FACTS Special Issue on Migration and Health

Migration is a global phenomenon involving hundreds of millions of people, with major social and economic impacts on migrants in their countries of origin and destination and on their communities. In the U.S., California is by far the most affected state by these population movements. The University of California Global Health Institute (UCGHI), Center of Expertise on Migration and Health (COEMH) is devoted to systematically studying the health consequences of global population movements and developing more effective strategies to address them. A key objective of the Center is to enhance educational opportunities related to migration and health. To do this, the Center implements graduate education, conducts research on immigrant and refugee communities, establishes distance education opportunities, and develops transnational collaborations. These activities provide a rich, real-world environment for training the next generation of leaders who will respond to emerging health issues related to migration. The Center’s annual Research Training Workshop is one such activity, resulting in rich discussions, cross-disciplinary interactions, and invaluable learning opportunities. This special issue on migration and health stems from the Research Training Workshop held on June 21-23, 2011, which was organized by COEMH. The workshop brought nineteen graduate students and postdoctoral fellows together in a multi-disciplinary setting to present their research and receive constructive feedback from University of California faculty members. Each paper presented in this special issue represents a unique issue related to migration and health.L'immigration est un phénomène mondial qui concerne des centaines de millions de personnes, et qui a des conséquences socio-économiques majeures sur les migrants dans leur pays d'origine et dans leur pays de destination, et également sur leurs communautés. Aux Etats-Unis, la Californie est de loin l'état le plus touché par ces mouvements de population. Le COEMH (Center of Expertise on Migration and Health) de l’UCGHI (University of California Global Health Institute), est spécialisé dans l'étude systématique des conséquences des mouvements de population sur la santé et dans l'élaboration de stratégies efficaces pour y remédier. L'un des objectifs clés du Centre est d'accroître les opportunités d'apprentissage liées à l'immigration et à la santé. Pour cela, le Centre met un œuvre un enseignement supérieur, conduit des recherches sur les communautés d'immigrants et de réfugiés, crée des opportunités d'enseignement à distance, et développe des collaborations transnationales. Ces activités constituent un environnement concret permettant de former la prochaine génération de dirigeants qui devra faire face aux problèmes de santé émergents liés à l'immigration. Le Research Training Workshop est l'une des initiatives annuelles du Centre. Il consiste en des débats approfondis, des interactions pluridisciplinaires et des opportunités d'apprentissage utiles. Ce numéro spécial consacré à l'immigration et à la santé découle du Research Training Workshop organisé par le COEMH du 21 au 23 juin 2011. Cet atelier a réuni dix-neuf étudiants diplômés et post-doctorants dans un contexte pluridisciplinaire qui ont présenté leurs travaux de recherche et reçu des commentaires constructifs de la part des membres de la faculté de l'Université de Californie. Chaque article de ce numéro spécial traite d'un sujet spécifique lié à l'immigration et à la santé.La migración es un fenómeno de escala mundial que involucra a cientos de millones de personas  y tiene un impacto social y económico tanto en los inmigrantes, como ensus países de origen y  destino, y en las comunidades en las que viven. En los Estados Unidos, el estado más afectado por estos movimientos de población es  California. El Centro de Expertos en Migración y Salud (COEMH por sus siglas en inglés) del Instituto de Salud Global de la Universidad de California (UCGHI por sus siglas en inglés) se dedica a realizar estudios sistemáticos sobre las consecuencias que estos  movimientos de población mundial tienen sobre la salud,  a fin de crear estrategias efectivas para abordarlos. Un objetivo clave del Centro es mejorar las oportunidades educativas relacionadas con la inmigración y la salud.  Para ello, el Centro imparte enseñanza universitaria, realiza estudios sobre las comunidades de inmigrantes y refugiados, crea oportunidades de educación a distancia y desarrolla colaboraciones transnacionales. Estas actividades proporcionan un ambiente rico en experiencias reales  para formar a la próxima generación de líderes que darán respuesta a los problemas de salud emergentes relacionados con la migración. Una de estas oportunidades que el Centro ofrece anualmente es el Taller de Formación e Investigación  que propicia profusos debates, e interacciones interdisciplinarias, además de valiosas oportunidades de aprendizaje. Este número especial sobre inmigración y salud nació a partir del Taller de Formación e Investigación celebrado del 21 al 23 de junio de 2011, organizado por COEMH. El taller reunió a 19 estudiantes de postgrado y becarios posdoctorales en un entorno multidisciplinario dónde pudieron presentar sus investigaciones y escuchar opiniones constructivas por parte del cuerpo de docentes de la Universidad de California. Cada trabajo presentado en este número especial representa un aspecto único relacionado con la migración y la salud

FACTS Special Issue on Migration and Health

Migration is a global phenomenon involving hundreds of millions of people, with major social and economic impacts on migrants in their countries of origin and destination and on their communities. In the U.S., California is by far the most affected state by these population movements. The University of California Global Health Institute (UCGHI), Center of Expertise on Migration and Health (COEMH) is devoted to systematically studying the health consequences of global population movements and developing more effective strategies to address them. A key objective of the Center is to enhance educational opportunities related to migration and health. To do this, the Center implements graduate education, conducts research on immigrant and refugee communities, establishes distance education opportunities, and develops transnational collaborations. These activities provide a rich, real-world environment for training the next generation of leaders who will respond to emerging health issues related to migration. The Center’s annual Research Training Workshop is one such activity, resulting in rich discussions, cross-disciplinary interactions, and invaluable learning opportunities. This special issue on migration and health stems from the Research Training Workshop held on June 21-23, 2011, which was organized by COEMH. The workshop brought nineteen graduate students and postdoctoral fellows together in a multi-disciplinary setting to present their research and receive constructive feedback from University of California faculty members. Each paper presented in this special issue represents a unique issue related to migration and health

Protocol for a cluster randomized controlled trial to study the effectiveness of an obesity and diabetes intervention (PASOS) in an immigrant farmworker population

Abstract Background Studies have shown that the prevalence of overweight, obesity and diabetes are higher in the largely Hispanic, immigrant farmworker population in California. Though to date, few interventional studies have focused on these issues in this at-risk population. The objective of this paper is to describe the study design of a cluster randomized controlled trial aimed at evaluating the effectiveness of an obesity and diabetes work place intervention in an immigrant farm worker population. Methods PASOS is an obesity and diabetes intervention program that will be implemented on ranches where immigrant farmworkers spend a considerable amount of time each day. This cluster randomized controlled study will enroll approximately 600 farmworkers. Using a uniform distribution for random number generation, ranches are randomized using a 1:1 ratio as either control or intervention. Baseline data will be taken from eligible participants and analyzed against data collected at the post-intervention, 6-month, 1-year, and 1.5-year follow-ups. The enrollment period is 1.5 years. Discussion Few studies have been conducted that aim to evaluate the effectiveness of a worksite intervention for obesity and diabetes prevention in a largely Hispanic, farmworker population. This study has been tailored to this population in order to enhance the feasibility of implementation and retention. If successful in reducing obesity and increasing healthy lifestyle choices to reduce diabetes, this study design can be implemented on a larger scale. Trial registration NCT02480244. Registered 24 June 2015

Protocol for a cluster randomized controlled trial to study the effectiveness of an obesity and diabetes intervention (PASOS) in an immigrant farmworker population.

BackgroundStudies have shown that the prevalence of overweight, obesity and diabetes are higher in the largely Hispanic, immigrant farmworker population in California. Though to date, few interventional studies have focused on these issues in this at-risk population. The objective of this paper is to describe the study design of a cluster randomized controlled trial aimed at evaluating the effectiveness of an obesity and diabetes work place intervention in an immigrant farm worker population.MethodsPASOS is an obesity and diabetes intervention program that will be implemented on ranches where immigrant farmworkers spend a considerable amount of time each day. This cluster randomized controlled study will enroll approximately 600 farmworkers. Using a uniform distribution for random number generation, ranches are randomized using a 1:1 ratio as either control or intervention. Baseline data will be taken from eligible participants and analyzed against data collected at the post-intervention, 6-month, 1-year, and 1.5-year follow-ups. The enrollment period is 1.5 years.DiscussionFew studies have been conducted that aim to evaluate the effectiveness of a worksite intervention for obesity and diabetes prevention in a largely Hispanic, farmworker population. This study has been tailored to this population in order to enhance the feasibility of implementation and retention. If successful in reducing obesity and increasing healthy lifestyle choices to reduce diabetes, this study design can be implemented on a larger scale.Trial registrationNCT02480244 . Registered 24 June 2015

Effectiveness of a worksite lifestyle intervention to reduce BMI among farmworkers in California: a cluster randomised controlled trial

ObjectiveTo evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite.DesignThis study was a two-arm parallel group, cluster randomised controlled trial, where participants received either a twelve-session lifestyle intervention (intervention) or six-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected socio-demographic and outcome data (i.e. BMI as primary outcome and waist circumference, glycated Hb (HbA1c), cholesterol and blood pressure as secondary outcomes) at baseline and follow-up assessments (i.e. 3 months, 6 months, 1 year and 1·5 years).SettingRecruitment and intervention delivery occurred at twelve study ranches in Oxnard, California.ParticipantsWe enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening.ResultsA total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (β = -0·01 for slope difference, P = 0·29). No significantly different trend by group was observed in secondary outcomes (P > 0·27).ConclusionsThe worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions

Exposure of agricultural workers in California to wildfire smoke under past and future climate conditions

Wildfire activity in the western U.S. has increased in frequency and severity in recent decades. Wildfire smoke emissions contribute to elevated fine particulate matter (PM _2.5 ) concentrations that are dangerous to public health. Due to the outdoor and physically demanding nature of their work, agricultural workers are particularly vulnerable to wildfire smoke pollution. In this study, we quantify the potential exposure of agricultural workers in California to past (2004–2009) and future (2046–2051) smoke PM _2.5 . We find that while absolute increases in smoke PM _2.5 exposure are largest in northern California, agricultural regions in the Central Valley and Central Coast may be highly vulnerable to future increases in smoke PM _2.5 concentrations. We find an increase from 6 to 8 million worker smoke exposure days (+35%) of ‘smokewave’ exposure for agricultural workers across the state under future climate conditions, with the largest increases in Tulare, Monterey, and Fresno counties. Under future climate conditions, we find 1.9 million worker smoke exposure days of agricultural worker exposure to levels of total PM _2.5 pollution deemed ‘Unhealthy for Sensitive Groups.’ This is a 190% increase over past climate conditions. Wildfire smoke PM _2.5 contributes, on average, to more than 90% of these daily PM _2.5 exceedances compared with non-fire sources of air pollution. Using the recent extreme wildfire season of 2020 as a case study, we show that existing monitoring networks do not provide adequate sampling of PM _2.5 in many future at-risk wildfire regions with large numbers of agricultural workers. Policies will need to consider the changing patterns of smoke PM _2.5 exposure under future climate conditions to better protect outdoor agricultural workers

Lessons learned obtaining informed consent in research with vulnerable populations in community health center settings

<p>Abstract</p> <p>Background</p> <p>To improve equity in access to medical research, successful strategies are needed to recruit diverse populations. Here, we examine experiences of community health center (CHC) staff who guided an informed consent process to overcome recruitment barriers in a medical record review study.</p> <p>Methods</p> <p>We conducted ten semi-structured interviews with CHC staff members. Interviews were audiotaped, transcribed, and structurally and thematically coded. We used NVivo, an ethnographic data management software program, to analyze themes related to recruitment challenges.</p> <p>Results</p> <p>CHC interviewees reported that a key challenge to recruitment included the difficult balance between institutional review board (IRB) requirements for informed consent, and conveying an appropriate level of risk to patients. CHC staff perceived that the requirements of IRB certification itself posed a barrier to allowing diverse staff to participate in recruitment efforts. A key barrier to recruitment also included the lack of updated contact information on CHC patients. CHC interviewees reported that the successes they experienced reflected an alignment between study aims and CHC goals, and trusted relationships between CHCs and staff and the patients they recruited.</p> <p>Conclusions</p> <p>Making IRB training more accessible to CHC-based staff, improving consent form clarity for participants, and developing processes for routinely updating patient information would greatly lower recruitment barriers for diverse populations in health services research.</p