Farmworkers face significant disease burden. Meanwhile, farmworker healthcare utilization is low. This study examined individual, environmental, and policy level correlates of U.S. farmworker healthcare utilization, guided by the Behavioral Model for Vulnerable Populations and the Ecological Model. The 2006-2008 administrations of the National Agricultural Workers Survey (NAWS) (N=4,891) provided the primary data for this cross-sectional study. Geographic Information Systems, the 2005 and 2006 Uniform Data System, and rurality/border proximity indices provided environmental variables. To identify factors associated with healthcare use, logistic regression was performed using Hierarchical Linear Modeling. Probability weights were applied in descriptive, bivariate, and multivariate analyses. The alpha level was set at .05 for all analyses. The majority of farmworkers were Hispanic (80.0%) and male (78.4%), with an average age of 35.6 (SE=.3) years. Annual family income (M=22,668.0; SE=304.9) and educational attainment (M=7.7; SE=.1) were low. Just over half (57.3%) used formal U.S. healthcare in the previous two years. Multiple factors were independently associated with healthcare use in multilevel models (all in the expected direction), including, at the individual level: sex, immigration and migrant status, English proficiency, access to transportation, and need; at the environmental level: total FQHC full-time equivalent medical professionals/staff and U.S.-Mexico border proximity; and, at the policy level: insurance status and payment structure. Findings were consistent with those from previous studies of Hispanic populations, as well as the limited literature documenting healthcare use correlates for farmworkers. Numerous individual and policy level moderators of associations between environmental level variables and healthcare use were identified. Using Stata, rates of healthcare use among farmworkers were compared to those among U.S. and other subpopulations with similar sociodemographic characteristics (from the 2006 Medical Expenditure Panel Survey). Rates of use were significantly lower for farmworkers than for the U.S. and low-income populations. However, they were significantly higher than rates for U.S. Hispanics and a comparison group (i.e., Hispanic, low income, and no educational degree). The low rate of use is concerning due to farmworkers' disproportionate disease burden. Multilevel recommendations for change, emphasizing change to the FQHC system, are made so that healthcare access can be improved for this vulnerable population

Purpose of the study

Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI).

Design and methods

Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors.

Results

Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year -0.19 vs -0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year -0.19 vs -0.49 hours/week; interaction p = .01).

Implications

The less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.