Suchergebnisse

Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health.

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.

BACKGROUND: Community health workers (CHWs) are widely recognized as essential to addressing disparities in health care delivery and outcomes in US vulnerable populations. In the state of Arizona, the sustainability of the workforce is threatened by low wages, poor job security, and limited opportunities for training and advancement within the profession. CHW voluntary certification offers an avenue to increase the recognition, compensation, training, and standardization of the workforce. However, passing voluntary certification legislation in an anti-regulatory state such as Arizona posed a major challenge that required a robust advocacy effort. CASE PRESENTATION: In this article, we describe the process of unifying the two major CHW workforces in Arizona, promotoras de salud in US-Mexico border communities and community health representatives (CHRs) serving American Indian communities. Differences in the origins, financing, and even language of the population-served contributed to historically divergent interests between CHRs and promotoras. In order to move forward as a collective workforce, it was imperative to integrate the perspectives of CHRs, who have a regular funding stream and work closely through the Indian Health Services, with those of promotoras, who are more likely to be grant-funded in community-based efforts. As a unified workforce, CHWs were better positioned to gain advocacy support from key health care providers and health insurance companies with policy influence. We seek to elucidate the lessons learned in our process that may be relevant to CHWs representing diverse communities across the US and internationally. CONCLUSIONS: Legislated voluntary certification provides a pathway for further professionalization of the CHW workforce by establishing a standard definition and set of core competencies. Voluntary certification also provides guidance to organizations in developing appropriate training and job activities, as well as ongoing professional development opportunities. In developing ...

Executive Summary The routine human rights abuses and due process violations of unaccompanied alien children (UAC) by US Customs and Border Protection (CBP) have contributed to a mounting humanitarian and legal crisis along the US–Mexico border. In the United States, the treatment of UAC is governed by laws, policies, and standards drawn from the Flores Settlement, the Trafficking Victims Protection Reauthorization Act (TVPRA), and CBP procedures and directives, which are intended to ensure UAC's protection, well-being, and ability to pursue relief from removal, such as asylum. As nongovernmental organizations and human rights groups have documented, however, CBP has repeatedly violated these legal standards and policies, and subjected UAC to abuses and rights violations. This article draws from surveys of 97 recently deported Mexican UAC, which examine their experiences with US immigration authorities. The study finds that Mexican UAC are detained in subpar conditions, are routinely not screened for fear of return to their home countries or for human trafficking, and are not sufficiently informed about the deportation process. The article recommends that CBP should take immediate steps to improve the treatment of UAC, that CBP and other entities responsible for the care of UAC be monitored to ensure their compliance with US law and policy, and that Mexican UAC be afforded the same procedures and protection under the TVPRA as UAC from noncontiguous states.

BACKGROUND: Public health advocacy is by necessity responsive to shifting socio-political climates, and thus a challenge of advocacy research is that the intervention must by definition be adaptive. Moving beyond the classification of advocacy efforts to measurable indicators and outcomes of policy therefore requires a dynamic research approach. OBJECTIVES: The purpose of this article is to: 1) Describe use of the CBPR approach in the development and measurement of a community health worker intervention designed to engage community members in public health advocacy; and 2) Provide a model for application of this approach in advocacy interventions addressing community-level systems and environmental change. METHODS: The Kingdon three-streams model of policy change provided a theoretical framework for the intervention. Research and community partners collaboratively identified and documented intervention data. We describe five research methods used to monitor and measure CHW advocacy activities that both emerged from and influenced intervention activities. DISCUSSION: Encounter forms provided a longitudinal perspective of how CHWs engaged in advocacy activities in the three streams. Strategy maps defined desired advocacy outcomes and health benefits. Technical assistance notes identified and documented intermediate outcomes. Focus group and interview data reflected CHW efforts engage community members in advocacy and the development of community leaders. APPLICATION OF LESSONS LEARNED: We provide a model for application of key principles of CPBR that are vital to effectively capturing the overarching and nuanced aspects of public health advocacy work in dynamic political and organizational environments.