“When This Breaks Down,It’s Black Gold”: Race and Gender in Agricultural Health and Safety

ABSTRACT

Farmers are growing older, and fewer new agriculturists are rising to take their place. Concurrently, women and minorities are entering agriculture at an increasing rate. These rates are particularly curious viewed in light of the racialized and gendered nature of agriculture. Slavery and agriculture share strong historical roots, with many male slaves performing agricultural labor. So then, why would African American women choose to engage in agriculture in any form? Participant observation and in-depth interviews with a group of African American women urban farmers in the southeastern United States were asked this question. Interviews with seven such women revealed their perception of self-sustainable small-scale agriculture as a departure from, not return to, slavery. The women drew metaphors between the Earth and femininity, believing their work to be uniquely feminine. Production of food for consumption and trade provides a source for community and healthy food amid urban poverty and the plight of food deserts. These data encourage agricultural health and safety professionals and researchers to tackle the health-promoting nature of such work, with the entrée of anthropology and other social sciences into the field. In many ways, these women portrayed small-scale food cultivation as an important component of, rather than a threat to, health and safety. Indeed, they viewed such labor as wholly health promoting. Their strong social connections provide a potential means for community-led dissemination of any relevant health and safety information.     

Should We End Military Recruiting in High Schools as a Matter of Child Protection and Public Health?

Recruiters for the various US armed forces have free access to our nation's high schools, as mandated by the No Child Left Behind Act. Military recruiter behaviors are disturbingly similar to predatory grooming. Adults in the active military service are reported to experience increased mental health risks, including stress, substance abuse, and suicide, and the youngest soldiers consistently show the worst health effects, suggesting military service is associated with disproportionately poor health for this population. We describe the actions of a high school parent teacher student association in Seattle, Washington, which sought to limit the aggressive recruitment of children younger than 18 years into the military.     

Peter Bourne’s Drug Policy and the Perils of a Public Health Ethic, 1976–1978

As President Jimmy Carter’s advisor for health issues, Peter Bourne promoted a rational and comprehensive drug strategy that combined new supply-side efforts to prevent drug use with previously established demand-side addiction treatment programs. Using a public health ethic that allowed the impact of substances on overall population health to guide drug control, Bourne advocated for marijuana decriminalization as well as increased regulations for barbiturates. A hostile political climate, a series of rumors, and pressure from both drug legalizers and prohibitionists caused Bourne to resign in disgrace in 1978. We argue that Bourne’s critics used his own public health framework to challenge him, describe the health critiques that contributed to Bourne’s resignation, and present the story of his departure as a cautionary tale for today’s drug policy reformers.Peter Bourne, a British-born physician with a medical degree from Emory University, helped Governor Jimmy Carter establish Georgia’s first statewide drug treatment program. After later serving in President Richard Nixon’s Special Action Office for Drug Abuse Prevention (SAODAP), Bourne resigned to work on Carter’s presidential campaign and became his advisor for health issues following the 1976 election.1Bourne also served as Carter’s director of the new Office of Drug Abuse Policy (ODAP), supervising both supply-side substance control strategies and the demand-side programs established under the office’s precursor, SAODAP. In this capacity, Bourne advocated for three controversial initiatives: marijuana decriminalization, spraying drug fields in Mexico with herbicide, and increased regulations for barbiturates. Behind the scenes and on the national stage, Bourne offered a remarkably consistent defense of these policy recommendations. We show that Bourne’s seemingly contradictory set of policies aligned with a single, coherent, three-tiered public health framework guided by epidemiological reasoning.We also draw on fresh source material to show how Bourne’s diverse critics used his own public health framework against him. Prohibitionists formed a burgeoning “parent movement” that faulted Bourne for promoting marijuana decriminalization and failing to invest in youth-oriented prevention campaigns. Marijuana legalizers such as Keith Stroup of the National Organization for the Reform of Marijuana Laws (NORML) criticized Bourne for supporting a crop eradication program that posed risks to drug consumers. Finally, Carter’s political opponents capitalized on Bourne’s apparent hypocrisy after he was found prescribing the sedative methaqualone (brand name Quaalude [William H. Rorer, Inc, Fort Washington, PA]) to a White House staffer under a false name. On July 20, 1978, Bourne resigned in disgrace.In contrast to previous accounts, we argue that Bourne’s defeat was not initially prompted by punitive-minded antidrug crusaders, but by a variety of health advocates who shared Bourne’s ultimate goal of substance abuse prevention but disagreed with the strategies he employed to achieve it.2 For reformers who hope that advocating for a “public health” approach to drug control will depoliticize the issue, Bourne’s story is a cautionary tale: it shows that a wide spectrum of controversial strategies, from supply-side interdiction to full legalization, have historically been justified by references to the same public health paradigm.     

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives. We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.Methods. We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.Results. Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated.Conclusions. Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.The integration of primary care and public health is a key strategy, recommended nationally and internationally, for assisting underserved populations; it encourages community-focused initiatives and transdisciplinary approaches to practice. Integration allows health providers (e.g., physicians, nurses, health workers) to use individual- and community-level interventions to influence, respectively, individual behavior and community health.1–3 Brazil’s Sistema Único de Saúde (Unified Health System) was created as a result of Brazil’s 1988 federal constitution and the 1990 Lei Orgânica da Saúde (Organic Health Law). This law aimed to establish a large, decentralized health system offering free, universal care from medical consultations to organ transplants, health campaigns, and sanitation.4 This system struggles with access, quality, and service coordination (e.g., scheduling, monitoring) mainly because it is incorporated under a single legal structure that contradicts decentralization and affects the integration of services that different sectors of the Sistema Único de Saúde, such as hospitals, provide.5To integrate primary care and public health, the Sistema Único de Saúde employs the Estratégia Saúde da Família (ESF; Family Health Strategy), a transdisciplinary approach used by health providers. ESF reflects “the new public health” paradigm, positing that integration best addresses health and environmental issues affecting communities.6–8 The World Health Organization recommends that diverse providers pursue community-level outcomes and medical cost reductions through service integration.9 Established in 1994 as the Programa de Saúde da Família, today the ESF consolidates a model of assistance operationalized by professional teams, including nurses, physicians, and community health workers (CHWs), that serve about 4000 individuals per team.10,11In Brazil, service integration is accomplished by transdisciplinary collaboration—providers delivering primary care alongside public health interventions (e.g., disease prevention campaigns).11–14 Providers strive to engage in evidence-based practice (EBP), which is characterized by providers assessing the impact of environmental issues (e.g., water supply) on health and by incorporating patient input and research findings into diagnosis and treatment. EBP is encouraged by training local providers in integration methods.15,16 ESF has improved adult patients’ awareness of their diagnoses and prognoses and their adherence to children’s immunization schedules and has decreased infant mortality, hospitalizations, and medication costs.10,11,17–19     

Health Professionals: How much Employee Loyalty Should We Expect in a Privatising System?

In recent years UK government policy has been drawing private companies into the operation of the British National Health Service as providers of health care. Hitherto the National Health Service has been the main employer of health care practitioners, but this may change as a result of this development. There is an issue as to whether professional health care practitioners owe the same moral commitment to an employer in the private sector as they would owe to an employer that is part of the state-run National Health Service. I explore some arguments around this issue, focusing on ways of identifying organisational commitment to good health care. With regard to the practitioners commitment to the organisation I consider two strengths of commitment, normative and calculative. I then undertake an analysis of performance, regulatory regimes, and organisational obligations for both sectors. I conclude that while performance and regulatory regimes show little difference between sectors, there is a reasonably compelling argument in favour of a stronger moral commitment to state bodies based on organisational obligations.     

Nutrition Competencies in Health Professionals’ Education and Training: A New Paradigm

Most health care professionals are not adequately trained to address diet and nutrition-related issues with their patients, thus missing important opportunities to ameliorate chronic diseases and improve outcomes in acute illness. In this symposium, the speakers reviewed the status of nutrition education for health care professionals in the United States, United Kingdom, and Australia. Nutrition education is not required for educating and training physicians in many countries. Nutrition education for the spectrum of health care professionals is uncoordinated, which runs contrary to the current theme of interprofessional education. The central role of competencies in guiding medical education was emphasized and the urgent need to establish competencies in nutrition-related patient care was presented. The importance of additional strategies to improve nutrition education of health care professionals was highlighted. Public health legislation such as the Patient Protection and Affordable Care Act recognizes the role of nutrition, however, to capitalize on this increasing momentum, health care professionals must be trained to deliver needed services. Thus, there is a pressing need to garner support from stakeholders to achieve this goal. Promoting a research agenda that provides outcome-based evidence on individual and public health levels is needed to improve and sustain effective interprofessional nutrition education.     

Ethical Concerns in Tobacco Control Nonsmoker and “Nonnicotine” Hiring Policies: The Implications of Employment Restrictions for Tobacco Control

Smoking has been restricted in workplaces for some time. A number of organizations with health promotion or tobacco control goals have taken the further step of implementing employment restrictions. These restrictions apply to smokers and, in some cases, to anyone testing positive on cotinine tests, which also capture users of nicotine-replacement therapy and those exposed to secondhand smoke.Such policies are defended as closely related to broader antismoking goals: first, only nonsmokers can be role models and advocates for tobacco control; second, nonsmoker and “nonnicotine” hiring policies help denormalize tobacco use, thus advancing a central aspect of tobacco control.However, these arguments are problematic: not only can hiring restrictions come into conflict with broader antismoking goals, but they also raise significant problems of their own.RESTRICTIONS ON SMOKING IN the workplace have become common in many parts of the world. More recently, however, a number of organizations have taken the further step of implementing nonsmoker hiring policies that bar tobacco users from employment. Some hospitals have even put in place what they call “nonnicotine hiring policies,” which exclude all job candidates who test positive on cotinine tests, including not only tobacco users but also those who use cessation aids containing nicotine or those who are exposed to secondhand smoke.Although such policies do not violate employment legislation in many US states,1,2 it does not follow that they are ethically permissible. Such hiring policies curtail, potentially severely, the employment opportunities of smokers and those who are exposed to nicotine for other reasons. They also raise concerns about social justice because smoking is more prevalent among lower socioeconomic groups who are also more vulnerable to unemployment and job insecurity. Although financial considerations are sometimes explicitly mentioned as motivators leading to the adoption of hiring restrictions,3 hospitals and organizations whose objectives are linked to tobacco control have defended these policies as being crucial to their objectives: excluding job candidates who use tobacco or are exposed to nicotine helps ensure that employees can be role models and advocates in the fight against smoking; furthermore, these policies contribute to antitobacco efforts by further denormalizing tobacco use. If these arguments succeed, we may judge these benefits to outweigh the costs of such policies. However, I argue that these positions are inconsistent with other goals and concerns of the tobacco control community and may in fact run counter to the pursuit of antismoking goals.     

It’s Your Game…Keep It Real: Can Innovative Public Health Prevention Research Thrive Within a Comparative Effectiveness Research Framework?

The federal comparative effectiveness research (CER) initiative is designed to evaluate best practices in health care settings where they can be disseminated for immediate benefit to patients. The CER strategic framework comprises four categories (research, human and scientific capital, data infrastructure, and dissemination) with three crosscutting themes (conditions, patient populations, and types of intervention). The challenge for the field of public health has been accommodating the CER framework within prevention research. Applying a medicine-based, research-to-practice CER approach to public health prevention research has raised concerns regarding definitions of acceptable evidence (an evidence challenge), effective intervention dissemination within heterogeneous communities (a dissemination and implementation challenge), and rewards for best practice at the cost of other promising but high-risk approaches (an innovation challenge). Herein, a dynamic operationalization of the CER framework is described that is compatible with the development, evaluation, and dissemination of innovative public health prevention interventions. An effective HIV, STI, and pregnancy prevention program, It’s Your Game…Keep It Real, provides a case study of this application, providing support that the CER framework can compatibly coexist with innovative, community-based public health prevention research.     

Public Health Agenda Setting in a Global Context: The International Labor Organization’s Decent Work Agenda

We drew on two agenda-setting theories usually applied at the state or national level to assess their utility at the global level: Kingdon’s multiple streams theory and Baumgartner and Jones’s punctuated equilibrium theory. We illustrate our analysis with findings from a qualitative study of the International Labor Organization’s Decent Work Agenda.We found that both theories help explain the agenda-setting mechanisms that operate in the global context, including how windows of opportunity open and what role institutions play as policy entrepreneurs.Future application of these theories could help characterize power struggles between global actors, whose voices are heard or silenced, and their impact on global policy agenda setting.Victor Hugo’s assertion that no one can resist “an idea whose time has come” still resonates today, but what factors contribute to making an idea timely?1^(p1) Many public health issues, including tackling climate change and improving healthy working conditions, hold the potential to garner political and public attention, to mobilize organizational interests, and to surface on policy agendas. Yet these and other health issues continuously compete for legitimacy and resources in the policy process. Agenda setting has inspired much research generally but somewhat less in the public health field.2Research has examined how such issues emerge to be considered as policies, how agendas are set and produced through the political interactions of social actors, and how attention is maintained and resources are allocated to these problems.2 If agenda setting is about shifting us toward what to think by indicating what to think about,3 what are the real-world factors, who are the relevant actors, and which factors and actors really matter? To these questions we add: what may be different about agenda-setting processes in the global context?Theories help scholars explain this contextual complexity to elucidate how and why issues get and stay on policy agendas, and theories help scholars identify the processes that drive these dynamics.4 We assessed the utility of Kingdon’s multiple streams theory and Baumgartner and Jones’s punctuated equilibrium theory for the study of global agenda setting,1,5 with illustrative findings from a qualitative study about the International Labor Organization’s (ILO’s) Decent Work Agenda (DWA). We analyzed selected attributes of these theories in terms of their applicability to the global policy agenda-setting context.     

“It’s Like Being in a Labyrinth:” Hispanic Immigrants’ Perceptions of Depression and Attitudes Toward Treatments

This study aimed to describe Hispanic immigrants’ perceptions of depression and attitudes toward treatments and to examine how demographics, acculturation, clinical factors, and past service use were associated with their perceptions and attitudes. A convenience sample of 95 Hispanic immigrant patients was presented a vignette depicting an individual with major depression. Structured interviews that included standardized instruments and open-ended questions were used to query patients about their views of depression and its treatments. Findings showed that Hispanic immigrants perceived depression as a serious condition caused by interpersonal and social factors. Consistent with existing literature, most patients endorsed positive attitudes toward depression treatments yet reported apprehensions toward antidepressants. Demographic factors, acculturation, depressive symptoms, and past mental health service use were related to patients’ views of depression and attitudes toward care. This study emphasizes the need to incorporate Hispanic immigrants’ perceptions and attitudes into depression treatments.     

Epidemiology and Public Health in 1906 England: Arthur Newsholme’s Methodological Innovation to Study Breastfeeding and Fatal Diarrhea

In 1906 Arthur Newsholme linked artificial feeding and fatal diarrhea in infants aged one year and younger on the basis of two independent sources of information: mortality registration and a three-year (1903–1905) census of infants from Brighton, United Kingdom. Artificial feeding was more common in the infants who had died (89.3%) than in those in the survey (22.3%). However, boldly assuming the two data sources were nested, Newsholme computed the risks of fatal diarrhea: these were 48 times greater for infants fed fresh cow’s milk and 94 times greater for those fed condensed milk than for infants who were exclusively breastfed. This mode of computing risks and risk ratios before the invention of the cohort study design was more innovative than was the usual investigation techniques of his contemporary epidemiologists. Newsholme’s conclusions were consistent with the current knowledge that breastfeeding protects against fatal diarrhea.AROUND 1900, MANY INFANT deaths in the United Kingdom were from diarrhea, which peaked at epidemic levels in the summer months.1 This “summer diarrhea” was an important public health problem. Its etiology remained elusive for decades until 1906, when Arthur Newsholme finally related it to the contamination of fresh, powdered, or condensed cow’s milk in the infants’ homes.2 The epidemiological study that led to this discovery was different from the typical epidemiological investigations of that time. Its innovative aspects are of great interest to trace, with hindsight, the evolution of epidemiological methods. Newsholme attempted to push as far as possible the interpretational potential of vital statistics–based epidemiology. In doing so, he anticipated the more formal epidemiological designs to come, in particular the cohort study, the first report of which date from 1912.3Sir Arthur Newsholme (1857–1943), a British physician, served as chief medical officer of health in Brighton, England, from 1888 to 1908. Newsholme later went on to become the medical officer of the local government board, 1908–1919, the nominal head of the English public health service.1 A self-trained but experienced methodologist in epidemiology, his 1889 textbook Vital Statistics had gone through three editions by 1906 and was important in late Victorian public health.The innovative aspects of Newsholme’s study on summer diarrhea stand out when it is compared with the typical epidemiological techniques that medical officers of health at that time employed. As Hardy showed for typhoid outbreak investigations, a disease that was one of the central concerns of the medical department of the local government board in the 1880s, epidemiological techniques “varied little” and “followed a fairly standard formula.”4^(p334) The primary approach consisted of comparing the mortality from typhoid in ever smaller geographic areas to identify the places the outbreak affected and to understand what they had in common (e.g., drinking water drawn from the same river, purchasing milk originating from the same farm). The investigators then visited the identified area and narrowed down the culprit by using field detective work. For localized peaks of incidence, the source could be a sick person or a singular event that had allowed a sick person to contaminate other people and initiate the outbreak. For example, when Newsholme investigated an outbreak of scarlet fever in Brighton in 1905, he was able to plot the primary and secondary cases of scarlet fever among the customers of one dairy, inside and outside Brighton, and show that they were much more numerous than were those in the rest of Brighton. He eventually showed that one farm was the fons et origo mali (Latin for “source and origin of the bad”), even though he could not identify an index case.5 A comparable approach had been used 36 years earlier by medical officer of health Edward Ballard in his “first epidemiological study to establish the hypothesis that milk could act as a vehicle for typhoid”6^(p12) and by inspector F. W. Barry, in 1890–1891, when he linked an outbreak of typhoid in Teesdale to contamination of the Tees River following a breached weir in the village of Barnard Castle.4These typical local government board techniques did not work to elucidate the cause of summer diarrhea because the disease did not produce localized outbreaks. It was a diffuse epidemic that could not be tracked to an index case or triggering event. Many children died in many places from independent contamination processes. Indeed, mortality studies, such as those Edward Ballard conducted in the 1880s, suggested that there were many local conditions that could favor summer diarrhea, but these studies failed to single out causes that could be acted on.1Around 1895, Newsholme began to suspect that bottle-feeding—as opposed to breastfeeding—was the culprit for fatal infant diarrhea. Inspections and home inquiries revealed that the overwhelming majority of the infants who died had been bottle-fed.1 Yet, this key observation could not be interpreted as causal until the fraction of infants in the population at large who were bottle-fed was known. This is most likely why Newsholme began to systematically collect information on feeding practices for infants who had died as well as in the population at large.1 Newsholme launched a “census” of infants in Brighton in 1903. His inspector visited households on a yearly basis, counted the children aged one year and younger, and collected information about their modes of feeding.2 This population survey provided Newsholme with indispensable information about the distribution of feeding habits in the population basin of the mortality statistics. This new combination of exposure data among living and deceased infants resulted in an analytic approach for which we know of no equivalent before the 1906 publication “Domestic infection in relation to epidemic diarrhoea,”2 which we have dissected.     

Primary Care Pediatrics and Public Health: Meeting the Needs of Today’s Children

The proportion of children suffering from chronic illnesses—such as asthma and obesity, which have significant environmental components—is increasing. Chronic disease states previously seen only in adulthood are emerging during childhood, and health inequalities by social class are increasing. Advocacy to ensure environmental health and to protect from the biological embedding of toxic stress has become a fundamental part of pediatrics. We have presented the rationale for addressing environmental and social determinants of children’s health, the epidemiology of issues facing children’s health, recent innovations in pediatric medical education that have incorporated public health principles, and policy opportunities that have arisen with the passage of the 2010 Patient Protection and Affordable Care Act.In pediatrics, the acknowledgment of child development as a transactional process and ultimate determinant of adult capacity has important implications for the development of systems, practice models, and training. If we are to ensure children’s health and, ultimately, overall population well-being, childhood service systems must become responsive and coordinated on many levels; practitioners must develop multiple skills outside the traditional medical model; and training strategies must become innovative. Promoting access to effective health and health-related services is essential for achieving Healthy People 2020 objectives (the US Department of Health and Human Services’ set of health-promotion and disease-prevention goals to be achieved nationwide by 2020). There are many examples of shortfalls in adequacy of available services, effectiveness of care provided, organization of services, and focus on primary prevention. Up to 50% of developmental problems in children are not identified until school entry,1 more than 8 million children remain without health care coverage in the United States, and a much larger number have no regular source of health care except in emergencies.2 In addition to inadequate funding for appropriate services, the network of programs serving children is increasingly fragmented, difficult to navigate, and unresponsive.A major challenge for children’s and youths’ services is to develop more effective and efficient service integration models. In the present system, pediatricians tend to avoid asking parents about matters for which they feel inadequately trained and for which they are not aware of patient resources, including child development, obesity, breastfeeding, family violence, environmental health, and mental health. The system will not respond without adequately prepared clinician–advocates who recognize and understand these issues and their relationship to ultimate outcomes.     

And She’s Buying a Stairway to Health: Signs and Participant Factors Influencing Stair Ascent at a Public Airport

Several studies have demonstrated that point-of-choice prompts modestly increase stair use (i.e., incidental physical activity) in many public places, but evidence of effectiveness in airport settings is weak. Furthermore, evaluating the effects of past physical activity on stair use and on point-of-choice prompts to increase stair use is lacking. The purpose of this study was to evaluate the influence of sign prompts and participant factors including past physical activity on stair ascent in an airport setting. We used a quasi-experimental design, systematically introducing and removing sign prompts daily across 22 days at the San Diego International Airport. Intercept interviewers recruited stair and escalator ascenders (N = 1091; 33.0% interview refusal rate) of the only stairs/escalators providing access to Terminal 1 from the parking lot. A 13-item questionnaire about demographics, physical activity, health behavior, and contextual factors provided data not available in nearly all other stair use studies. We examined the effects of signs and self-reported covariates using multivariable logistic regression analyses, and tested whether physical activity and other covariates modified the intervention effect. Adjusting for all significant covariates, prompts increased the odds of stair use (odds ratio 3.67; p < .001). Past participation in vigorous physical activity increased the odds of stair use by 1.62 (p = 0.001). None of the covariates moderated the intervention effect. In conclusion, vigorous physical activity and correlates of physical activity were related to stair use in expected directions, but did not modify the effect of the intervention. This indicates that the effects of point-of-choice prompts are independent of past physical activity, making them effective interventions for active adults and the higher risk population of inactive adults. Signs can prompt stair use in an airport setting and might be employed at most public stairs to increase rates of incidental physical activity and contribute to overall improvements in population health.     

Household Overcrowding in Iran,a Low-middle-income Country: How Major of a Public Health Concern Is It?

ObjectivesHousehold overcrowding (HC) can contribute to both physical and mental disorders among the members of overcrowded households. This study aimed to measure the status of HC and its main determinants across the provinces of Iran.MethodsData from 39 864 households from the 2016 Iranian Household Income and Expenditures Survey were used in this study. The Equivalized Crowding Index (ECI) and HC index were applied to measure the overcrowding of households. Regression models were estimated to show the relationships between different variables and the ECI.ResultsThe overall, urban, and rural prevalence of HC was 8.2%, 6.3%, and 10.1%, respectively. The highest prevalence of HC was found in Sistan and Baluchestan Province (28.7%), while the lowest was found in Guilan Province (1.8%). The number of men in the household, rural residency, the average age of household members, yearly income, and the household wealth index were identified as the main determinants of the ECI and HC.ConclusionsThe study demonstrated that the ECI and HC were higher in regions near the borders of Iran than in other regions. Therefore, health promotion and empowerment strategies are required to avoid the negative consequences of HC, and screening programs are needed to identify at-risk families.     

“We’re Changing Our Ways”: Women’s Coping Strategies for Obesity Risk-reducing Behaviors in American Indian Households

This article reveals women caregivers’ perceptions and coping strategies to improve households’ food and physical activity habits. Results emerged from the pre-intervention formative research phase of a multi-site, multi-level obesity prevention pilot intervention on American Indian (AI) reservations. Using purposive sampling, 250 adults and children participated in qualitative research. Results reveal that having local institutional support was a key structural facilitator. ‘Family connectedness’ emerged as a key relational facilitator. Hegemony of systems, food deserts, transportation, and weather were key structural barriers; Childcare needs and time constraints were key relational barriers. Women’s coping strategies included planning ahead, maximizing, apportioning, tempting healthy, and social support. Findings informed the development and implementation of a novel obesity prevention pilot intervention tailored for each participating AI community addressing culturally relevant messages, institutional policies, and programs. We conclude with future consideration for comparative, ethnicity-based, class-based, and gender-specific studies on women’s coping strategies for household health behaviors.     

Up in Smoke: Vanishing Evidence of Tobacco Disparities in the Institute of Medicine’s Report on Sexual and Gender Minority Health

The Institute of Medicine (IOM) released a groundbreaking report on lesbian, gay, bisexual, and transgender (LGBT) health in 2011, finding limited evidence of tobacco disparities. We examined IOM search terms and used 2 systematic reviews to identify 71 articles on LGBT tobacco use. The IOM omitted standard tobacco-related search terms. The report also omitted references to studies on LGBT tobacco use (n = 56), some with rigorous designs. The IOM report may underestimate LGBT tobacco use compared with general population use.Tobacco remains the leading cause of premature mortality in the United States1; however, burdens of the epidemic are not equally shared among groups with various sociodemographic characteristics.2–4 Over the past 20 years, evidence has accumulated that lesbian, gay, bisexual, and transgender (LGBT) individuals (i.e., sexual and gender minorities) are among the groups at higher risk for smoking.5Two separate systematic reviews about the prevalence5 and etiology6 of smoking among sexual minorities report on the results of 63 unduplicated studies. Combined, the results suggest “compelling evidence that an elevated prevalence of tobacco use among LGBT men and women exists” compared with heterosexual men and women,5^(p279) a sentiment echoed by both the American Lung Association7 and Healthy People 2020.8By contrast, in the groundbreaking report on LGBT health by the Institute of Medicine (IOM),9 which is used by federal agencies and funders to set public health policy and priorities, tobacco use is largely absent and the limited discussion is equivocal: smoking rates among youths “may be higher”9^(p4) and adults “may have higher rates.”9^(p5) Given the seeming disconnect between the tobacco literature and the findings of the IOM report, we sought to identify possible gaps in tobacco-related evidence in the IOM report.     

“They Can’t Understand It”: Maternity Health and Care Needs of Immigrant Muslim Women in St. John’s, Newfoundland

Objectives The purpose of this qualitative study was to document and explore the maternity health care needs and the barriers to accessing maternity health services from the perspective of immigrant Muslim women living in St. John’s, Canada. Methods A purposive approach was used in recruiting six individuals to participate in in-depth semi-structured interviews. Data were analyzed using a two-step process of content analysis. Three metathemes were identified and compared to previous research on maternity health and the care needs of immigrant women. Results Women experienced discrimination, insensitivity and lack of knowledge about their religious and cultural practices. Health information was limited or lacked the cultural and religious specificity to meet their needs during pregnancy, labor and delivery, and postpartum phases. There were also significant gaps between existing maternity health services and women’s needs for emotional support, and culturally and linguistically appropriate information. This gap was further complicated by the functional and cultural adjustments associated with immigration. Conclusions Maternity health care information and practices designed to meet the needs of mainstream Canadian-born women lacked the flexibility to meet the needs of immigrant Muslim women. Recommendations for change directed at decision makers include improving access to culturally and linguistically appropriate maternity and health related information, developing the diversity responsiveness of health care providers and the organizations where they work and establishing social support networks and partnerships with immigrant communities. Changes that address the needs of immigrant Muslim women have the potential to create more inclusive and responsive maternity health services for all Canadian women.     

When a “Poach” Is Not a Poach: Re-Defining Human Mate Poaching and Re-Estimating Its Frequency

For a romantic attraction to be considered a mate poach, the pursuer must be aware that, while attempting to attract the targeted individual, the target is already in a nominally exclusive relationship. We investigated a methodological alternative for investigating the frequency of mate poaching. We presented university students with a survey informed by a definition of poaching that, in contrast to that which informed previous surveys, explicitly stated that the poacher must be aware while pursuing the targeted individual that the target was already in an exclusive relationship. Relative to participants in previous research, the current participants reported fewer experiences with poaching. We concluded that the current survey reduced the likelihood of participants reporting experiences with non-poaching forms of romantic attraction as experiences with poaching, and thereby provided more accurate estimates of the frequency of poaching. We also investigated the frequency of a previously uninvestigated form and temporal context of poaching and used a more fine-grained measure of the frequency of poaching than used in previous research. Discussion addresses limitations of the current research and suggests future directions for addressing them.     

Considerations for Incorporating “Well-Being” in Public Policy for Workers and Workplaces

Action to address workforce functioning and productivity requires a broader approach than the traditional scope of occupational safety and health. Focus on “well-being” may be one way to develop a more encompassing objective. Well-being is widely cited in public policy pronouncements, but often as “. . . and well-being” (e.g., health and well-being). It is generally not defined in policy and rarely operationalized for functional use. Many definitions of well-being exist in the occupational realm. Generally, it is a synonym for health and a summative term to describe a flourishing worker who benefits from a safe, supportive workplace, engages in satisfying work, and enjoys a fulfilling work life. We identified issues for considering well-being in public policy related to workers and the workplace.Major changes in population demographics and the world of work have significant implications for the workforce, business, and the nation.1–8 New patterns of hazards, resulting from the interaction of work and nonwork factors, are affecting the workforce.1,2,8–11 As a consequence, there is a need for an overarching or unifying concept that can be operationalized to optimize the benefits of work and simultaneously address these overlapping hazards. Traditionally, the distinct disciplines of occupational safety and health, human resources, health promotion, economics, and law have addressed work and nonwork factors from specialized perspectives, but today changes in the world of work require a holistic view.There are numerous definitions of well-being within and between disciplines, with subjective and objective orientations addressing such conceptualizations as happiness, flourishing, income, health, autonomy, and capability.12–22 Well-being is widely cited in public policy pronouncements, but often in the conjunctive form of “. . . and well-being” (as in health and well-being). It is rarely defined or operationalized in policy.In this article, we consider if the concept of “well-being” is useful in addressing contemporary issues related to work and the workforce and, if so, whether it can be operationalized for public policy and what the implications are of doing so. We discuss the need to evaluate a broad range of work and nonwork variables related to worker health and safety and to develop a unified approach to this evaluation. We discuss the potential of well-being to serve as a unifying concept, with focus on the definitions and determinants of well-being. Within this part of the discussion, we touch on topics of responsibility for well-being. We also explore issues of importance when one is incorporating well-being into public policy. We present examples of the incorporation of the principles of well-being into public policy, and the results thus far of the implementation of such guidance. We describe research needs for assessing well-being, particularly the need to operationalize this construct for empirical analysis. We aim to contribute to the ongoing efforts of occupational safety and health and public health researchers, practitioners, and policymakers to protect working populations.