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Gutiérrez Á, López-Anuarbe M, Webster NJ, Mahmoudi E. Rural-Urban Health Care Cost Differences Among Latinx Adults With and Without Dementia in the United States. J Aging Health 2024; 36:559-569. [PMID: 37899581 DOI: 10.1177/08982643231207517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
OBJECTIVES To compare rural-urban health care costs among Latinx adults ages 51+ and examine variations by dementia status. METHODS Data are from the Health and Retirement Study (2006-2018 waves; n = 15,567). We inflation-adjusted all health care costs using the 2021 consumer price index. Geographic context and dementia status were the main exposure variables. We applied multivariate two-part generalized linear models and adjusted for sociodemographic and health characteristics. RESULTS Rural residents had higher total health care costs, regardless of dementia status. Total health care costs were $850 higher in rural ($2,640) compared to urban ($1,789) areas (p < .001). Out-of-pocket costs were $870 higher in rural ($2,677) compared to urban ($1,806) areas (p < .001). Dementia status was not an effect modifier. DISCUSSION Health care costs are disproportionately higher among Latinx rural, relative to urban, residents. Addressing health care costs among Latinx rural residents is a public health priority.
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Affiliation(s)
- Ángela Gutiérrez
- Department of Social Medicine, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | | | - Noah J Webster
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Elham Mahmoudi
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
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Rowland S, Ahmed R, Roman MJS, Ramos AK. Workplace health culture and trust in the occupational health office: A descriptive study of meatpacking workers. Am J Ind Med 2024; 67:723-731. [PMID: 38770904 DOI: 10.1002/ajim.23617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 05/07/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION Worker trust in employer-provided occupational health services has not been explored in essential industries, such as meatpacking. The purpose of this study was to describe workplace health culture and trust in the occupational health office and highlight meatpacking workers' experiences with the occupational health office. METHODS Meatpacking workers were surveyed between February 2021 and October 2022. Descriptive statistics and nonparametric tests were used to explore trust across demographic variables, including workplace health culture. Thematic analysis was used to examine the short-answer qualitative data. RESULTS Among workers who completed surveys (n = 731), health culture was rated low (M = 1.3 (0.73); possible range 0-3). Trust in the occupational health office was also rated low (M = 8.2 (5.06); possible range 0-20). Workers' descriptions of interactions with the occupational health office were mostly unfavorable (287 negative opinion units; 97 positive opinion units) and primarily focused on quality of care, communication, the supervisor as gatekeeper to health services, and the prioritization of company interests. CONCLUSION Meatpacking worker health may be improved by building worker trust in the occupational health office. Suggested strategies include enhanced communication, protection of confidentiality, prioritization of worker well-being, and promotion of a stronger health culture in plants and throughout the industry. Supporting workers without a regular healthcare provider to establish a relationship with a primary care provider of their choice is also recommended.
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Affiliation(s)
- Sheri Rowland
- College of Nursing, University of Nebraska Medical Center, Lincoln, Nebraska, USA
| | - Rishad Ahmed
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria Jose Sanchez Roman
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Athena K Ramos
- Department of Health Promotion, College of Public Health - Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Schüßler C, Nicolai S, Stoll-Kleemann S, Bartkowski B. Moral disengagement in the media discourses on meat and dairy production systems. Appetite 2024; 196:107269. [PMID: 38360400 DOI: 10.1016/j.appet.2024.107269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Meat and dairy production and consumption are the subject of ongoing public debates that touch on various sustainability issues such as biodiversity loss, climate change, animal welfare, and social and health aspects. Despite extensive discussions specifically relating to the environmental impacts of livestock farming in conjunction with animal welfare aspects, there have been no substantial changes in production or consumption patterns. Moreover, the focus of extant research is usually on consumers' responses to public concerns around livestock production. In this study, we shed light on the discrepancy between the normative discourse and action of relevant value chain actors with the help of Bandura's theory of moral disengagement, which allows us to identify mechanisms that contribute to the perpetuation of unsustainable production and consumption patterns. In particular, we focus on the shifting of responsibility between actors in the normatively charged field of sustainable livestock production. We collected 109 media interviews on meat and dairy production and consumption from the years 2020-2022, including interviews with actors from agriculture, processing industries, and food retail. Using qualitative content analysis, we investigated the role of moral disengagement in the media discourse on meat and dairy production and explored differences between actors in terms of moral disengagement. We found that shifting of responsibility shows a quasi-circular dynamic of being shifted from all actors to all, in our case most frequently to consumers, politics, and (diffuse) economic forces. In addition, our analysis showed the use of social justifications, beneficial comparisons, and euphemistic labelling to be common mechanisms of moral disengagement, constituting a collective problem within agri-food systems.
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Affiliation(s)
- Charlotte Schüßler
- Helmholtz Centre for Environmental Research - UFZ, Department of Economics, Permoserstraße 15, 04318, Leipzig, Germany; University of Greifswald, Chair of Sustainability Science and Applied Geography, Domstraße 11, 17489, Greifswald, Germany.
| | - Susanne Nicolai
- University of Greifswald, Chair of Sustainability Science and Applied Geography, Domstraße 11, 17489, Greifswald, Germany
| | - Susanne Stoll-Kleemann
- University of Greifswald, Chair of Sustainability Science and Applied Geography, Domstraße 11, 17489, Greifswald, Germany
| | - Bartosz Bartkowski
- Helmholtz Centre for Environmental Research - UFZ, Department of Economics, Permoserstraße 15, 04318, Leipzig, Germany; Martin Luther University Halle-Wittenberg, Department of Economics, Große Steinstraße 73, 06108, Halle, Germany
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Schofield K, Ramos A, Weichelt B, Bent B. Realities of Workers' Compensation Coverage for Agricultural Workers: Before, during, and into the Future of the COVID-19 Pandemic. J Agromedicine 2023; 28:69-72. [PMID: 36396619 DOI: 10.1080/1059924x.2022.2147624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Katherine Schofield
- Department of Mechanical and Indistrial Engineering, University of Minnesota, Duluth, MN, USA
| | - Athena Ramos
- University of Nebraska Medical Center - Department of Health Promotion, Center for Reducing Health Disparities, 984340 Nebraska Medical Center, Omaha, NE, USA
| | - Bryan Weichelt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA.,National Children's Center for Rural and Agricultural Safety and Health, Marshfield, WI, USA
| | - Brian Bent
- Vice President, Director of Underwriting, SFM- the Work Comp Experts, Minneapolis, MN, USA
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Dineen KK, Lowe A, Kass NE, Lee LM, Wynia MK, Voo TC, Mohapatra S, Lookadoo R, Ramos AK, Herstein JJ, Donovan S, Lawler JV, Lowe JJ, Schwedhelm S, Sederstrom NO. Treating Workers as Essential Too: An Ethical Framework for Public Health Interventions to Prevent and Control COVID-19 Infections among Meat-processing Facility Workers and Their Communities in the United States. JOURNAL OF BIOETHICAL INQUIRY 2022; 19:301-314. [PMID: 35522376 PMCID: PMC9073494 DOI: 10.1007/s11673-022-10170-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Meat is a multi-billion-dollar industry that relies on people performing risky physical work inside meat-processing facilities over long shifts in close proximity. These workers are socially disempowered, and many are members of groups beset by historic and ongoing structural discrimination. The combination of working conditions and worker characteristics facilitate the spread of SARS-CoV-2, the virus that causes COVID-19. Workers have been expected to put their health and lives at risk during the pandemic because of government and industry pressures to keep this "essential industry" producing. Numerous interventions can significantly reduce the risks to workers and their communities; however, the industry's implementation has been sporadic and inconsistent. With a focus on the U.S. context, this paper offers an ethical framework for infection prevention and control recommendations grounded in public health values of health and safety, interdependence and solidarity, and health equity and justice, with particular attention to considerations of reciprocity, equitable burden sharing, harm reduction, and health promotion. Meat-processing workers are owed an approach that protects their health relative to the risks of harms to them, their families, and their communities. Sacrifices from businesses benefitting financially from essential industry status are ethically warranted and should acknowledge the risks assumed by workers in the context of existing structural inequities.
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Affiliation(s)
- Kelly K. Dineen
- School of Law, School of Medicine (secondary), Creighton University, 2500 California Plaza, Omaha, NE 68178 USA
| | - Abigail Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Nancy E. Kass
- Berman Institute of Bioethics & Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Lisa M. Lee
- Office of the Vice President for Research and Innovation & Department of Population Health Sciences, Virginia Tech, Blacksburg, VA USA
| | - Matthew K. Wynia
- Center for Bioethics and Humanities & Internal Medicine University of Colorado School of Medicine, Aurora, CO USA
| | - Teck Chuan Voo
- Centre for Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Rachel Lookadoo
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Athena K. Ramos
- College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Jocelyn J. Herstein
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center, Omaha, NE USA
| | - Sara Donovan
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE USA
| | - James V. Lawler
- Global Center for Health Security & Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE USA
| | - John J. Lowe
- Global Center for Health Security & College of Public Health, University of Nebraska Medical Center & Nebraska Biocontainment Unit, Nebraska Medicine, Omaha, NE USA
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Salinas JL, Salinas M. Systemic racism and undocumented Latino migrant laborers during COVID-19: A narrative review and implications for improving occupational health. J Migr Health 2022; 5:100106. [PMID: 35434678 PMCID: PMC9004221 DOI: 10.1016/j.jmh.2022.100106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 03/31/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022] Open
Abstract
Background Systemic racism is built upon the racial exploitation of minorities and has been further exposed inequalities amidst the COVID-19 global pandemic. The historic reliance of undocumented migrant Latino laborers continues to influence the modern-day work conditions Latinos face such as low wages, limited benefits, and an emphasis on productivity over safety, which also increases their risk for adverse health outcomes. Objective This narrative review aims to describe and highlight key risk factors on the impact of systemic racism and how it shapes the work and occupational health experiences of Latino laborers in the US, as well as strategies to overcome barriers. Method In this review, we explore empirical studies, news reports, and policy briefs that highlight the social factors impacting occupational health outcomes for undocumented Latino migrant laborers and synthesize the information to report major challenges experienced during the pandemic and propose recommendations for improving conditions and occupational health of these groups. Results Existing literature demonstrated that (1) documentation status was a barrier to federal relief programs during COVID-19; (2) though categorized as essential workers, workplace conditions were harmful towards preventing infection and transmission of COVID-19; and (3) there was an increased burden particularly for undocumented Latino women both in the workplace and at home during the pandemic. Recommendations include prioritization of undocumented immigrants in government relief, and addressing both individual and environmental level stressors in the workplace to promote inclusivity and reduce unnecessary suffering of Latino migrant workers. Conclusion Latino laborers should be treated with dignity and respect with workplace protections as they are designated as essential workers during the COVID-19 pandemic.
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Affiliation(s)
- Juan L. Salinas
- University of North Florida, 1 UNF Dr., Jacksonville FL 32224, USA
| | - Manisha Salinas
- Mayo Clinic, 4500 San Pablo Rd S., Jacksonville FL 32224, USA
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Lowe AE, Dineen KK, Mohapatra S. Structural Discrimination in Pandemic Policy: Essential Protections for Essential Workers. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:67-75. [PMID: 35243996 DOI: 10.1017/jme.2022.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
An inordinate number of low wage workers in essential industries are Black, Hispanic, or Latino, immigrants or refugees - groups beset by centuries of discrimination and burdened with disproportionate but preventable harms during the COVID-19 pandemic.
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Ramos AK, Carvajal-Suarez M, Trinidad N, Quintero SA, Molina D, Johnson-Beller R, Rowland SA. Health and Well-Being of Hispanic/Latino Meatpacking Workers in Nebraska: An Application of the Health Belief Model. Workplace Health Saf 2021; 69:564-572. [PMID: 34167388 DOI: 10.1177/21650799211016907] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Meatpacking is dirty, dangerous, and demanding work. In the United States, the industry predominately employs people from racial/ethnic minority backgrounds and immigrants, with 45% of the workforce identifying as Hispanic/Latino. Little is known about how the work environment affects worker engagement in health-promoting activities; however, occupational health professionals are uniquely positioned to advance worker health, safety, and general well-being. METHODS Hispanic/Latino meatpacking workers with work-related musculoskeletal pain and active health concerns were recruited to participate in a study to explore health, health behaviors, and the work environment. Five focus groups (N = 28) were conducted in Nebraska between March 2019 and February 2020. Thematic analysis using the Health Belief Model constructs was used to explain workers' health behaviors including utilization of occupational health services at their workplace. FINDINGS Workers believed that there was little they could do to prevent and treat health problems. They understood the perceived threat of health problems and the benefits of self-care, but the perceived barriers often outweighed the benefits. The workplace had few prompts to motivate or incentivize self-care both in and outside of work. In addition, workers did not trust the occupational health office and saw few benefits to accessing services. Together, these conditions resulted in low self-efficacy and limited engagement in health-promoting behaviors. CONCLUSION/APPLICATION TO PRACTICE Occupational health professionals should promote Total Worker Health and foster trust by providing culturally, linguistically, and literacy appropriate services and by identifying opportunities and reducing barriers for workers to engage in activities to promote their health, safety, and well-being.
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Rowland SA, Ramos AK, Carvajal-Suarez M, Trinidad N, Johnson-Beller R, Struwe L, Quintero SA, Pozehl B. Musculoskeletal Pain and Cardiovascular Risk in Hispanic/Latino Meatpacking Workers. Workplace Health Saf 2021; 69:556-563. [PMID: 34425720 DOI: 10.1177/21650799211016908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Most meatpacking workers have pain affecting their back, arms, and/or wrists from work-related repetitive motions, forceful exertion, and awkward positioning. Chronic musculoskeletal pain is associated with obesity, hypertension, type II diabetes, heart attack, and stroke. Hispanic/Latino workers in the meatpacking industry are a vulnerable population; limited English, lack of health insurance, and fear of deportation often deter them from seeking care where preventable cardiovascular risks might be detected. The purpose of this study was to examine perceived health and actual cardiovascular risk among Hispanic/Latino meatpacking workers with musculoskeletal pain in Nebraska. METHODS Structured interviews were used to examine perceived health, awareness of cardiometabolic risk, and capacity for health self-management. Body mass index (BMI), lipids, blood pressure, Hemoglobin A1c (HbA1c), and cardiorespiratory fitness (step test) were used to examine cardiovascular risk. FINDINGS Of those interviewed (n = 39), musculoskeletal pain affected usual life activities in 64% (n = 25) of participants. Of those tested (n = 30), 93% (n = 28) had a BMI > 30 kg/m2, 86% (n = 26) had at least one lipid abnormality, 50% (n = 15) had blood pressure > 120/80 mm Hg, and 43% (n = 13) had an HbA1c > 5.7%. Males had greater fitness than females (p = .03), but also greater lifetime risk of heart attack or stroke compared with females (p = .02). CONCLUSION/APPLICATION TO PRACTICE In this sample, cardiovascular risk exceeded that found in the general Hispanic population in the United States. Occupational health nurses can assist workers to be aware of their risk by measuring and providing culturally and linguistically appropriate education on blood pressure, BMI, cholesterol, and HbA1c.
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Affiliation(s)
| | | | | | | | | | - Leeza Struwe
- University of Nebraska Medical Center College of Nursing
| | | | - Bunny Pozehl
- University of Nebraska Medical Center College of Nursing
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