young people. Our findings highlight that sexuality education, cisgender hetero culture, and social norms have put the onus of responsibility on people identifying as women for sexual and reproductive health. An unintended consequence of that is that young people identifying as men may feel powerless and uninformed around their own SRH. Our findings illustrate the importance of using culture-centered and gender-transformative approaches to ASRH to address inequity.

The Need for Community-Responsive and Flexible Sex Ed for Historically Marginalized Youth.

Introduction: When it is offered, sexuality education in the USA is far from standardized. While studies have explored differences in delivery and type of sexuality education across the USA, sexual and reproductive health inequities persist among historically marginalized groups (Latino/a/x, Black, African American, LGBTQ +). There is a critical need to better understand the systemic barriers to receiving effective sexuality education in these communities. Methods: Participatory research methods were used in working with a community advisory board (CAB)-consisting of emerging adults and service providers from community-based organizations (CBOs) serving youth-to examine how structural barriers contribute to adolescent sexual and reproductive health (ASRH) inequities in Massachusetts. CAB meetings and semi-structured interviews were conducted in the cities of Springfield (n = 14) and Lynn (n = 9) between December 2020 and May 2021. Results: Inflexible funding guidelines, a related evidence-based curricular mandate, and a lack of community-responsive sexuality education fail to meet the sexual and reproductive health (SRH) needs of these youth. Conclusions: Current evidence-based mandates must be revisited to improve young people's access to quality sexuality information in public schools. To guarantee sexuality education curricula is centered in the context of the community and population in which it is implemented, collaboration between youth-serving CBOs and school districts could improve students' overall experience and social-emotional growth by providing comprehensive, positive, and community-responsive curricula. Policy Implications: Funders and programming should prioritize community responsiveness by financially supporting and developing and/or adapting evidence-based curricula to better match the community's needs, which can be completed through culture-centered training and community-based partnership.

Structural Racism and Its Influence On Sexual and Reproductive Health Inequities Among Immigrant Youth.

This community-based participatory research study explores the influence of structural racism on sexual and reproductive health (SRH) inequities among immigrant, including refugee, youth. We conducted interviews with emerging youth and youth service providers living in two communities in Massachusetts. Our results detail three major themes illustrating how structural racism influences SRH inequities among immigrant youth: (1) lack of culture-centered SRH supports for recently immigrated youth; (2) immigration enforcement and fear impacting access to adolescent SRH (ASRH) education and services; and (3) perceived ineligibility related to tenuous legal status as a barrier to accessing ASRH services. Conclusions: Findings illustrate the importance of rooting sexuality education curricula in a culture centered framework that recognizes local cultural understandings, acknowledges structural constraints faced by young people, and prioritizes youth agency and voice when engaging in this work. Raising awareness of SRH resources available to immigrant youth may expand access for this underserved population.

Perceived Normalization of Drug Trafficking and Adolescent Substance Use on the US-Mexico Border.

Background: Historically marginalized youth are at risk for daily substance use. Daily use may be associated with social and environmental factors. Methods: In March 2018, we surveyed primarily Latino adolescents ages 14-18 who lived on the US-Mexico border and assessed associations between daily substance use, neighborhood stress, border community and immigration stress, and family support. Results: Of 443 surveyed adolescents, 41 (9%) reported daily use. Those who used daily were more likely to be older, identify as male, and reported lower social support and higher neighborhood and border community stress compared to those who did not use daily. Perceived neighborhood stress (OR = 1.95, 95% CI 1.37-2.80) and border community and immigration stress (OR = 1.55, 95% CI 1.12-2.02) were associated with increased odds of daily substance use. Discussion: Latino adolescents who live near the US-Mexico border experience unique socioenvironmental stress which is associated with daily substance use.

The use of digital stories as a health promotion intervention: a scoping review.

BACKGROUND: It is challenging to develop health promotion interventions created in collaboration with communities affected by inequities that focus beyond individual behavior change. One potential solution is interventions that use digital stories (DS). Digital storytelling (DST) is an opportunity for reflection, connection with others, and the elevation of voices often absent from daily discourse. Consequently, public health researchers and practitioners frequently employ the DST workshop process to develop messaging that promotes health and highlights concerns in partnership with historically marginalized communities. With participants' permission, DS can reach beyond the storytellers through behavior or attitude change interventions for health promotion among communities who share the targeted health concern. Our goal was to synthesize the literature describing interventions that use DS for health promotion to identify gaps. METHODS: We conducted a scoping review. Our inclusion criteria were articles that: 1) described empirical research; 2) used DS that were developed using the StoryCenter DST method; 3) assessed an intervention that used DS to address the health promotion of viewers (individuals, families, community, and/or society) impacted by the targeted health issue 4) were written in English or Spanish. To synthesize the results of the included studies, we mapped them to the health determinants in the National Institute of Minority Health and Health Disparities (NIMHD) research framework. We assessed the number of occurrences of each determinant described in the results of each article. RESULTS: Ten articles met the eligibility criteria. All the included articles highlighted health equity issues. Our mapping of the articles with definitive results to the NIMHD research framework indicates that interventions that use DS addressed 17 out of 20 health determinants. All mapped interventions influenced intentions to change health behaviors (NIMHD level/domain: Individual/Behavioral), increased health literacy (Individual/Health Care System), and/or stimulated conversations that addressed community norms (Community/Sociocultural Environment). CONCLUSIONS: Interventions that use DS appear to positively affect the health promotion of participants across a range of health issues and determinants. Future research is needed in the Interpersonal, Community, and Societal levels and within the Biological, Physical/Built Environment, and Sociocultural Environment domains.

Using Participatory Methods to Enhance Youth Engagement in Substance Use Research.

Youth engagement in substance use research is critical to the understanding of correlates that lead to detrimental health and social outcomes for adolescents. In addition to the documented challenges related to youth recruitment for substance use research, Latinx youth living on the U.S.-Mexico border may be difficult for researchers to engage in substance use research because they could face retributory harm if they identify their experiences to any entity perceived as an authority (e.g., researchers). Empirical findings that posit viable strategies to engage marginalized youth in substance use research are lacking. Participatory approaches show promise in increasing participation of historically underrepresented youth in research. Building on previously published work on our youth participatory action research mixed-methods study, this article discusses the youth-led participatory approach used to (1) develop and pilot test a culturally, regionally, and linguistically tailored substance use instrument and (2) engage 445 Latinx youth to participate in a cross-sectional study to assess epidemiological patterns of youth substance use on the U.S.-Mexico border. We share lessons learned related to the youth-led instrument design, youth-led recruitment strategy, and assuring participant confidentiality.

The Gendered Effects of Local Immigration Enforcement: Latinas' Social Isolation in Chicago, Houston, Los Angeles, and Phoenix.

The 2017 revitalization of the controversial Security Communities program, which requires local law enforcement to cooperate with federal immigration officials in the United States, has made it urgent to better understand such enforcement programs' effects on the well-being of Latinas/os, especially the foreign-born. Social isolation from increased immigration enforcement can have significant impacts on economic, social, and health outcomes among Latina/o immigrants and non-immigrants. This article analyzes the gendered impacts of different levels of increased local involvement in immigration enforcement on social isolation, using a survey of over 2000 Latinas/os in four large US cities, all considered to be traditional destinations. Unsurprisingly, respondents reported increased social isolation resulting from local law enforcement's involvement in immigration enforcement. In contrast to results from previous research, our analysis found that women and men were equally likely to feel socially isolated and that having children led to more social isolation for both women and men. Personal and vicarious experiences with immigration enforcement, as well as living in Phoenix and Houston - two urban areas with the strictest enforcement regimes - were strongly related to social isolation. Our results indicate that local authorities' increased involvement in immigration enforcement can lead to more social isolation for Latina immigrants, particularly those who have children, aligning their experiences with men's and, thus, undermining Latinas' previously recognized role as bridges between their families and social institutions and as community builders.

Socioenvironmental Risk Factors for Adolescent Marijuana Use in a United States-Mexico Border Community.

PURPOSE: We examined how socioenvironmental risk factors unique to the United States-Mexico border, defined as border community and immigration stress, normalization of drug trafficking, and perceived disordered neighborhood stress, contribute to tobacco, alcohol, and marijuana use among adolescents residing there. DESIGN: Cross-sectional design. SETTING: The study was conducted at a high school on the United States-Mexico border. SUBJECTS: A sample of 445 primarily Hispanic students (ages 14-18). MEASURE: Perceived Disordered Neighborhood Stress Scale, Border Community and Immigration Stress Scale, and Normalization of Drug Trafficking Scale. ANALYSIS: Logistic regression assessed the association between the socioenvironmental risk factors and past 30-day tobacco, alcohol, and marijuana use. RESULTS: Participants with higher border community and immigration stress scores were significantly more likely to have used tobacco (adjusted odds ratio [aOR] = 1.41, P < .01) and alcohol (aOR = 1.31, P < .01) in the past 30 days. Perceived disordered neighborhood stress also was associated with past 30-day alcohol use (aOR = 1.46, P < .00). The normalization of drug trafficking was associated with past 30-day marijuana use (aOR = 1.45, P < .05). CONCLUSIONS: Public health practitioners, educational institutions, and policy makers should consider the economic and normative environment of the United States-Mexico border for future substance use prevention and risk reduction efforts targeting border adolescents.

Roles of the cholinergic system and vagal innervation in the regulation of GnRH secretion and ovulation: Experimental evidence.

Reproduction is the biological process that sustains life. It is regulated by a neuro-hormonal mechanism that is synchronized by the interaction among the hypothalamus, hypophysis, and ovaries. Ovulation is regulated by the secretion of the gonadotropin-releasing hormone (GnRH), which stimulates the release of the luteinizing hormone (LH) and follicle-stimulating hormone (FSH). In addition to these neuroendocrine signals, other signals originating from the central nervous system, hypophysis, thyroid, adrenal glands, and the ovary itself are also involved. One of the neurotransmission systems involved in the regulation of ovulation is the cholinergic system, which not only participates in the regulation of reproductive functions but also modulates motor coordination, thermoregulation, and cognitive function. In mammals, the vagus nerve is one of the pathways through which acetylcholine reaches the ovary, and this pathway also participates in the regulation of ovulation. However, this regulation depends on the age of the animal (prepubertal or adult) and its endocrine status. The present review analyzes evidence of the roles of the central and peripheral cholinergic system and vagal innervation in the regulation of GnRH secretion and ovulation as well as their roles in the development and persistence of polycystic ovary syndrome (PCOS).

Role of the superior ovarian nerve in the regulation of follicular development and steroidogenesis in the morning of diestrus 1.

PURPOSE: Little is known about the role of the superior ovarian nerve (SON) in follicular development during the estrus cycle. The aim of the present study was to analyze the role of neural signals arriving through the SON at the ovaries in the regulation of follicular development and ovarian steroid secretion in diestrus 1 of cyclic rats. METHODS: Cyclic rats were subjected to left, right, or bilateral SON sectioning or to unilateral or bilateral laparotomy at diestrus 1 at 11:00 h. Animals were sacrificed 24 h after surgery. RESULTS: Compared to laparotomized animals, unilateral SON sectioning decreased the number of preovulatory follicles, while bilateral SON sectioning resulted in a decreased number of atretic preantral follicles. An important observation was the presence of invaginations in the follicular wall of large antral and preovulatory follicles in animals with denervation. Furthermore, left SON sectioning increased progesterone levels but decreased testosterone levels, which are effects that were not observed in animals that were subjected to right denervation. CONCLUSIONS: At 11:00 h of diestrus 1, the SON was found to stimulate follicle development, possibly via neural signals, such as noradrenaline and/or vasoactive intestinal peptide, and this stimulation induced the formation of follicle-stimulating hormone receptors. The role of the SON in the regulation of ovarian steroid secretion is asymmetric: the left SON inhibits the regulation of progesterone and stimulates testosterone secretion, and the right nerve does not participate in these processes.

Youth Participatory Action Research for Youth Substance Use Prevention: A Systematic Review.

Background: A growing body of research points to the efficacy of participatory methods in decreasing rates of alcohol, tobacco, and other drug use and other risky behaviors among youth. However, to date, no systematic review of the literature has been conducted on Youth Participatory Action Research (YPAR) for youth substance use prevention. This review draws on the peer-reviewed literature on YPAR in the context of youth substance use prevention published from January 1, 1998 through April 30, 2018. Methods: We summarize (1) the published evidence regarding YPAR for youth substance use prevention; (2) the level of youth engagement in the research process; (3) the methodologies used in YPAR studies for youth substance use prevention; and (4) where more research is needed. We used Reliability-Tested Guidelines for Assessing Participatory Research Projects to assess the level of youth engagement in the research process. Results: In all, we identified 15 unduplicated peer-reviewed, English-language articles that referenced YPAR, Community Based Participatory Research, youth, and substance use prevention. Conclusions: Our findings indicated that youth participation in research and social action resulted in increased community awareness of substance use and related solutions. This supports the premise of youth participation as an agent of community change by producing community-specific substance use data and prevention materials. Identified weaknesses include inconsistent levels of youth engagement throughout the research process, a lack of formalized agreements between youth and researchers with regard to project and data management, and a lack of outcome evaluation measures for assessing YPAR for youth substance use prevention.

Developing a Binational Community-Based Participatory Research Partnership to Address Reproductive Health on the U.S.-Mexico Border.

BACKGROUND: U.S.-Mexico border communities bear a disproportionate burden of adolescent pregnancy. Binational community-based participatory research (CBPR) partnerships can help to remediate identified health disparities. OBJECTIVES: The purpose of this article is to share the experiences and lessons learned from the development of a binational CBPR partnership. METHODS: Mexican and U.S. academics, community members, and promotoras used the Community Community-Campus Partnerships for Health (CCPH) Guiding Principles of Partnership to form a binational CBPR partnership to remediate adolescent pregnancy on the U.S.-Mexico border. LESSONS LEARNED: We learned how to use existing networks to form the partnership and leverage resources to address an existing health disparity. We learned the importance of engaging in effective communication with partners and the necessity of flexibility when working within a different governmental culture. We learned how to leverage critical partnerships to bridge national, cultural, and linguistic differences to conduct binational partnership research, and to be responsive to unforeseen situations when working in low-resource communities.

How the U.S.-Mexico border influences adolescent substance use: Youth participatory action research using photovoice.

INTRODUCTION: The purpose of this study is to use Youth Participatory Action Research (YPAR) methods and Photovoice to identify the perceived environmental factors that influence substance use among adolescents living at the U.S.-Mexico border. METHODS: One academic and a local youth health coalition engaged in Youth Participatory Action Research (YPAR) using Photovoice and qualitative methods to examine the perceived factors influencing adolescent substance use in their border community. RESULTS: Identified novel risk factors for adolescent substance use on the border included the normalization of drug trafficking, normalization of substance use, and cross-border access to substances. Novel protective factors included living in a close-knit binational community and having strong binational family and social support systems. The findings also illustrate a nexus of 'factors' wherein risk and protective elements overlap. CONCLUSION: This study contributes to the broader literature on international border health and how living in a border space influences adolescent substance use. The examination of influential border-bound factors provides a more complete understanding of the experiences of youth living on the U.S.-Mexico border, and informs the field of the importance of considering the border experience for future prevention and risk reduction efforts with border adolescents.

INSULIN TIMING: A PATIENT-CENTERED APPROACH TO IMPROVE CONTROL IN TYPE 1 DIABETES.

OBJECTIVE: The goal of insulin therapy in type 1 diabetes (T1D) is to reduce hemoglobin A1C (A1C) to ≤7.0% (53 mmol/mol) with minimal hypoglycemia. We investigated the possibility that "insulin timing" would improve A1C without incurring severe hypoglycemia in volunteers with T1D over a 6-month observation period. METHODS: Forty healthy adult volunteers with T1D were randomly assigned for 6 months to either a control group or an insulin timing group. The primary endpoint was the difference in A1C between the two groups. As a secondary endpoint, both groups were further divided to assess the importance of the baseline A1C in determining the response to timing. The insulin timing algorithm altered the time when the meal dose of insulin was injected or infused from 30 minutes before the meal to 15 minutes after the meal, depending upon the premeal blood glucose concentration. RESULTS: An improvement in mean A1C was observed in the timing group compared with no change in the control group, but this improvement did not reach statistical significance (P>.05). In contrast, when the two groups were analyzed according to baseline A1C, the timing volunteers with baseline A1C values in the upper half (separated by the A1C median of 7.45% [57.9 mmol/mol]) of the timing group had a more robust response to timing (decline in A1C) than the upper half of the control group (P<.05). CONCLUSION: Insulin timing is a patient-centered translational approach that is safe and effective in improving A1C in individuals with T1D with an elevated A1C. ABBREVIATIONS: A1C = hemoglobin A1C ANOVA = analysis of variance CGM = continuous glucose monitoring CSII = continuous subcutaneous insulin infusion MDI = multiple daily injection T1D = type 1 diabetes.

Structural Vulnerability Among Migrating Women and Children Fleeing Central America and Mexico: The Public Health Impact of "Humanitarian Parole".

Since October 2013, US Customs and Border Patrol has apprehended 15,979 families on the Southwest Border of the US. Daily, migrating women and children from Mexico and Central America that qualify for humanitarian parole are released from immigration detention to a humanitarian aid organization in Southern Arizona. After several days in detention facilities, these families arrive tired, hungry, dehydrated, and with minimal direction regarding their final destination, and adherence to the parameters of their parole. Project helping hands (PHHs) utilizes a network of volunteers to provide the women and children with food, water, clothing, hygiene products, hospitality, and legal orientation. The aim of this assessment was to document the experiences of families granted humanitarian parole through the lens of structural vulnerability. Here, we apply qualitative methods to elicit PHH lead volunteer perspectives regarding the migration experience of migrating families. Using inductive analysis, we found six major themes emerged from the qualitative data: reasons for leaving, experience on the journey, dehumanization in detention, family separation, vulnerability, and resiliency. These findings elucidate the different physical and psychological distresses that migrating families from Mexico and Central America experience before, during and after their arrival at the US-Mexico border. We posit that these distresses are a result of, or exacerbated by, structural vulnerability. Structural vulnerability has life-long health implications for a sub-population of young mothers and their children. The number of migrating families who have experienced traumatic events before and during their migration experience continues to expand and thus warrants consideration of mental health surveillance and intervention efforts for these families. More public health research is needed to better understand and combat the health challenges of this growing population.