Alexis J. Handal

Latine immigrants in the U.S. face discrimination, a lack of access to resources, fear of deportation, family separation, and a lack of understanding of the complex factors that have led them to seek safety and survival in a new country, factors that critically impact their mental health. Academic and community partners implemented the Immigrant Well-Being Project (IWP), a mental health intervention that partners community-based organizations (CBOs) and universities to bring Latine immigrants and university students together to engage in mutual learning and social change efforts. We assessed the feasibility of the IWP model and preliminary outcomes from a pilot implementation with three cohorts of Latine immigrant adults (N = 54) between 2018 and 2021. Employing a within-group longitudinal, mixed-methods design with qualitative interviews and quantitative surveys over 12 months (pre-intervention, post-intervention, and 6-month follow-up), we examined engagement and the impact of the 6-month intervention, as well as explored feasibility/acceptability and participants’ experiences. Multilevel growth modeling revealed significant decreases in depression and anxiety symptoms and difficulty accessing resources, with dosage and cohort significantly moderating intervention effects on these variables. Some cohorts also experienced significant decreases in PTSD symptoms and increases in satisfaction with resources. Qualitative results revealed that having student and CBO support navigating services positively impacted mental health, which highlights the importance of connecting immigrants to existing community resources. Findings are discussed in the context of COVID-19 and hostile immigration policies, emphasizing the importance of addressing social–structural determinants of mental health for immigrants.

Background: The Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture (SEMILLA) is a community-based birth cohort study carried out in the Cayambe, Pedro Moncayo region, Ecuador, with intensive industrial floricultural activity. Maternal occupational and environmental pesticide exposure was assessed among three groups of pregnant women stratified according to "maternal occupational activity" at the time of recruitment. This article describes the recruitment process and strategies used, determines their effectiveness in targeting pregnant women with different levels of exposure, and discusses reasons that influenced recruitment rates. Methods: The projected sample was stratified into three occupational activity groups: floricultural/agricultural workers, non-agricultural workers, and non-workers (women not working outside the home for pay). Recruitment strategies include community activities, collaboration with health care providers, information from obstetric records (“Obstetric Census”), and non-monetary recognition. Analyses were conducted by occupational activity at the time of recruitment. Recruitment rates were calculated by occupational group. Monitoring indicators included the number and percentage of participants recruited by strategy. Wilcoxon rank-sum test and Fisher's exact test were used to compare characteristics between eligible and participating pregnant women; the Kruskal–Wallis test was used to compare among participant groups. Results: A total of 409 participants were recruited, 74% of floricultural/agricultural workers, 81% of non-agricultural workers, and 64.5% of non-workers. The strategy that referred the highest number of participants was the “non-monetary recognition” (60.9%), proving its effectiveness for recruiting floricultural/agricultural and non-agricultural workers (74.5% and 67.7%, respectively). The “Obstetric Census” was the second most important strategy (30.6%), especially effective in recruiting non-workers (49.6%). Compared to floricultural/agricultural and non-agricultural workers, non-workers were younger ( p < 0.001) and had a significantly higher average number of prenatal check-ups ( p = 0.0006). Floricultural/agricultural workers had a significantly higher average number of pregnancies and living children than the other two groups ( p > 0.01). Time restrictions among women working outside the home for pay, and lack of autonomy among non-workers, were crucial factors that limited participation in the study. Conclusions: Stratifying recruitment by comparability groups requires differentiated strategies. Understanding living conditions and the social context of the study region are critical to effectively targeting recruitment efforts.

Background: Ethylenebisdithiocarbamates, widely used in floriculture, degrade into ethylenethiourea (ETU), a teratogen. The SEMILLA study investigates prenatal ETU exposure and infant health in Ecuador’s flower-growing region. This analysis examines whether prenatal ETU metabolite levels differ by work sector and whether maternal urinary ETU increases with longer work hours. Methods: Participants (agricultural workers, non-agricultural workers, and non-workers) provided baseline urine samples, which were processed and stored for ETU analysis. Surveys captured ETU exposure predictors. Regression models assessed associations between work sector, weekly work hours, and urinary ETU levels (specific gravity-corrected), controlling for key covariates. Results: The sample includes 111 agricultural workers (92% floriculture), 149 non-agricultural workers, and 149 non-workers. At baseline, maternal age averaged 27 years (SD = 5.8) and gestational age 15 weeks (SD = 3.2). Urinary ETU_SG levels were elevated across the sample (geometric mean: 3.38 µg/L). Agricultural workers had significantly higher ETU_SG levels than others (5.61 vs. 3.07 and 2.57 µg/L; p < 0.001). Among agricultural workers, ETU_SG levels increased with weekly hours (B = 0.288, p = 0.001). Conclusions: Agricultural work strongly predicts higher prenatal ETU exposure, with evidence of a dose–response relationship. Research on prenatal fungicide exposure and infant health among pregnant workers is limited. Findings highlight the need for targeted interventions to protect pregnant workers and infant health.

Retention in birth cohort studies varies globally, with rates of over 80% in high-income countries and 30%-75% in low- and middle-income settings due to socioeconomic vulnerability, geographic dispersion, and infrastructural barriers. Despite the importance of participant retention, evidence on structured tracking systems contextualized to these settings remains limited. This paper describes the design, adaptations, and outcomes of a participant tracking system developed for the Study of Environmental Exposure of Mothers and Infants Impacted by Large-Scale Agriculture, a community-based birth cohort that enrolled 409 pregnant participants in a floriculture-intensive rural area of Ecuador. In this setting, retention was challenged by informal employment, variable phone access, and high mobility. The tracking system was implemented from pregnancy through 18 months postpartum, including two final follow-up waves conducted at 12 and 18 months. It comprised a predefined follow-up schedule, a team with defined roles, a real-time digital planner for recording contact attempts, participation status, and activity completion, and a five-tier participation classification. Tracking was conducted through office visits, phone calls, and home visits. Flexible protocols and targeted outreach addressed pandemic-related disruptions and irregular work schedules. Overall retention was 77%, with 84% and 75% at 12 and 18 months, respectively. Partial refusals (27%) were primarily linked to mobility and work demands, while 94 participants fully discontinued. Home visits enabled completion for 154 participants, with an 88% success rate. This experience illustrates how context-adapted tracking systems can sustain high retention in rural settings, offering a scalable model to inform global health research in underserved populations.

Agricultural work presents significant physical and social challenges globally and in the United States, with women farmworkers facing unique risks that remain underexplored. This study examines the social and occupational hazards confronted by women farmworkers in Michigan using data from the Michigan Farmworker Project. In‐depth interviews with farmworkers were thematically analyzed. Results highlight five main dimensions of working and living conditions: gender‐based discrimination, sexual harassment, reproductive health concerns, pregnancy challenges, and work‐life balance issues. Women and men participants (n = 35; average age of 42 years; 57% women) reported hazardous and exploitative conditions including sexual harassment, chemical exposures, and challenges with proper hygiene and sanitation—especially during menstruation—including lack of bathroom access and other problems leading to urinary tract infections. Participants discussed pregnancy‐specific concerns and concerns regarding work‐life balance and childcare (i.e., insufficient time for family, challenges with coordination of childcare). Findings underscore the need for policies to address these disparities, especially for single women farmworkers. Interventions and policies informed by this study can improve the well‐being of women workers and their families in agricultural settings.

Background/Objectives: Women of childbearing age not only reside in agricultural communities but also form an integral part of the agricultural labor force. Limited research investigates the impact of prenatal fungicide exposure on infant health, specifically ethylenebisdithiocarbamates and their toxic by-product, ethylenethiourea (ETU), particularly in occupational settings. This paper describes the background, aims, protocol, and baseline sample characteristics for the SEMILLA study, which investigates prenatal ETU exposure, neonatal thyroid function, infant growth, and neurobehavioral development in an agricultural region of Ecuador. Methods: This cohort study follows pregnant women and their infants up to 18 months of age, incorporating urinary biomarkers and survey data on ETU exposure and infant growth and neurodevelopmental measures. Data collection includes detailed questionnaires, scales, and physical examinations on maternal and infant health and development, as well as environmental factors. Descriptive statistics on key characteristics of the study population at baseline are presented. Results: SEMILLA enrolled 409 participants (72% enrollment rate): 111 agricultural workers (mostly floricultural), 149 non-agricultural workers, and 149 non-workers. Baseline characteristics show comparability between work sector groups, with some economic differences. Conclusions: SEMILLA will provide key evidence on prenatal fungicide exposure and infant development and encompass comprehensive multistage data collection procedures in pregnancy and infancy, focusing on structural and social determinants of health as well as individual-level chemical exposures. The community-based approach has proven essential, even amid challenges like the COVID-19 pandemic. The medium-term objective is to inform sustainable interventions promoting maternal and child health, with a long-term goal to reduce community exposures and improve worker health policies, particularly for women and pregnant workers.

Precarious employment is an important social determinant of health inequities. Through in-depth qualitative interviews ( n = 35), we examine precarious employment and labor exploitation, their potential impact on the working environment, and, ultimately, the health of farmworkers. We present results from the community-based participatory Michigan Farmworker Project. Our analysis identified dimensions of precarious employment and labor exploitation that involved lacking access to fundamental labor and social rights—including dehumanization—discriminatory occupational practices, and insufficient access to health care and social benefits. Policy reform is needed to address precarious employment and labor exploitation among farmworkers due to their potential long-lasting health effects.

Migration processes encompass uncertainty, discrimination, racism, stigma, social isolation, lack of access to resources, fear of deportation, and family separation, having a critical impact on the health of Latinx/@ immigrants in the United States. It is essential to accurately measure the ways in which social, legal, economic, and political contexts impact mental health. This article discusses adaptation and use of discrimination and historical loss measures in a multilevel community-based advocacy, learning, and social support intervention (Immigrant Well-Being Project) with Latinx/@ immigrants in New Mexico, using participatory research approaches. Participants (n = 52) were recruited through community partner organizations and completed four qualitative and quantitative interviews over a 12-month period. The present analysis draws on the baseline quantitative data. Results show it is possible to adapt standardized measures of discrimination developed to assess the experiences of other racial/ethnic groups; however, the most common responses involved response options added by our research team. For the historical loss instrument, there was a high frequency of "never" answers for many items, suggesting that they were not relevant for participants or did not capture their experiences of loss. As with the discrimination measures, the items we added resonated the most with participants. The contexts of discrimination and loss for Latinx/@ immigrant populations are complex, thus the tools we use to measure these experiences and their impact on health must account for this complexity. This study contributes to these endeavors through involving community members in the conceptualization and measurement of discrimination and historical loss among Latinx/@ immigrants. Public Policy Relevance Statement Latinx/@ immigrants comprise a heterogeneous population with diverse backgrounds and social-cultural-political contexts that affect their experiences in the United States. Understanding this complexity and its impact on health and health disparities requires accurate measurement of Latinx/@ immigrants' experiences. This study contributes to these efforts through the adaptation of measures of discrimination and historical loss, which can improve researchers' abilities to inform more sustainable and effective health promotion policies. Policies must reflect lived experiences more accurately to have meaningful and sustainable impacts.