Organizational environments may encourage community health workers (CHWs) to engage community mem... more Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.
This mixed-methods study explores community health worker (CHW) engagement in professional advoca... more This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.
Public health scholars have called for research into the impact of state level immigration polici... more Public health scholars have called for research into the impact of state level immigration policies on the public's health and have recognized these policies may exacerbate existing racial and ethnic disparities among immigrant populations and their co-ethnics. Objective: The purpose of this study was to apply the theory of everyday violence to explore immigration policy and militarization of the US-Mexico border as a structural determinant of health. Methods: Through qualitative and quantitative data, the prevalence and type of direct and indirect experiences of immigration related ethno- racial profiling, mistreatment and resistance to institutionalized victimization were explored among 499 Mexican border farmworkers during the years 2005-2007. Results: Farmworkers were predominately US citizens and permanent residents with more than two decades working in US agriculture. Approximately 25% described a personally experienced and/ or witnessed immigration related mistreatment en...
The community health worker (CHW) movement has deep roots in Arizona, beginning in the 1960s with... more The community health worker (CHW) movement has deep roots in Arizona, beginning in the 1960s with Community Health Representatives in tribal communities and the Promotora movement beginning in the 1980s. In 1998, the University of Arizona conducted the first national study of CHWs and provided a national description of the workforce including core roles and competencies and subsequent research from 1999 forward has provided a strong evidence base for the effectiveness of CHWs in chronic disease and community advocacy to reduce health disparities. While for over a decade the Arizona Community Health Outreach Workers Network (AZCHOW), the Red de Promotoras and the HOPE and HEART Networks have connected CHWs throughout the state. Despite this long history, no one person, agency or network seems to have found “the magic pill” to ensure continuity of programs or long-term sustainability of this vital workforce in our state. In April 2013 in direct response to these issues and emerging po...
Mexican-descent persons living at the border have high rates of diabetes. Health consequences are... more Mexican-descent persons living at the border have high rates of diabetes. Health consequences are further exacerbated by SES and health care access disparities, and within Arizona, an intense socio-political environment associated with immigration enforcement. This work examines context-relevant stressors as well as a more general stress and mental health problems, in relating to diabetes. The participants are from proportional household samples of adult Latino farmworkers (Southwest Arizona; N=299) and of Latino adults (Southeast Arizona; N = 648). The data were part of community-based participatory research involving diverse partnerships of academics, promotoras and other community advocates, and other public health professionals requesting surveillance, programmatic and policy-related data. Response rates were over 85%, a testament to the community partnerships and strong community rapport. Except for social-ecologic stress (1st sample only; from the Border Community and Immigrat...
Public health advocacy is by necessity responsive to shifting political climates and thus a chall... more Public health advocacy is by necessity responsive to shifting political climates and thus a challenge of advocacy research is that the intervention must by definition be flexible. Moving beyond the classification of advocacy efforts to measurable indicators of policy change and outcomes therefore requires a dynamic research approach. In this presentation, we will engage in a critical reflection on the use of the community based participatory research approach (CBPR) to develop and measure the impact of Accin, a community advocacy intervention in which community health workers (CHWs) engage community members in making positive changes to their communities. The Kingdon 3-streams model of policy change provided a theoretical framework for the Accin intervention. Research and community partners collaboratively developed research methods to identify and collect Accin intervention data. Over the course of the intervention, the flexible nature of CBPR led to the integration of additional d...
Service learning (SL) is a form of community-centered experiential education that places emerging... more Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community-campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities.
Public policy that seeks to achieve sustainable improvements in the social determinants of health... more Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
The Community Health Worker model is recognized nationally as a means to address glaring inequiti... more The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.
Journal of immigrant and minority health / Center for Minority Public Health, 2012
Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-l... more Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed ...
Background: The militarization of the US–Mexico border region exacerbates the process of “Otherin... more Background: The militarization of the US–Mexico border region exacerbates the process of “Othering” Latino immigrants – as “illegal aliens.” The internalization of “illegality” can manifest as a sense of “undeservingness” of legal protection in the population and be detrimental on a biopsychological level.
Objective: We explore the impacts of “illegality” among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law.
Methods: Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, “Challenges to Farmworker Health at the US–Mexico Border” study, a community-based participatory research project conducted at the Arizona–Sonora border, we compared Arizona resident farmworkers (N = 349) to Mexico-based farmworkers (N = 140) or Transnational farmworkers who cross the US–Mexico border daily or weekly to work in US agriculture.
Results: Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear.
Conclusion: The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi-institutional and community-centered systems for reporting immigration-related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and permanent residents.
Organizational environments may encourage community health workers (CHWs) to engage community mem... more Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.
This mixed-methods study explores community health worker (CHW) engagement in professional advoca... more This mixed-methods study explores community health worker (CHW) engagement in professional advocacy. Data from the National Community Health Worker Advocacy Survey (n = 1661) assessed the relationship between CHW professional advocacy and CHW demographics, and work characteristics. Qualitative data articulated the quality of professional advocacy efforts. Approximately, 30% of CHW respondents advocated for professional advancement or collaborated with other CHWs to advance the workforce. Advocacy was more prevalent among CHWs affiliated with a professional network. CHW advocacy targeted recognition of the field, appropriate training and compensation, and sustainable funding. CHW professional advocacy is imperative to advancement of the field.
Public health scholars have called for research into the impact of state level immigration polici... more Public health scholars have called for research into the impact of state level immigration policies on the public's health and have recognized these policies may exacerbate existing racial and ethnic disparities among immigrant populations and their co-ethnics. Objective: The purpose of this study was to apply the theory of everyday violence to explore immigration policy and militarization of the US-Mexico border as a structural determinant of health. Methods: Through qualitative and quantitative data, the prevalence and type of direct and indirect experiences of immigration related ethno- racial profiling, mistreatment and resistance to institutionalized victimization were explored among 499 Mexican border farmworkers during the years 2005-2007. Results: Farmworkers were predominately US citizens and permanent residents with more than two decades working in US agriculture. Approximately 25% described a personally experienced and/ or witnessed immigration related mistreatment en...
The community health worker (CHW) movement has deep roots in Arizona, beginning in the 1960s with... more The community health worker (CHW) movement has deep roots in Arizona, beginning in the 1960s with Community Health Representatives in tribal communities and the Promotora movement beginning in the 1980s. In 1998, the University of Arizona conducted the first national study of CHWs and provided a national description of the workforce including core roles and competencies and subsequent research from 1999 forward has provided a strong evidence base for the effectiveness of CHWs in chronic disease and community advocacy to reduce health disparities. While for over a decade the Arizona Community Health Outreach Workers Network (AZCHOW), the Red de Promotoras and the HOPE and HEART Networks have connected CHWs throughout the state. Despite this long history, no one person, agency or network seems to have found “the magic pill” to ensure continuity of programs or long-term sustainability of this vital workforce in our state. In April 2013 in direct response to these issues and emerging po...
Mexican-descent persons living at the border have high rates of diabetes. Health consequences are... more Mexican-descent persons living at the border have high rates of diabetes. Health consequences are further exacerbated by SES and health care access disparities, and within Arizona, an intense socio-political environment associated with immigration enforcement. This work examines context-relevant stressors as well as a more general stress and mental health problems, in relating to diabetes. The participants are from proportional household samples of adult Latino farmworkers (Southwest Arizona; N=299) and of Latino adults (Southeast Arizona; N = 648). The data were part of community-based participatory research involving diverse partnerships of academics, promotoras and other community advocates, and other public health professionals requesting surveillance, programmatic and policy-related data. Response rates were over 85%, a testament to the community partnerships and strong community rapport. Except for social-ecologic stress (1st sample only; from the Border Community and Immigrat...
Public health advocacy is by necessity responsive to shifting political climates and thus a chall... more Public health advocacy is by necessity responsive to shifting political climates and thus a challenge of advocacy research is that the intervention must by definition be flexible. Moving beyond the classification of advocacy efforts to measurable indicators of policy change and outcomes therefore requires a dynamic research approach. In this presentation, we will engage in a critical reflection on the use of the community based participatory research approach (CBPR) to develop and measure the impact of Accin, a community advocacy intervention in which community health workers (CHWs) engage community members in making positive changes to their communities. The Kingdon 3-streams model of policy change provided a theoretical framework for the Accin intervention. Research and community partners collaboratively developed research methods to identify and collect Accin intervention data. Over the course of the intervention, the flexible nature of CBPR led to the integration of additional d...
Service learning (SL) is a form of community-centered experiential education that places emerging... more Service learning (SL) is a form of community-centered experiential education that places emerging health professionals in community-generated service projects and provides structured opportunities for reflection on the broader social, economic, and political contexts of health. We describe the elements and impact of five distinct week-long intensive SL courses focused on the context of urban, rural, border, and indigenous health contexts. Students involved in these SL courses demonstrated a commitment to community-engaged scholarship and practice in both their student and professional lives. SL is directly in line with the core public health value of social justice and serves as a venue to strengthen community-campus partnerships in addressing health disparities through sustained collaboration and action in vulnerable communities.
Public policy that seeks to achieve sustainable improvements in the social determinants of health... more Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
The Community Health Worker model is recognized nationally as a means to address glaring inequiti... more The Community Health Worker model is recognized nationally as a means to address glaring inequities in the burden of adverse health conditions that exist among specific population groups in the United States. This study explored Arizona CHW involvement in advocacy beyond the individual patient level into the realm of advocating for community level change as a mechanism to reduce the structural underpinnings of health disparities. A survey of CHWs in Arizona found that CHWs advocate at local, state and federal political levels as well as within health and social service agencies and business. Characteristics significantly associated with advocacy include employment in a not for profit organization, previous leadership training, and a work environment that allows flexible work hours and the autonomy to start new projects at work. Intrinsic characteristics of CHWs associated with advocacy include their belief that they can influence community decisions, self perception that they are leaders in the community, and knowledge of who to talk to in their community to make change. Community-level advocacy has been identified as a core CHW function and has the potential to address structural issues such as poverty, employment, housing, and discrimination. Agencies utilizing the CHW model could encourage community advocacy by providing a flexible working environment, ongoing leadership training, and opportunities to collaborate with both veteran CHWs and local community leaders. Further research is needed to understand the nature and impact of CHW community advocacy activities on both systems change and health outcomes.
Journal of immigrant and minority health / Center for Minority Public Health, 2012
Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-l... more Understanding contemporary socio-cultural stressors may assist educational, clinical and policy-level health promotion efforts. This study presents descriptive findings on a new measure, the border community and immigration stress scale. The data were from two community surveys as part of community based participatory projects conducted in the Southwestern US border region. This scale includes stressful experiences reflected in extant measures, with new items reflecting heightened local migration pressures and health care barriers. Stressors representing each main domain, including novel ones, were reported with frequency and at high intensity in the predominantly Mexican-descent samples. Total stress was also significantly associated with mental and physical health indicators. The study suggests particularly high health burdens tied to the experience of stressors in the US border region. Further, many of the stressors are also likely relevant for other communities within developed ...
Background: The militarization of the US–Mexico border region exacerbates the process of “Otherin... more Background: The militarization of the US–Mexico border region exacerbates the process of “Othering” Latino immigrants – as “illegal aliens.” The internalization of “illegality” can manifest as a sense of “undeservingness” of legal protection in the population and be detrimental on a biopsychological level.
Objective: We explore the impacts of “illegality” among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law.
Methods: Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, “Challenges to Farmworker Health at the US–Mexico Border” study, a community-based participatory research project conducted at the Arizona–Sonora border, we compared Arizona resident farmworkers (N = 349) to Mexico-based farmworkers (N = 140) or Transnational farmworkers who cross the US–Mexico border daily or weekly to work in US agriculture.
Results: Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear.
Conclusion: The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi-institutional and community-centered systems for reporting immigration-related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and permanent residents.
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Papers by Samantha Sabo
Objective: We explore the impacts of “illegality” among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law.
Methods: Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, “Challenges to Farmworker Health at the US–Mexico Border” study, a community-based participatory research project conducted at the Arizona–Sonora border, we compared Arizona resident farmworkers (N = 349) to Mexico-based farmworkers (N = 140) or Transnational farmworkers who cross the US–Mexico border daily or weekly to work in US agriculture.
Results: Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear.
Conclusion: The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi-institutional and community-centered systems for reporting immigration-related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and permanent residents.
Objective: We explore the impacts of “illegality” among a population of US citizen and permanent resident farmworkers of Mexican descent. We do so through the lens of immigration enforcement-related stress and the ability to file formal complaints of discrimination and mistreatment perpetrated by local immigration enforcement agents, including local police authorized to enforce immigration law.
Methods: Drawing from cross-sectional data gathered through the National Institute of Occupation Safety and Health, “Challenges to Farmworker Health at the US–Mexico Border” study, a community-based participatory research project conducted at the Arizona–Sonora border, we compared Arizona resident farmworkers (N = 349) to Mexico-based farmworkers (N = 140) or Transnational farmworkers who cross the US–Mexico border daily or weekly to work in US agriculture.
Results: Both samples of farmworkers experience significant levels of stress in anticipation of encounters with immigration officials. Fear was cited as the greatest factor preventing individuals from reporting immigration abuses. The groups varied slightly in the relative weight attributed to different types of fear.
Conclusion: The militarization of the border has consequences for individuals who are not the target of immigration enforcement. These spillover effects cause harm to farmworkers in multiple ways. Multi-institutional and community-centered systems for reporting immigration-related victimization is required. Applied participatory research with affected communities can mitigate the public health effects of state-sponsored immigration discrimination and violence among US citizen and permanent residents.