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Harwell EL, LePrevost CE, Cofie LE, Lee JGL. Community Health Workers' Role in Addressing Farmworker Health Disparities. J Agromedicine 2022; 27:391-401. [PMID: 35168470 PMCID: PMC9395548 DOI: 10.1080/1059924x.2022.2040069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Community health workers (CHWs) are uniquely positioned to connect migrant and seasonal farmworkers to health promotion and clinical services. However, research on CHWs' experiences, particularly related to their provision of health education to farmworkers, is limited. To explore CHWs' practices and challenges in conducting health education outreach, we conducted three focus group discussions with farmworker health CHWs (N = 28) in North Carolina in the spring of 2020. We analyzed the focus group transcripts, and we compared the code outputs, thematic code summaries, and memos maintained throughout the analytic process to examine the experiences of CHWs in acquiring and disseminating health information and resources, including use of technology. We identified three themes related to CHWs' experiences providing health information to farmworkers. First, CHWs described short-term preparation, immediately before providing health outreach, and long-term activities, devoted to maintaining and improving their capacity to provide relevant health information to farmworkers. Second, they described their use of health education delivery methods, including open-ended questions, participatory and interactive approaches, and non-verbal aids. Third, participants described their current use of technology and related challenges, as well as the technology needed to enhance health outreach, including internet access. Findings reveal opportunities to improve farmworker health education through professional development for CHWs, identification of preferred methods of health education delivery to farmworkers, and provision of technology to farmworker-serving organizations. Establishing rural internet access and equipping outreach organizations with technology would position CHWs to be maximally effective as they strive to reduce farmworkers' health inequities.Abbreviations: CHW: Community health worker; FGD: focus group discussion; NC: North Carolina.
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Affiliation(s)
- Emery L Harwell
- Department of Applied Ecology, North Carolina State University, Raleigh, North Carolina, USA
| | - Catherine E LePrevost
- Department of Applied Ecology, North Carolina State University, Raleigh, North Carolina, USA
| | - Leslie E Cofie
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
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Slater A, Cantero PJ, Alvarez G, Cervantes BS, Bracho A, Billimek J. Latino Health Access: Comparative Effectiveness of a Community-Initiated Promotor/a-Led Diabetes Self-management Education Program. FAMILY & COMMUNITY HEALTH 2022; 45:34-45. [PMID: 34783689 PMCID: PMC9831659 DOI: 10.1097/fch.0000000000000311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Community-initiated health interventions fill important gaps in access to health services. This study examines the effectiveness of a community-initiated health intervention to improve diabetes management in an underserved community of color using a retrospective observational study, comparing a study intervention, the Latino Health Access Diabetes Self-Management Program (LHA-DSMP), with usual care. The LHA-DSMP is a 12-session community health worker (promotor/a) intervention developed and implemented by a community-based organization in a medically underserved area. Usual care was delivered at a federally qualified health center in the same geographic area. Participants were 688 predominantly Spanish-speaking Latinx adults with type 2 diabetes. The main outcome was change in glycemic control (glycosylated hemoglobin [HbA1c]) from baseline to follow-up. At 14-week follow-up, mean (95% CI) HbA1c decrease was -1.1 (-1.3 to -0.9; P < .001) in the LHA-DSMP cohort compared with -0.3 (-0.4 to -0.2; P < .001) in the comparison cohort. Controlling for baseline differences between cohorts, the adjusted difference-in-differences value in HbA1c was -0.6 (-0.8 to -0.3; P < .001) favoring the LHA-DSMP. A community-initiated promotor/a-led educational program for diabetes self-management is associated with clinically significant improvement in blood sugar control, superior to what was observed with usual medical care.
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Affiliation(s)
- Allison Slater
- Program in Medical Education for the Latino Community (PRIME-LC), School of Medicine (Dr Slater and Dr Billimek), Health Policy Research Institute (Mr Cervantes and Dr Billimek), and Department of Family Medicine (Dr Billimek), University of California, Irvine; and Latino Health Access, Santa Ana, California (Drs Cantero and Bracho and Mr Alvarez)
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Bloss JE, LePrevost CE, Zahra AG, Firnhaber GC, Cofie LE, Zepeda R, Lee JGL. Advancing the Health of Migrant and Seasonal Farmworkers in the United States: Identifying Gaps in the Existing Literature, 2021. Health Promot Pract 2021; 23:432-444. [PMID: 34549654 PMCID: PMC9096586 DOI: 10.1177/15248399211033308] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
There are profound health inequities for agricultural workers. We sought to assess the literature on migrant and seasonal farmworker health with an eye toward health promotion interventions, special populations, use of community health workers (CHWs), and technology. We conducted a systematic mapping review by searching five databases in March 2021. Using quantitative content analysis after establishing interrater reliability, we coded titles and abstracts to assess 13 topics and six characteristics of the research such as its focus on health promotion, use of technology, and inclusion of CHWs. We identified 1,083 records. Just 8.2% of records described or evaluated a health promotion effort to intervene in farmworker well-being and even fewer (4.2%) examined unique populations of farmworkers such as indigenous farmworkers (n = 11) or sexual minority farmworkers (n = 1). A small body of literature focused on the role of CHWs or promotores most frequently described their role in implementing health interventions. The literature on farmworker health has gaps regarding health promotion interventions, special populations, and integration of CHWs into research projects. We offer suggestions to fill in identified gaps in the literature.
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Affiliation(s)
| | - Catherine E LePrevost
- North Carolina State University, Raleigh, NC, USA.,North Carolina Agromedicine Institute, Greenville, NC, USA
| | | | | | | | - Ramón Zepeda
- Student Action with Farmworkers, Durham, NC, USA
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Quandt SA, LaMonto NJ, Mora DC, Talton JW, Laurienti PJ, Arcury TA. COVID-19 Pandemic Among Immigrant Latinx Farmworker and Non-farmworker Families: A Rural-Urban Comparison of Economic, Educational, Healthcare, and Immigration Concerns. New Solut 2021; 31:30-47. [PMID: 33557699 DOI: 10.1177/1048291121992468] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
COVID-19 has revealed social and health inequities in the United States. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice. Policy implications are highlighted.
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Affiliation(s)
- Sara A Quandt
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dana C Mora
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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Genetic Knowledge and Communication Among Mexican Farmworkers and Non-farmworkers in North Carolina. J Immigr Minor Health 2021; 23:1026-1034. [PMID: 33469784 DOI: 10.1007/s10903-020-01136-w] [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] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
It is important to understand genetics within the context of health. This paper assesses (a) genetic knowledge among Mexican-born farmworker and non-farmworker adults; (b) their interpersonal and device sources of genetic knowledge; and (c) the association between their genetic knowledge and the sources of this genetic knowledge.Interviews were conducted with Mexican-born farmworkers (100) and non-farmworkers (100) in North Carolina. Participants answered 15 questions to assess genetic knowledge, and sources from which they had seen or heard about genes and genetics.Results show limited knowledge of genetics, with farmworkers and non-farmworkers providing a similar level of correct responses (6.6 versus 7.3), but with farmworkers providing more incorrect responses (4.0 versus 2.7). Important sources of genetic information for farmworkers were promotoras (47%), compared to teachers (49%) for non-farmworkers.This study demonstrates a need for increased dissemination of genetic information to Mexican-origin farmworkers and non-farmworkers.
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Morgan-Daniel J, Ansell M, Adkins LE. Consumer Health Information for Rural Communities. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2020. [DOI: 10.1080/15398285.2020.1833648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Jane Morgan-Daniel
- Health Science Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Margaret Ansell
- Health Science Center Libraries, University of Florida, Gainesville, Florida, USA
| | - Lauren E. Adkins
- Health Science Center Libraries, University of Florida, Gainesville, Florida, USA
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Quandt SA, LaMonto NJ, Mora DC, Talton JW, Laurienti PJ, Arcury TA. COVID-19 Pandemic Among Immigrant Latinx Farmworker and Non-farmworker Families: A Rural-Urban Comparison of Economic, Educational, Healthcare, and Immigration Concerns. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020. [PMID: 33173921 PMCID: PMC7654917 DOI: 10.1101/2020.10.30.20223156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
COVID-19 has highlighted social and health injustices in the US. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice.
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Affiliation(s)
- Sara A Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dana C Mora
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jennifer W Talton
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Paul J Laurienti
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Lee JGL, LePrevost CE, Harwell EL, Bloss JE, Cofie LE, Wiggins MF, Firnhaber GC. Coronavirus pandemic highlights critical gaps in rural Internet access for migrant and seasonal farmworkers: a call for partnership with medical libraries. J Med Libr Assoc 2020; 108:651-655. [PMID: 33013227 PMCID: PMC7524630 DOI: 10.5195/jmla.2020.1045] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Migrant and seasonal farmworkers, who are essential workers in the coronavirus global public health emergency, face unique risks to their health as well as longstanding health inequities. This commentary highlights these risks and argues that Internet access represents an underappreciated but critical part of the public health response. The authors first discuss the unique risks farmworkers face. We note the importance of Internet access in the time of physical distancing, the fact that many health outreach workers are no longer visiting camps, the need for telemedicine infrastructure, and the role of Internet access in providing connections to families in communities of origin. We describe existing efforts that have been implemented in North Carolina to raise awareness among public health and health promotion practitioners and researchers. The current coronavirus pandemic demands the attention of medical libraries, public health practitioners, and policy makers to address the digital divide for farmworkers and their families.
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Affiliation(s)
- Joseph G L Lee
- , Associate Professor, Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | - Catherine E LePrevost
- , Teaching Associate Professor, Department of Applied Ecology, North Carolina State University and North Carolina Agromedicine Institute, Raleigh, NC
| | - Emery L Harwell
- , Research Assistant, Department of Applied Ecology, North Carolina State University, Raleigh, NC
| | - Jamie E Bloss
- , Assistant Professor, Laupus Health Sciences Library, East Carolina University, Greenville, NC
| | - Leslie E Cofie
- , Assistant Professor, Department of Health Education and Promotion, East Carolina University, Greenville, NC
| | | | - Gina C Firnhaber
- , Assistant Professor, College of Nursing, East Carolina University, Greenville, NC
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COVID-19 Pandemic among Latinx Farmworker and Nonfarmworker Families in North Carolina: Knowledge, Risk Perceptions, and Preventive Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165786. [PMID: 32785108 PMCID: PMC7459606 DOI: 10.3390/ijerph17165786] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/01/2020] [Accepted: 08/07/2020] [Indexed: 12/20/2022]
Abstract
(1) Background: The COVID-19 pandemic poses substantial threats to Latinx farmworkers and other immigrants in food production and processing. Classified as essential, such workers cannot shelter at home. Therefore, knowledge and preventive behaviors are important to reduce COVID-19 spread in the community. (2) Methods: Respondents for 67 families with at least one farmworker (FWF) and 38 comparable families with no farmworkers (nonFWF) in North Carolina completed a telephone survey in May 2020. The survey queried knowledge of COVID-19, perceptions of its severity, self-efficacy, and preventive behaviors. Detailed data were collected to document household members’ social interaction and use of face coverings. (3) Results: Knowledge of COVID-19 and prevention methods was high in both groups, as was its perceived severity. NonFWF had higher self-efficacy for preventing infection. Both groups claimed to practice preventive behaviors, though FWF emphasized social avoidance and nonFWF emphasized personal hygiene. Detailed social interactions showed high rates of inter-personal contact at home, at work, and in the community with more mask use in nonFWF than FWF. (4) Conclusions: Despite high levels of knowledge and perceived severity for COVID-19, these immigrant families were engaged in frequent interpersonal contact that could expose community members and themselves to COVID-19.
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Arnold TJ, Arcury TA, Sandberg JC, Quandt SA, Talton JW, Mora DC, Kearney GD, Chen H, Wiggins MF, Daniel SS. Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study. New Solut 2020; 30:111-126. [PMID: 32349618 DOI: 10.1177/1048291120920571] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.
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Affiliation(s)
- Taylor J Arnold
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Joanne C Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, USA
| | - Jennifer W Talton
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, USA
| | - Dana C Mora
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA
| | - Gregory D Kearney
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, USA
| | | | - Stephanie S Daniel
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, USA
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Mendez IM, Pories ML, Cordova L, Malki A, Wiggins MF, Lee JGL. A pilot project to increase health literacy among youth from seasonal farmworker families in rural eastern North Carolina: a qualitative exploration of implementation and impact. J Med Libr Assoc 2019; 107:179-186. [PMID: 31019386 PMCID: PMC6466499 DOI: 10.5195/jmla.2019.560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 10/01/2018] [Indexed: 11/20/2022] Open
Abstract
Objective There are substantial health inequalities for seasonal agricultural workers and their families in the United States. One identified inequality is in health literacy. The authors explored the implementation and impact of connecting youth from seasonal farmworker families who participated in a leadership and college pipeline program with Internet access by providing a tablet with a paid cellular data plan and university library–based health literacy training. Methods With the support of a National Network of Libraries of Medicine Health Information Outreach Award, we conducted a qualitative, utilization-focused evaluation by conducting semi-structured interviews from December 2017 through February 2018 with middle and high school age participants in the program (n=10). After parental consent and youth assent, we recorded interviews with participants at program activity locations or in their homes. We then utilized inductive thematic analysis with 2 primary coders. Results We identified four themes: (1) having access to the Internet can be transformative, (2) access resulted in increased knowledge of and interest in one’s own and others’ health, (3) “Google” is the norm, and (4) participant training increased self-efficacy to determine credible sources and resources. Conclusion Providing Internet access and iPads was possible to implement and resulted in increased utilization of health information. The combination of Internet access with training on information literacy was a key factor in achieving these positive outcomes. The findings suggest the importance of ensuring equitable access to the Internet in efforts to improve educational and health outcomes for seasonal farmworkers and their families.
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Affiliation(s)
- Israel M Mendez
- Research Assistant, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC,
| | - Mary Lisa Pories
- College of Health and Human Performance, East Carolina University, Greenville, NC,
| | - Leah Cordova
- STEM Librarian, Research and Instructional Services, Joyner Library, East Carolina University, Greenville, NC,
| | - Andreina Malki
- Youth Director, Student Action with Farmworkers, Durham, NC,
| | | | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, and Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC,
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Arnold TJ, Malki A, Leyva J, Ibarra J, Daniel SS, Ballard PJ, Sandberg JC, Quandt SA, Arcury TA. Engaging Youth Advocates in Community-Based Participatory Research on Child Farmworker Health in North Carolina. Prog Community Health Partnersh 2019; 13:191-199. [PMID: 31178454 PMCID: PMC6559374 DOI: 10.1353/cpr.2019.0019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Wake Forest School of Medicine (WFSM) investigators and Student Action with Farmworkers' (SAF) Levante Leadership Institute, a farmworker youth program, are collaborating on a community-based participatory research (CBPR) study. OBJECTIVES 1) Describe the collaborative process between WFSM investigators and the Levante advisory board during the strategic planning and implementation phase and 2) highlight practices that support the collaboration and project success. METHODS The longitudinal Hired Child Farmworker Study examines the health and safety of hired Latino child farm-workers in North Carolina. Two Levante alumni co- investigators lead research-related activities with the Levante advisory board. LESSONS LEARNED Challenges to CBPR with youth are overcome by the longstanding partnership between WFSM and SAF, attention to logistical details, power sharing, building on shared values, and assessment of youth preferences. CONCLUSIONS The partnership between WFSM and Levante demonstrates the mutual benefit of CBPR and will continue during the upcoming study phases.
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