College of Health and Human Development

The research report is an assessment of U.S. laws, policies, regulations, and organizational practices as they relate to children crossing the U.S. border originating from Mexico, Honduras, Guatemala and El Salvador. Interviews were conducted with key stakeholders in academia and policy, health care, and community organizations as well as with people who have migrated to the U.S. from Mexico or Central America. The aims of the project were to identify specific conditions, factors and upstream determinants that contribute to increasing or decreasing health risks during the migration journey; barriers to quality health and healthcare services experienced by migrant children and their families; and effective strategies to reduce health risks and eliminate barriers to health care among child migrants. The research findings were hypothesized to: (1) facilitate a constructive policy dialogue among relevant stakeholders including policymakers, health departments, health systems, healthcare providers, community organizations and immigrant communities; and (2) stimulate additional research and action among a growing network of researchers. Research results enabled the development of policy alternatives consistent with human rights standards that continue to inform ongoing policy dialogues around improving child migrant health and access to medical care.

AbSTrAcT Background: This review seeks to understand whether and how seafarers can exercise their human right to health care and the factors that facilitate or impede that exercise. The general focus is on a critical policy analysis of labour policies from the mid-twentieth century through today, with a specific focus on how Filipino seafarers access their health care rights. Materials and methods: The methodology includes a critical policy analysis of seafaring, focusing on mid-twentieth century political shifts in the recognition and regulation of health care rights. The analysis of international and United States policy provides the backbone for understanding the health care experiences of seafarers by laying the ideological, theoretical, and political foundations of labour rights and precarious employment. Results: Policy analysis shows that there are numerous laws, regulations, and human rights norms that have been established to protect seafarers, but uncertain and limited recourse to lay claim to such laws, regulations, and norms while at sea. Lack of recourse to policies and regulations, taken together with the changed conditions of labour and worker protections through technology and neoliberal policies, create the conditions that may increase the health inequity among seafarers'. Conclusions: Health policy discussions in the United States and internationally must not solely focus on the health of seafarers as an interruption to travel and trade, but policy makers should consider that their decisions may contribute to how seafarers can exercise their rights to health care. In this context, health is more than disease and access to care — economic and governance structures come to not only matter, but play an integral role in the facilitation or impediment of health care and to the health arrangements/ conditions of workers.

In 2015, the Office of Health Policy and Legislative Affairs
(HPLA) at the University of Texas Medical Branch (UTMB)
founded the Adverse Childhood and Community Experiences
Collaborative (ACEs-Collaborative), alongside a community
partner – the Family Service Center of Galveston County
(FSC), to transform community systems and political action
to support the healthy psychosocial development of children
and adults in the Galveston County area. Our goals are to create
policy solutions, promote public awareness, increase prevention
efforts, and build capacity for trauma-informed care.
Through the ACEs Collaborative, we have engaged multi-sector
organizations, including researchers, physicians, farmer’s
markets, neighborhood development committees, behavioral
health professionals, law enforcement, and school personnel.
Collaborative partners incorporated existing and created new
programs to address societal violence through policy, awareness,
prevention, and trauma-informed care. As detailed below,
this action has already resulted in three successful initiatives.

Impact" describes how research informs policy and societal change, and "impact agenda" describes strategies to increase engagement between research and policymaking. Both are notoriously difficult to conceptualize and measure. However, funders must find ways to define and identify the success of different research-policy initiatives. We seek to answer, but also widen, their implicit question: in what should we invest if we seek to maximize the impact of research? We map the activities of 346 organizations investing in research-policy engagement. We categorize their activities as belonging to three "generations" fostering linear, relational, and systems approaches to evidence use. Some seem successful, but the available evidence is not clear and organizations often do not provide explicit aims to compare with outcomes. As such, it is difficult to know where funders and researches should invest their energy. We relate these findings to studies of policy analysis, policy process research, and critical social science to identify seven key challenges for the "impact agenda". They include: clarify the purpose of engagement, who it is for, if it is achievable in complex policymaking systems, and how far researchers should go to seek it. These challenges should help inform future studies of evidence use, as well as future strategies to improve the impact of research.

Teen dating violence is a public health concern that can lead to short- and long-term mental and physical health consequences, including depression, anxiety, risky behaviors, and unhealthy future relationships. Research shows that social and structural determinants of health, such as racism, low socio-economic status, and neighborhood conditions, may predispose certain communities to violence. To better understand methods to reduce TDV among ethnically and economically diverse populations, we used a trauma-informed race equity lens to adapt an efficacious prevention program known as Fourth R. This universal program has been shown to reduce some dating violence, substance use, and risky sexual behaviors, but there remains room for improvement. Specifically, more attention to trauma and the importance of societal risk and protective factors may improve the program’s effectiveness. Thus, focus group discussions were conducted with students and we then adapted Fourth R lessons specific ...

With fatal injuries six times the rate of all US occupations, people who live and work at sea are part of one of the most dangerous occupations. Few ships have health care workers aboard despite many seafarers being at sea for months. While seafarers are guaranteed a right to health care through maritime labor laws and conventions, it is unclear whether or how they access these rights. Therefore, photo-ethnography was used to examine what health care access means for seafarers through the lens of structural violence. The study site was the vessel the seafarers worked and lived on, which docked in the Gulf of Mexico once-aweek, flies a flag of convenience, and travels in international waters. The photo-ethnography was implemented over a one-year period and included male Filipino seafarers who worked 9-month contracts at sea. The historical, structural, and political-economic production of injury, illness, and death were questioned to understand why migrant seafarers do not have de facto access to their de jure health rights. In this way, health prevention was analyzed through the discourse of power distribution instead of risk and disease. Results from the project reveal that seafarers routinely underreport adverse work and health conditions for fear of losing future work contracts. Adverse work experiences included dangerous vessels and routes as well as being encouraged to work with little sleep or through storms. Adverse health issues included severe to moderate injury and illness, which they concealed from management. Ultimately, it was revealed that political-economic systems are internalized and embodied among migrant workers who are employed under short-term contracts, leading to decreased healthcare-seeking behaviors and increased health disparities.

This review seeks to understand whether and how seafarers can exercise their human right to health care and the factors that facilitate or impede that exercise. The general focus is on a critical policy analysis of labour policies from the mid-twentieth century through today, with a specific focus on how Filipino seafarers access their health care rights. The methodology includes a critical policy analysis of seafaring, focusing on mid-twentieth century political shifts in the recognition and regulation of health care rights. The analysis of international and United States policy provides the backbone for understanding the health care experiences of seafarers by laying the ideological, theoretical, and political foundations of labour rights and precarious employment. Policy analysis shows that there are numerous laws, regulations, and human rights norms that have been established to protect seafarers, but uncertain and limited recourse to lay claim to such laws, regulations, and nor...

Despite the effectiveness of some school-based programs to prevent teen dating violence, the burden it puts on schools and teachers presents a unique challenge. A simple, low-cost alternative is a text message campaign. Data suggest that most adolescents have access to a mobile phone, and texting is the leading form of social interaction. The current qualitative study examined the design and feasibility of a 6-week healthy relationships campaign, and a text message intervention designed to reduce teen dating violence and promote healthy relationships. Twenty-four adolescents participated in three focus groups for the first round of text messages ('pilot project'), with another twenty-two adolescents texting their feedback after the campaign went live to the public ('initial implementation project'). Overall, participants reported that the campaign was helpful in acquiring new knowledge and maintaining healthy relationships. They also found it more engaging than other means of intervention, such as brochures or social media applications.

In the face of increasing risk for intimate partner violence (IPV) and sexual assault during the COVID-19 pandemic, there is an urgent need to understand the experiences of the workforce providing support to survivors, as well as the evolving service delivery methods, shifting safety planning approaches, and occupational stress of frontline workers. We addressed this gap by conducting an online survey of members of IPV and sexual assault workforce using a broad, web-based recruitment strategy. In total, 352 staff from 24 states participated. We collaborated with practitioner networks and anti-violence coalitions to develop the brief survey, which included questions about work and health, safety planning, and stress. We used chi-square, t-test, and ANOVA analysis techniques to analyze differences within position and demographic variables. For qualitative data, we used thematic analysis to analyze responses from four open-ended questions. The sample was majority female-identified (93....

With fatal injuries six times the rate of all US occupations, people who live and work at sea are part of one of the most dangerous occupations. Few ships have health care workers aboard despite many seafarers being at sea for months. While seafarers are guaranteed a right to health care through maritime labor laws and conventions, it is unclear whether or how they access these rights. Therefore, photo-ethnography was used to examine what health care access means for seafarers through the lens of structural violence. The study site was the vessel the seafarers worked and lived on, which docked in the Gulf of Mexico once-a-week, flies a flag of convenience, and travels in international waters. The photo-ethnography was implemented over a one-year period and included male Filipino seafarers who worked 9-month contracts at sea. The historical, structural, and political-economic production of injury, illness, and death were questioned to understand why migrant seafarers do not have de f...

The COVID-19 pandemic and related quarantine has created additional problems for survivors of interpersonal violence. The purpose of this study is to gain a preliminary understanding of the health, safety, and economic impacts of the COVID-19 pandemic on people that are experiencing or have previously experienced violence, stalking, threats, and/or abuse. An online survey, open from April to June 2020, was taken by people with safety concerns from interpersonal violence. Participants were recruited from IPV and sexual assault-focused agencies, state coalitions, and social media. Quantitative data were summarized using descriptive methods in SPSS and coding methods from thematic and content analysis was used to analyze qualitative data from open-ended questions. A total of 53 participants were recruited for the survey. Individuals with safety concerns have experienced increased challenges with health and work concerns, stress from economic instability, difficulties staying safe, and access resources and support. Over 40% of participants reported safety had decreased. Use of social media and avoidance strategies were the most common safety approaches used. Participants reported mixed experiences with virtual services. The COVID-19 pandemic has exacerbated existing structural concerns for survivors of violence like IPV and sexual assault. Increased support and economic resource access, coupled with modified safety planning and improved virtual approaches, would better help meet survivor needs.

This study assessed racial disparities in associations between four levels of residential segregation and five social determinants of health (SDH). The data for this study was drawn from 500-City Health Dashboard that aggregated a variety of health indicators in 2018. Those 500 cities were ranked according to their levels of segregation. Next, the associations between four segregation gradients and five different community indicators were tested including (1) absenteeism, (2) children in poverty, (3) high school graduation, (4) limited access healthy foods, and (5) unemployment. All analyses were stratified by race. The total population of this data is 103,020,800, which accounts for one-third of the total U.S. populations. Among nine regions, 69% of cities in the East South-Central region have a high white/black segregation. On the other hand, the Pacific region has the lowest level of segregation. Consistent with literature, African Americans are still at a higher risk than white people to experience school absenteeism (6.1% higher), poverty (28.8% higher), educational attainment (4.9% lower), and unemployment (8.4% higher). However, unlike the literature, the study did not find any statistically significant disparities in access to healthy foods associated with level of segregation. The study concludes with suggestions to mitigate these adverse effects due to segregation policy against African Americans. The findings also encourage local departments to use 500-City Health Dashboard and our analytic methods to facilitate decision making and implement citywide, cross-sector initiatives.

Background:To improve the use of evidence in policy and practice, many organisations and individuals seek to promote research-policy engagement activities, but little is known about what works. Aims and objectives:We sought (a) to identify existing research-policy engagement activities, and (b) evidence on impacts of these activities on research and decision making. Methods:We conducted systematic desk-based searches for organisations active in this area (such as funders, practice organisations, and universities) and reviewed websites, strategy documents, published evaluations and relevant research. We used a stakeholder roundtable, and follow-up survey and interviews, with a subset of the sample to check the quality and robustness of our approach. Findings:We identified 1923 initiatives in 513 organisations world-wide. However, we found only 57 organisations had publicly-available evaluations, and only 6% (141/2321) of initiatives were evaluated. Most activities aim to improve rese...

Background Community-led interventions that address structural and social determinants of health are lacking among (im)migrant workers, especially seafood workers. This lack of medical attention is especially alarming given their high rate of injury and death. Methods Community-based participatory research (CBPR), a relational model that values the participants as equal partners in research, dissemination, and implementation, guided the interviews and mobile clinic. Seafood workers were engaged throughout data collection, analysis, and interpretation and played a significant role in moving the findings from research into actionable change. Results To address the lack of healthcare options for (im)migrants, and at the request of the seafood workers participating in the ongoing CBPR study, we successfully implemented and treated workers in our mobile clinic. Discussion Many of these individuals had not been seen by a healthcare provider in years, highlighting the importance of communi...

The leading businesses that, in many aspects, advance the "sharing economy" concept are no longer new comers. Founded in 2008, Airbnb is a major provider of travel accommodation, and a pioneer in the recent sharing economy. With a total of 550,000 listings made on the platform in the United States alone, Airbnb might have replaced the demand for incumbent hotels to some extent. We speculate that it has had a significant impact on incumbent hotels' performance in affected markets. The purpose of this study is to analyze the effects of Airbnb in a hotel market, and to demonstrate the use of spatial market performance analysis by geographically weighted regression (GWR), which explores important local variations between the independent and the dependent variables. This study selects Miami as an affected market to analyze, since it is one of the largest markets both in the hotel industry and Airbnb.