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Growing Academic Alliances with Vulnerable Hispanic and Latino Communities in the Southeast Region, USA

Pam Cromer, DNP, FNP-BC-TTS
Debbie Layman, BSN, Community Liaison

NATIONAL HISPANIC MEDICAL ASSOCIATION
Arlington, VA - March 26, 2022

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Beginnings

01

outline

Aims and Approaches

02

Latinos and Health Disparity

03

CDC Frameworks

04

Team Focus:

Research, Education,

and Service

05

Disclosures: None

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�Costa Layman International Community Outreach Programs (CLIOPS) �for �Latino Farmworkers

Annual Worksite Health Fair

Annual Women’s Clinic

125 – 400 farmworkers annual participation

65 – 92 female annual participation

Started in 2005

Started in 2006

Program utilizes space on location and at the University

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��We are Leaders: �Improving the Health of Latinos & Other Underserved Rural Populations ��

Goals: Driven by a deep interest in health disparities and health inequities

that impact Hispanic communities

Healthful Relationships

Resource Support - At-Risk Populations

Culturally Appropriate

Rural Health Workforce Competencies

Address Risks and Trauma

(accidents, injuries, chronic diseases) that may affect their mental and mental and physical health for years

Demonstrate the unique intersections between the scientific community & agricultural industry in Georgia and South Carolina

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��Multidisciplinary Collaborations �Transforming Latino Communities� �

Community Partnerships in the Southeast Region help support:

Data banks along with a serum biorepository

Faculty/student research, presentations and publications

International industry recognition through Costa Farms media outlets

Health screening protocols

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The Plan
improve healthcare access for agricultural workers

Reduce Unmet Healthcare Needs

Consistent access to healthcare

and services

Expanded health care programs

Improved services

The Academics – training and capacity building of rural healthcare provider competencies

Cultural competency, awareness and humility

Earlier identification and interventions for workers with health issues

The Relationships - integrate and grow community alliances

Costa Farms and SC Peach Growers Association
FQHC’s, migrant clinics, private practices
Public Health Departments and laboratory affiliations
SC Hispanic Association
CLAS and Volunteer Interpreters

Our Approach

7

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America’s Health Rankings �2021 Health Disparities Report - United Health Foundation

3X

29.9%

Wide disparities in maternal mortality, mental health, chronic disease, and food insecurity

Hispanics still face the highest rate of severe housing problems

Uninsured rate for Hispanics is 3 times higher than in white populations

<>

Strong connection between education and health outcomes

https://nhma.memberclicks.net/assets/AHRJulyNewsletterContent.pdf

https://assets.americashealthrankings.org/app/uploads/2021_ahr_health-disparities-report_executive_brief_final.pdf

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COVID-19 Pandemic �Amplified the need to identify and address health concerns of Latinos

https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html

1.3X

2.3X

With the pandemic, the Latino population:

Has vaccination rates that are significantly lower than their Caucasian counterparts

Is 2.3 times more likely to die from Covid

Is 1.3 times more likely to be hospitalized

↓

these needs became more important than ever

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Action Framework

CDC (n.d.). HI-5 Health Impact in 5 years.www.cdc.gov/hi5

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CDC (n.d.). HI-5 Health Impact in 5 years.www.cdc.gov/hi5

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CDC (n.d.). HI-5 Health Impact in 5 years.www.cdc.gov/hi5

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CDC (n.d.). HI-5 Health Impact in 5 years.www.cdc.gov/hi5

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�CDC’s Healthy People 2030 Guidelines �

To get and stay healthy:

- Healthy eating

- Robust health care

- Physical activity

- No smoking

- Stay in touch with friends and family

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And �Major Augusta University Executive Supporters��

Dean Tonya Sudia, College of Nursing

Dr. Brooks Keel, President of

Augusta University

Dr. Jose Vazquez, Section Chief

Infectious Disease

Dr. Yanbin Dong, Associate Director

Georgia Prevention Institute

Debbie Layman, Costa Layman Community Partner

Laura Brower, CNO, Augusta

University Medical Center

Dr. Bill Strong, Senior Advisor to

the Director of Institute

of Public and Preventive Health,

Augusta University

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CHARM STUDY: IPPH Grant (2013-2017 and 2020)�Cardiometabolic Risks in Hispanic Farm-Workers: A Health-Fair Model �Study in the Southeastern Region � � Co-PI’s:� Debbie Layman, BSN, RN� PI: Yanbin Dong, MD Pam Cromer, DNP, FNP� � �Research Partners: � Nursing, Georgia Prevention Institute � Respiratory and Physical Therapy Departments� � �

Study Coordinator:

Dr. Jigar Bhagatwala

Co-PI: Dr. Andy Mazzolli

Shaoyong Su, PhD

Rudolf Lucas, PhD

Haidong Zhu, MD PhD

Miriam Cortez-Cooper, PhD PT

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Jigar Bhagatwala, Pamela Cromer, Andrew Mazzoli, Haidong Zhu, Nirja Acharya, Riya Basu, Kunal Patel, Ying Huang, Shaoyong Su, Rudolf Lucas, Debbie Layman, and Yanbin Dong

Results

Introduction

Cardiovascular and metabolic disorders are among the top 5 causes of mortality in the Hispanics living in the United States (US).
More than 80% of the farm workers are Hispanic, and farming is one of the most dangerous jobs.
The National Center for Farm-worker Health (NCFH) indicates a paucity of research related to health problems of Hispanic farm-workers.
Low literacy, language barrier and lack of health insurance limits their utilization of health care making it challenging to study this population in a traditional research setting.
We aimed to partner with community leaders, and employ health screenings as an outreach strategy to profile the health risk of Hispanic farm-workers in the southeastern US.

Participants and Methods

Obesity, prehypertension/hypertension, and abnormal lipid profiles, but not prediabetes/diabetes are common in young Hispanic farmer-workers in the Southeastern region.
Hispanic males seem to have higher BP, and more unfavorable lipid profile than females.
Longitudinal studies in this population are urgently needed to better characterize the progression of cardiometabolic risk to clinical diseases.

Translational Impact

Conclusions

Cardiometabolic risk profiling of young farm workers of Hispanic origin in the Southeastern United States: A researcher-community partnership study

Hypothesis

We hypothesize that the young uneducated farm workers of Hispanic origin in the southeastern United States are at risk of cardiovascular and metabolic diseases.

This study was a part of ongoing longitudinal follow up study characterizing the Cardiometabolic risk of young Hispanic fARM workers in Southeastern United States (CHARM).
The one-day free-service Health Fair, located at the Costa Layman Farms, Trenton, South Carolina, was provided by regional, community, GRU students and faculty in July, 2013.
A total of 140 Hispanic farm workers (Mean age: 35.3±8.0 years, 60% males) were recruited.
Fasting blood samples were collected for the measurement of glucose and lipid profile.
Prediabetes and diabetes were defined by the American Diabetes Association (ADA) criteria.
Abnormal lipid profile was defined using Adult treatment panel 3 (ATP III) criteria.
Height, weight, hip and waist circumferences were measured.
Body mass index (BMI) was calculated using the Center for Disease Control and Prevention (CDC) formula.
Sitting blood pressures were measured using a manual sphygmomanometer after 5 minutes of rest. Prehypertension and hypertension were defined using The Seventh Report of the Joint National Committee (JNC 7) criteria.
Participants provided written and informed consent in Spanish.

A total of 81.5% of the participants were either overweight or obese.
The prevalence of prehypertension/hypertension combined was 64%, yet the prevalence of prediabetes/diabetes combined was 5.7%.
The prevalence of high low-density lipoprotein (LDL), low high-density lipoprotein (HDL) and hypertriglyceridemia was 14.3%, 32.1% and 37.8%, respectively.
Males compared to females had higher rates of prehypertension/hypertension (78.4% vs. 36%), and hypertriglyceridemia (30.0% vs. 15.0%) (ps<0.05).
In addition, males vs. females had significantly higher total cholesterol (184.2±33.3 vs. 171.6±30.8 mg/dl), LDL (105.1±27.0 vs. 93.8±29.8 mg/dl), triglyceride (175.1±113.6 vs. 139.4±74.4 mg/dl), systolic blood pressure (127.9±12.2 vs. 116.1±13.6 mmHg), and diastolic blood pressure (80.0±9.5 vs. 74.3±9.9 mmHg) (all ps<0.05). (Figure 2)

Figure 1. Comparing the prevalence of cardiometabolic risk factors in the young study participants and the Hispanics in the United States

Figure 2 . Differences in TC, LDL, Triglycerides, SBP and DBP between Hispanic males and females.

*: Statistically significant difference.

Pairing university researchers with community organizations is vital to characterizing, understanding and improving health risk factors in Hispanic farm workers in the Southeastern regions.
Longitudinal follow-ups, preventive and interventional managements may be implemented through the researcher-community partnership.
Our study offers a great platform for translational approaches exploring the genetic, epigenetic and immune mechanisms involved in the development and progression of obesity related cardiometabolic disorders in this population.

Funding: Community Health Partnership Grant, Institute of Public and Preventive Health (IPPH), Georgia Regents University.

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Education

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�� Worksite and Clinical Healthcare Services� �

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Community Support and Referral Services

FQHC Migrant Clinic

Community directory services

Costa transport services

Student clothes closet

Dental College of Georgia

AU Lab/Pathology Services and COVID -19 antibody testing

Physician consultations

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COVID-19 Vaccination Day

Registration desk

FQHC Pharmacist oversite preparing

the COVID-19 vaccine injections

Costa Layman

and

Ridge Peach Growers Association Employees

(1200 workers vaccinated in one day)

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Costa Layman International Outreach Programs ��

Founder

Debbie Layman

and Layman Wholesale Nurseries in collaboration

with the College of Nursing

A partnership created by an insight into the healthcare needs of the agricultural community and passion for the students and faculty of MCG/Augusta University

“No one left behind”

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THIS CAPTION SUMS IT UP FOR ALL OUR TEAMS

AND DEMONSTRATES OUR STEADFAST SUPPORT OF RURAL HEALTH SERVICES

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References

AHRJulyNewsletterContent.pdf (n.d.). https://nhma.memberclicks.net/assets?AHRJulyNewsletterContent.pdf.

America’s Health Rankings - United Health Foundation (2021). Health Disparities Report 2021 [Executive Brief]. https://assets.americashealthrankings.org/app/uploads/2021_ahr_health-disparities-report_executive_brief_final.pdf.

America’s Health Rankings – United Health Foundation 30 Years. (2021). Abled-Bodied Public Health Statement. https://www.americashealthrankings.org/explore/disparity.

Center for Disease Control and Prevention (n.d.). HI-5 Health Impact in 5 years. Office of the Associate Director for Policy Centers for Disease Control and Prevention. www.cdc.gov/hi5.

Center for Disease Control and Prevention (9/9/2021). Risk for Covid-19 Infection, Hospitalization, and Death By Race/Ethnicity. Data & Surveillance. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html.

Marsh, Michelle & 7News Staff (11/4/2021). Celebrating Hispanic Heritage Month – wjla.com/celebrate. https://wjla.com/features/hispanic-heritage-month/join-7news-for-a-live-town-hall-celebrating-hispanic-heritage-month.

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Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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ISSUE

STRATEGY

Hispanics in Kansas lagged in COVID-19 vaccinations, mostly due to safety concerns, lack of trust, and doubts on the vaccine efficacy.

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

Established a solid program to address all concerns and engage with the Hispanic community by educating them about the vaccine, using L2L's proven communication model via an engaging and culturally relevant messaging.

E

Educate, Empower, Engage

3

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DIGITAL PERSONAS

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

5

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Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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Use of medical perspective to validate statements and facts

Mythbusting via creative elements to demystify negative messages

Use of key real community individuals to effectively share the message

INSIGHTS

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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+35,000 Hispanics vaccinated in Phase 1

(June - September 2021)

Over 184,000 Hispanics

are now Vaccinated

As of January 2022

RESULTS

+37,000 Hispanics vaccinated in Phase 2

(October '21 - January '22)

Hispanics Overindex in VX rates by age groups versus other group

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

+95.9 Million Impressions
83,775 clicks
Viewability of 84.94%
93,197 landing page visits

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CAMPAING RESULTS

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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JULY

AUGUST

SEPTEMBER

OCTOBER

NOVEMBER

DECEMBER

Phase 1 Start

Phase 1 End

Gov. PSA

Phase 2 Start

Holiday Campaign

JANUARY

Phase 2 End

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

+184,000

CAMPAING RESULTS

Hispanics Vaccinated

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¡GRACIAS!

Thank You!

Latin2Latin Marketing, LLC | CONFIDENTIAL. Not to be distributed without L2L Marketing authorization.

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Marisol McDaniel, DrPH, MPH

Deborah Parra-Medina, PhD

Ruth Enid Zambrana, PhD

Latino Research Institute at The University of Texas at Austin

The Central Role of Providers in Mitigating Risk of HIV/AIDS among Latino LGBTQ populations

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To empirically assess Latino providers' 1) social, demographic, and practice characteristics; 2) knowledge, attitudes, and beliefs about PrEP prescription; and 3) HIV prevention practices including PrEP prescription

Study Aim (s)

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Only 14% of Latinos who could benefit from PrEP were prescribed PrEP in 2019, compared to 23% of the overall population.

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Overview

A cross-sectional online survey

NHMA
AMA
Convenience Network Sample

The survey collected information in 3 areas

Providers’ demographics
Medical training, practice, and positions
Patient population and HIV prevention

Methods

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Overview

Do you support the provision of HIV PrEP to at-risk individuals?
No
Yes
Unsure
Have you (or would you) provide PrEP? (select all that apply)
Have not provided PrEP but would
Have provided PrEP
PrEP is not relevant to my practice
Have not or would not provide PrEP because (all that apply):
Concern about compliance and future resistance
Cost/payer issues
Concerns about potentially toxic drugs in healthy persons
Insufficient evidence for efficacy of real-world PrEP
Other reasons
Rank order of barriers to provision of PrEP, sum of ranks
Time consuming to counsel and assess adherence
Starting a potentially toxic drug in healthy persons
Future drug resistance
Too costly and patients can't afford it
Patient population is not at risk for HIV infection
Concerns about efficacy of real-world PrEP

Maile Y. Karris, Susan E. Beekmann, Sanjay R. Mehta, Christy M. Anderson, Philip M. Polgreen, Are We Prepped for Preexposure Prophylaxis (PrEP)? Provider Opinions on the Real-World Use of PrEP in the United States and Canada, Clinical Infectious Diseases, Volume 58, Issue 5, 1 March 2014, Pages 704–712, https://doi.org/10.1093/cid/cit796

This Photo by Unknown Author is licensed under CC BY-ND

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Preliminary Results

Main Preliminary Findings

67.39% very comfortable with reviewing sexual history

67.69% conduct sexual history face-to-face

63.08% discuss partners and practices and protection from STDs during the sexual history

59.62% discuss past history of STDs

Demographics

~49 years old

48.33% female

25% LGBTQIA

78.69% Latinx/a/o/e

47.54% practice Catholicism

Participation

6/15/2021-3/14/2022

65 consented

81.82% MD/DO

23.64% University-based practice

18.18% Public hospital/clinic

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Preliminary Results

PrEP Prescription Practices

73.92% of participants very familiar or familiar with PrEP

91.30% support providing PrEP to at risk individuals

�25.64% of participants ranked “time-consuming to counsel and assess adherence” as major barrier

38.46% of participants ranked “too costly and patients can’t afford it” as major barrier

For the Karris scale, none of the respondents answered the question as “ Have not or would not provide PrEP because (all that apply):”

Concern about compliance and future resistance

Cost/payer issues

Concerns about potentially toxic drugs in healthy persons

Insufficient evidence for efficacy of real-world PrEP

Other reasons

Therefore it was difficult to ascertain why people would not provide PrEP

The two biggest barriers identified were “too costly and patients cant afford it” at 38.46% and “time consuming to counsel and assess adherence” at 25.64%

For the two barriers discussed, there is a solution to cost and needed for counseling

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Next Steps: Reducing Barriers to PrEP Access

NEW RECOMMENDATION: All sexually active adult and adolescent patients should receive information about PrEP

Offer PrEP as a core primary care service

Reduce missed opportunities for PrEP provision

Become a PrEP provider or add widget to website/social media

https://npin.cdc.gov/preplocator

COST/Affordability

Federal Ready, Set, PrEP program (available to those below 200% FPL)

https://www.hiv.gov/federal-response/ending-the-hiv-epidemic/prep-program

Gilead Patient Support Program and other programs (addresses the uninsured)

https://www.pleaseprepme.org/payment

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Ending the HIV Epidemic in the United States for Latino LGBTQ Populations!

Diagnose all people with HIV as early as possible

Treat people with HIV rapidly and effectively to reach sustained viral suppression

�

Prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs)

Respond quickly to potential HIV outbreaks to get vital prevention and treatment services to people who need them

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Referenced Works

Bonacci, R. A., Smith, D. K., & Ojikutu, B. O. (2021). Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the US. American Journal of Preventive Medicine, 61(5), S60-S72.Garcia, M., & Saw, G. (2019). Socioeconomic disparities associated with awareness, access, and usage of Pre Exposure Prophylaxis among Latino MSM ages 21-30 in San Antonio, TX. Journal of HIV/AIDS & social services, 18(2), 206–211. https://doi.org/10.1080/15381501.2019.1607795

Garcia, M., & Saw, G. (2019). Socioeconomic disparities associated with awareness, access, and usage of Pre-Exposure Prophylaxis among Latino MSM ages 21–30 in San Antonio, TX. Journal of HIV/AIDS & social services, 18(2), 206-211.

Karris, M. Y., Beekmann, S. E., Mehta, S. R., Anderson, C. M., & Polgreen, P. M. (2014). Are we prepped for preexposure prophylaxis (PrEP)? Provider opinions on the real-world use of PrEP in the United States and Canada. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 58(5), 704–712. https://doi.org/10.1093/cid/cit796

Maiorana, Zamudio-Haas, S., Santiago-Rodríguez, E. I., Sauceda, J. A., Rodríguez-Díaz, C. E., Brooks, R. A., & Myers, J. J. (2022). HIV Disclosure Practices to Family among Mexican and Puerto Rican Sexual Minority Men with HIV in the Continental USA: Intersections of Sexual Orientation and HIV Stigma. Journal of Homosexuality, 1–25. https://doi.org/10.1080/00918369.2022.2043731

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For further information and questions:

Marisol McDaniel: marisol.d.mcdaniel@austin.utexas.edu

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Helping Patients Pay for PrEP Care

Commercially insured patients have no out-of-pocket cost for medication, clinical care, and lab tests

USPSTF Grade A recommendation

Final Recommendation Statement: Prevention of Human Immunodeficiency Virus (HIV) Infection: Preexposure Prophylaxis | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)

CMS rule

FAQS ABOUT AFFORDABLE CARE ACT IMPLEMENTATION PART 47 (dol.gov)

Uninsured persons

Healthcare.gov

Get 2022 health coverage. Health Insurance Marketplace® | HealthCare.gov

Free medication from

Ready, Set, PrEP (hiv.gov)

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Resources for Clinicians

PrEPline �855-448-7737 (855-HIV-PrEP) toll-free

Clinical care questions
Access to advanced diagnostics for

Ambiguous test results
Person who acquire HIV while prescribed PrEP

NASTAD

Billing and coding guide

https://www.nastad.org/resource/billing-coding-guide-hiv-prevention

PrEP healthcare coverage calculator

NASTAD (checkbookhealth.org)

HIV Nexus

https://www.cdc.gov/hiv/clinicians/index.html

PrEP Update Flyer

https://www.cdc.gov/hiv/pdf/clinicians/materials/cdc-hiv-FlyerPrEPUpdateProvider508.pdf

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HIV Nexus: A Clinical Resource

Serves as a one-stop hub for resources designed to support clinicians
Contains latest research and information on HIV prevention, screening, and treatment
Provides access to free continuing medical education programs
Highlights CDC guidelines and recommendations
Includes patient education materials

www.cdc.gov/HIVNexus

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Screen & Intervene: Addressing Food Insecurity

Alexandra Maria Ashbrook | Director Root Causes & Specific Populations | aashbrook@frac.org | March 26, 2022

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Food Insecurity in 2020

Source: 2020 Current Population Survey Food Security Supplement

Households with food insecurity: 10.5%

Low food security: 6.6%

Very low food security: 3.9%

Based on the annual USDA survey – Over 38 million Americans lived in households that struggled against hunger.

10.5 percent of households in America experienced food insecurity. — meaning they were, at times, unable to acquire adequate food for one or more household members because they lacked the money and other resources for food.”
6.6% of households experienced low food security — a reduction in the quality of food and
3.9% of households experience very low food insecurity – reduced quality and quantity

And as you all well know – food insecurity has serious health repercussions across the lifespan, negatively impacting the ability of children to develop and learn, as well as fueling costly and chronic health conditions, like diabetes, hypertension, poor mental health, iron deficiency, poor disease management, and more

Food insecurity: “Households were, at times, unable to acquire adequate food for one or more household members because they lacked the money and other resources for food.” Food insecurity is further divided into low food security, primarily the reduced quality of food; and very low food security, the reduced quality and quantity of food.

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Hunger: Food Insecurity, 2019 vs 2020

Source: Coleman-Jensen et al (2021)

Households with food insecurity:

Low food security:

Very low food security:

10.5%

6.4%

4.1%

6.6%

3.9%

2020

2019

People living in households with food insecurity (millions):

35.2m

38.3m

Increase of 3 million people

Now when we look at food insecurity rates before and during the pandemic – the overall rate did not change – it remained at 10.5% -that might surprise you given the terrible impact of COVID –

So why is this case? –

Well, first take into account that the data collection for the food security survey is complex and may have been disrupted by COVID-19. USDA recommends that “more research is needed to understand the dynamics of food insecurity and other food hardships in U.S. households during the pandemic.” So these rates may underestimate the extent of America’s hunger problem.

These data do shed light on how important federal aid was in mitigating the economic and food hardship during the pandemic; Things would have been a lot worse without actions to expand access to and strengthen the federal nutrition programs have played a key role in reducing hardship during the pandemic.

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Hardest Hit Populations during COVID-19

Source: Coleman-Jensen et al (2021)

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Disparities in Food Insecurity Rates

Black

Latino

National Average

Multiracial or Other Race

White

COVID-19 amplified already unacceptable rates of hunger and exacerbated pre-exisitng disparities in who goes hunger in America based on race and the ethnicity

For Black and Latino families these disproportionate rates of food insecyrity widened even more compared to White families

It is critical to our work to address hunger that we understand the root causes of these disparities and how they are distinct for different groups.

When FRAC looks at opportunities to decrease FI for Latino families, we partner with leading latino groups at the national, state, and local level and also reach out to engage people with lived expertise:

In partnership with the National Immigration Law Center, we conducted a series of focus group with Latino parents to better understand obstacles and opportunities to address food insecurity – and some of the things they shared that drove these disproportionate rates were:

lack of a pathway for citizenship and discrimination that affected employment, housing, and qualify for government programs
a host of immigration related fears that made it difficult to access nutrition programs SNAP
in some cases, language access barriers to access services
misinformation from attorneys and the media about what will happen if you participate in programs

So we know that solutions need to be centered on the experiences of the different communities experiencing food insecurity

prior to COVID-19, many members of the Latinx communities experience a host of immigration-related fears discrimination from immigration enforcement and the 2019 public charge rule (blocked permanently in March 2021), resulting in the distrust of public services.

This has had important implications for program participation and access to vaccines during COVID-19.

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The Federal Nutrition Programs

Supplemental Nutrition Assistance Program (SNAP)
Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)
Childcare Meals (CACFP)
School Breakfast & Lunch
Afterschool Meals
Summer Meals
Pandemic EBT(During COVID-19)

All Ages

Pregnant women, children 0 – 5 yo

Daycare

School Age

A key to addressing food insecurity is connecting families to the federal nutrition programs – and working the strengthen these programs and ensure that all people regardless of immigration status can access these programs.

So I want you all to reflect back on how rates for food insecurity remained at about 10.5 in 2019 and 2020 – and while their are data constraints - -one thing we do know is that

that things would be far worse without federal aid (like stimulus payments, ACA expansion, the child tax credits,) and enhancements to the federal nutrition programs.

The federal nutrition programs have played a key role in reducing hardship during the pandemic. All these programs can readily expand to meet need bc entitlement programs – And while 80% of the 60 million Latinos in the US are citizens, I did want to lift up some immigration-related concerns that impact participation and impact our work to connect families to programs and ensure that no one in America goes hungry.

The good news is that all the programs – school meals, wic, child care meal - are available to any eligible child or older adult – there is no citizenship test.

So all l the nutrition programs except SNAP are available to people regardless of immigration status. Even though SNAP is available to certain “qualified” immigrants, too many eligible immigrants do not participate. Parents who are not eligible for SNAP can still apply for an eligible child but too often do not feel safe doing so because of misinformation and immigration-related fears. It is our job to make sure we give families accuare info. so they can access whether to participate or not.

There are about 60 million Latinos in the US and nearly 80% are latinos many US citizens and do not have to worry about their own immigration issues. Immigration related issues impact us all

https://www.unidosus.org/facts/statistics-about-latinos-in-the-us-unidosus/

SNAP is available to “qualified immigrants” which includes:

adults who have been LPRs for five years or have 40 quarters of qualifying work
refugees and aslylees
and children who are LPRs

It’s important to note that in mixed status families – a parent who may not be eligible for SNAP can apply for their child

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Benefits of the Federal Nutrition Programs

Reduce poverty

Reduce

food insecurity

Improve dietary quality

Protect

against obesity

Improve health & well-being

Source: Harline-Grafton, H., Henchy, G. 2017. The Role of the Federal Child Nutrition Programs in Improving Health and Well-Being, Food Research & Action Center. Washington D.C.

Before the pandemic – these programs have reams and reams of research on their tremendous benefits to health and well-being.

During the pandemic these benefits were leveraged by government action:

SNAP benefits were temporarily increased and application process was made easier
School meals were made available free for all families and when school were closed families could get P-EBT benefits to make up for the loss of school meals
WIC benefits included more funding for more fruits and vegetables

These programs responded in ways that protected families from even greater hardships

***********************

WIC reduces the prevalence of household food insecurity by at least 20 percent, based on a national sample of children under the age of 5 who lived in households that were income-eligible for WIC.

Pregnant women experiencing household food insecurity with hunger who enroll in WIC in the first or second trimester (versus the third trimester) have a reduced risk of any food insecurity post-partum.

Families receiving housing subsidies, SNAP, and WIC benefits were 72 percent more likely to be housingsecure (i.e., defined as living without overcrowding or frequent moves within the last year), compared to those families receiving housing subsidies alone, based on a study of low-income caregivers of children younger than 3 years old.

WIC participation is associated with better dietary intake and overall dietary quality, including increased iron density of the diet, increased consumption of fruits and vegetables, greater variety of foods consumed, and reduced added sugar intake

Multiple studies link the revised WIC food packages with improvements in overall dietary quality and the consumption of fruits, vegetables, whole-grains, and lower-fat milk.130,131,132 Research also finds improvements in infant feeding practices in terms of the appropriate introduction of solid foods as well as increases in breastfeeding initiation.

Overweight and obesity rates declined modestly among young children enrolled in New York state’s WIC program within three years of introducing the revised WIC food packages.143 Other research suggests WIC may protect against obesity among young children in families facing multiple stressors (i.e., household food insecurity and caregiver depressive symptoms).

A study set in eight New York City-area primary care practices found that food insecurity was significantly associated with increased BMI only among those women who were not receiving food assistance (SNAP or WIC), suggesting that food assistance program participation plays a protective role against obesity among foodinsecure women.

WIC enrollment and greater WIC food package utilization during pregnancy are associated with improved birth outcomes, including lower risk of preterm birth, low birth weight, and perinatal death.151 Similarly, prenatal WIC participation is associated with lower infant mortality rates, especially for African-Americans.152

Compared to low-income non-participants, young children participating in SNAP, WIC, or both programs have lower rates of anemia, nutritional deficiency, and failure to thrive, and lower risk of abuse and neglect, based on administrative data from more than 350,000 children in Illinois.

Prenatal and early childhood participation in WIC is associated with stronger cognitive development at age two, and better performance on reading assessments in elementary school, leading researchers to conclude that “these findings suggest that WIC meaningfully contributes to children’s educational prospects.

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Screen and Intervene: Opportunities for Health Provides

And many health providers were instrumental in connecting families to these programs – to help providers engage in this work FRAC partnered with the American Academy of Pediatrics to create a tool kit to:

Screen for food insecurity and then intervene by connecting patients to the federal nutrition programs.

And I suspect that many of you in this room are doing this work — in our Q & A session, I look forward to hearing more ideas on how we can engage Latino families and medical professionals more in this work.

I did want highlight a few resources that we have related to toolkit that can help make this work more response to the needs of the Latino community:

create a hunger champion in your practice who ideally understands the culture, language, and other needs of your patient community
get informed information on immigration -related issues in accessing programs
partner with community that are trusted by the Latino community
make sure your materials are translated

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And last but not least – we are working to highlight opportunities for dr’s to do this work to address food insecurity and malnutrition in a sustainable manner including getting reimbursed for this important work –

And there’s great news on that front – CMS has improved

the inclusion the first nutrition-related improvement MIPS improvement activity supporting comprehensive nutrition risk and food insecurity risk identification and treatment. Please make sure to check out the Malnutrition Quality Improvement website for more information

I also wanted to share from Andie Lee Gonzalez, PhD, MPH, RDN, LD, FAND

2021-2022 Texas Academy of Nutrition and Dietetics Delegate

2021-2022 Latinos and Hispanics in Dietetics and Nutrition Chair

2021-2022 Unidos Contra La Diabetes Co Chair

This presentation sounds like a great one! I hope I can attend.

Not sure the context but it would be great to elaborate how important preventative services like Medical Nutrition Therapy can be an access point for nutrition education and prevention/treatment (malnutrition) for our Hispanic/Latino/x community. There are a few bills currently that we are encouraging our Congressman to consider. I’ve listed them below. We need more allies and collaborative approach to these.

HR. 3108 Medical Nutrition Therapy Act of 2021
HR. 5804 Expanding Access to Diabetes Self-Management Training Act
HR. 1577 Treat and Reduce Obesity Act

I am planning to attend NHMA on 25^th and 26^th for the Gala maybe we can connect. It’ll be a short trip as I will be going to ASPEN right after for work.

Again, on behalf of LAHIDAN we look forward to seeing how we can help support future opportunities.

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