Suchergebnisse

Farmworkers face significant disease burden. Meanwhile, farmworker healthcare utilization is low. This study examined individual, environmental, and policy level correlates of U.S. farmworker healthcare utilization, guided by the Behavioral Model for Vulnerable Populations and the Ecological Model. The 2006-2008 administrations of the National Agricultural Workers Survey (NAWS) (N=4,891) provided the primary data for this cross-sectional study. Geographic Information Systems, the 2005 and 2006 Uniform Data System, and rurality/border proximity indices provided environmental variables. To identify factors associated with healthcare use, logistic regression was performed using Hierarchical Linear Modeling. Probability weights were applied in descriptive, bivariate, and multivariate analyses. The alpha level was set at .05 for all analyses. The majority of farmworkers were Hispanic (80.0%) and male (78.4%), with an average age of 35.6 (SE=.3) years. Annual family income (M=22,668.0; SE=304.9) and educational attainment (M=7.7; SE=.1) were low. Just over half (57.3%) used formal U.S. healthcare in the previous two years. Multiple factors were independently associated with healthcare use in multilevel models (all in the expected direction), including, at the individual level: sex, immigration and migrant status, English proficiency, access to transportation, and need; at the environmental level: total FQHC full-time equivalent medical professionals/staff and U.S.-Mexico border proximity; and, at the policy level: insurance status and payment structure. Findings were consistent with those from previous studies of Hispanic populations, as well as the limited literature documenting healthcare use correlates for farmworkers. Numerous individual and policy level moderators of associations between environmental level variables and healthcare use were identified. Using Stata, rates of healthcare use among farmworkers were compared to those among U.S. and other subpopulations with similar sociodemographic characteristics (from the 2006 Medical Expenditure Panel Survey). Rates of use were significantly lower for farmworkers than for the U.S. and low-income populations. However, they were significantly higher than rates for U.S. Hispanics and a comparison group (i.e., Hispanic, low income, and no educational degree). The low rate of use is concerning due to farmworkers' disproportionate disease burden. Multilevel recommendations for change, emphasizing change to the FQHC system, are made so that healthcare access can be improved for this vulnerable population

The Correlates of Indoor Tanning in Youth (CITY100) project evaluated individual, built-environmental, and policy correlates of indoor tanning by adolescents in the 100 most populous US cities. After CITY100's completion, the research team obtained supplemental dissemination funding to strategically share data with stakeholders. The primary CITY100 dissemination message was to encourage state-level banning of indoor tanning among youth. We created a user-friendly website to broadly share the most relevant CITY100 data. Journalists were a primary target audience, as were health organizations that would be well positioned to advocate for legislative change. CITY100 data were used to pass the first US state law to ban indoor tanning among those under 18 (CA, USA), as well as in other legislative advocacy activities. This paper concludes with lessons learned from CITY100 dissemination activities that we hope will encourage more health researchers to proactively address policy implications of their data and to design relevant, effective dissemination strategies.

PURPOSE: Social support is an important correlate of health behaviors and outcomes. Studies suggest that veterans have lower social support than civilians, but interpretation is hindered by methodological limitations. Furthermore, little is known about how sex influences veteran–civilian differences. Therefore, we examined veteran–civilian differences in several dimensions of social support and whether differences varied by sex. METHODS: We performed a cross-sectional analysis of the 2012–2013 National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative sample of 34,331 respondents (male veterans = 2569; female veterans = 356). We examined veteran–civilian differences in functional and structural social support using linear regression and variation by sex with interactions. We adjusted for socio-demographics, childhood experiences, and physical and mental health. RESULTS: Compared to civilians, veterans had lower social network diversity scores (difference [diff] = −0.13, 95% confidence interval [CI] −0.23, −0.03). Among women but not men, veterans had smaller social network size (diff = −2.27, 95% CI −3.81, −0.73) than civilians, attributable to differences in religious groups, volunteers, and coworkers. Among men, veterans had lower social network diversity scores than civilians (diff = −0.13, 95% CI −0.23, −0.03); while among women, the difference was similar but did not reach statistical significance (diff = −0.13, 95% CI −0.23, 0.09). There was limited evidence of functional social support differences. CONCLUSION: After accounting for factors that influence military entry and social support, veterans reported significantly lower structural social support, which may be attributable to reintegration challenges and geographic mobility. Findings suggest that veterans could benefit from programs to enhance structural social support and improve health outcomes, with female veterans potentially in greatest need.

Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design: Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting: Veterans Affairs Medical Center. Participants: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). Intervention: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. Analysis: Baseline to 16-week paired t tests and template analysis. Results: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [ M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight ( M = −14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD ( M = −17.9 [SD = 12.2]) improvements, P < .05. Conclusions: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.

Military service assimilates individuals into a socially cohesive force to address dangerous and traumatic situations that have no counterpart in civilian life. Upon leaving active duty, many veterans experience a "reverse culture shock" when trying to reintegrate into civilian institutions and cultivate supportive social networks. Poor social reintegration is associated with greater morbidity and premature mortality in part due to adoption of risky health behaviors, social isolation, and inadequate engagement in health care services. Although institutions like the Veterans Health Administration (VA) do much to address the complex psychosocial and health care needs of veterans and their families with evidence-based care, only 61% of Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans are enrolled in VA care and there are numerous perceived barriers to care for enrollees. To address this gap, a community-based nonprofit organization, Team Red, White & Blue (RWB), was created to help veterans establish health-enriching social connections with communities through the consistent provision of inclusive and locally tailored physical, social, and service activities. This article provides an overview of the development and refinement of a theory-based framework for veteran health called the Enrichment Equation, comprised of three core constructs: health, people, and purpose. By operationalizing programming activities and roles, we describe how theoretical components were translated into a social networking implementation package that enabled rapid national spread of Team RWB. We conclude with future opportunities to partner with researchers and other organizations to understand program impact, and to identify effective intervention components that could be adapted for similar vulnerable groups.

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.