Health In Mexico Research Articles

Characteristics and health conditions in older people who work in Mexico. A comparative analysis between cohorts and sex.

The study of the work and health of older adults is limited but relevant considering that the living and health conditions in which they age are not the best in Mexico, given the job insecurity that does not access to decent contributory pensions. To analyse the differences in the sociodemographic, labour and health conditions characteristics of two cohorts of older people aged 65 to 74 years who are employed in the labour market. Analysis of the National Study of Health and Aging in Mexico for 2001 and 2021 of sociodemographic and work characteristics and health conditions by cohort and sex. Logistic regression models, whose dependent variable was the birth cohort, were estimated. 1,115 people from 2001 and 1,189 from 2021 between 65 and 74 years old who worked the week before the study were included. By sex and cohort, findings are presented. Although the schooling of older people in the most recent cohort has increased, women face more precarious working conditions and a higher prevalence of disability.

Epidemiological Studies on COVID-19 and Mental Health in Mexico: Better Methodology for Better results: a Literature Review

Background. Updated information is required on studies conducted in Mexico on the mental health consequences of COVID-19. Objective. In comparison with previous efforts, we increased the timeframe of the literature search to February 2023 and used a larger list of potential mental health outcomes. Method. We used common international literature databases and more local databases, such as SciELO, and the Biblioteca Virtual en Salud (BVS). We focussed on the methodological issues of these studies, their prevalence estimates and suspected risk factors. Results. We reported on ninety-five studies that included Mexican data on symptoms of alcohol use, anxiety, depression, gaming, sleep problems and suicidal thoughts and behaviours. In most cases, we found a cross-sectional survey with self-reported information on mental health symptoms usually although not always with validated screening instruments and scales. These studies were implemented on websites, and sometimes over the phone, on self-selected volunteers. We found a small subset of fourteen longitudinal datasets (for alcohol use, anxiety, depression, and suicidal thoughts and behaviours) that suggested a more cautious interpretation of the effects of the COVID-19 pandemic on the mental health of Mexicans. Discussion and conclusion. Although the initial rapid studies during the early phases of the pandemic yielded warning signs, they did not necessarily follow standard epidemiological principles. Methodological improvements are required for future studies on the mental health consequences of natural, man-made disasters and epidemic contingencies.

Critical success factors for ergonomics programs and their relationship to benefits of health and safety in Mexico’s manufacturing industries

This research determines the critical factors for implementing ergonomics programs related to health and safety benefits in the manufacturing industries of Ciudad Juarez, Mexico, from the middle/upper management perspective. The sample was non-probabilistically selected for convenience, comprising individuals in middle and senior management positions. An original questionnaire containing 105 items measuring five latent variables was developed, reviewed, and validated for data collection. The sample size totalled 206 participants. Structural equation models using partial least squares (PLS) were employed to analyse interrelationships between variables. This research demonstrated acceptable reliability and quality indices. Management commitment emerged as the most significant factor, exerting the highest direct, indirect, and total effects on the work environment and prevention activities, significantly enhancing health and safety benefits. Consequently, manufacturing companies in Juarez City must strive to improve management commitment in the working environment and prevention activities since both strategies can increase employee health and safety benefits.

Dengue, rabies and measles in the post-COVID-19 pandemic era

After the COVID-19 pandemic, efforts have gradually been focused on medical care, epidemiological surveillance, and preventive health programs. An example of this is the identification during 2023 by the Epidemiological Surveillance System [of Mexico] of the increase in dengue cases and the presence of serotype 3, as well as cases of measles (imported and related to importation) and, at the same time, cases of human rabies with transmission from pet animals. Mexico's health system has been characterized by achievements in vaccine-preventable pathologies, as well as the robust epidemiological surveillance system for febrile exanthematous illness and vector-transmitted diseases. In this essay, the previous and current situation of selected diseases in Mexico in the post-pandemic stage of COVID-19 is presented.

The Mental Health Provider Shortage in the Mexican Public Sector: 2023 estimates of psychiatrists and psychologists

Introduction. Mental health has historically been overlooked in public policies in Mexico, with up to 80% of people with mental health and substance-related disorders in Mexico lacking adequate care. Objective. To characterize the mental health provider (psychiatrists and psychologists) shortage in the Mexican public sector. Method. Descriptive study. Data from SINERHIAS (Ministry of Health of Mexico) up to the first half of 2023 were analyzed. Results. A total of 1,504 psychiatrists worked in the public sector (1.1 per 100,000 population). The Health Ministry (Secretaría de Salud; Spanish acronym SS) employed 55.9%, IMSS 25.9%, ISSSTE 7.2%, while 1.0% were affiliated to other public institutions. There were 8,668 psychologists in the public sector (6.9 per 100,000 population), of which the SS employed 78.9%, IMSS 6.3%, ISSSTE 2.4%, while 12.3% worked at other public institutions. Thirty-four per cent of psychiatrists were in Mexico City, while 21 states, accounting for 70% of the population, had one psychiatrist or fewer per 100,000 population. Hospital units employed 83.3% of psychiatrists. Discussion. Mexico has an insufficient number of mental health providers at public institutions, with disparities between states and most providers affiliated to hospital units. Conclusion. There is an acute mental health provider shortage in the Mexican public sector, together with limited resources for community mental health care, affecting the treatment of mental health and substance use disorders.

Prevalence of Post-COVID conditions among Mexican COVID-19 survivors: a nationwide cross-sectional study

BackgroundThere are limited population-representative data that describe the potential burden of Post-COVID conditions (PCC) in Mexico. We estimated the prevalence of PCC overall and by sociodemographic characteristics among a representative sample of adults previously diagnosed with COVID-19 in Mexico. We additionally, characterized the PCC symptoms, and estimated the association between diagnosed type-2 diabetes and hypertension with PCC.MethodsWe used data from the 2021 National Health and Nutrition Survey in Mexico, a nationally and regionally representative survey, from August 1st to October 31st, 2021. Using the WHO definition, we estimated the prevalence of PCC by sociodemographics and prevalence of PCC symptoms. We fit multivariable log-binomial regression models to estimate the associations.ResultsThe prevalence of PCC was 37.0%. The most common persistent symptoms were fatigue (56.8%), myalgia or arthralgia (47.5%), respiratory distress and dyspnea (42.7%), headache (34.0%), and cough (25.7%). The prevalence was higher in older people, women, and individuals with low socioeconomic status. There was no significant association between hypertension and PCC or diabetes and PCC prevalence.ConclusionsAbout one-third of the adult Mexican population who had COVID-19 in 2021 had Post-COVID conditions. Our population-based estimates can help assess potential priorities for PCC-related health services, which is critical in light of our weak health system and limited funding.

Place-based strengths and vulnerabilities for mental wellness among rural minority older adults: an intervention development study protocol

IntroductionSevere inequities in depression and its diagnosis and treatment among rural-dwelling, racial-minority and ethnic-minority older adults compared with their urban white counterparts result in cognitive impairment, comorbidities and increased mortality,...

Enablers and obstacles for designing and implementing intersectoral health policies: Lessons from Mexico

AbstractBackgroundThis study analyzes how national intersectoral public policy experiences have been adopted and implemented using a Health in All Policies (HiAP) approach in the past two decades. It seeks to provide evidence on enabling factors that triggered three effective intersectoral public policies to improve population health in Mexico by improving nutritional, educational, and healthcare access conditions, reducing road traffic injuries, and addressing obesogenic feeding practices.MethodsWe followed a qualitative approach to analyze the three intersectoral public policies selected as case studies. First, we designed an analytical framework to assess how intersectoral public policies are adopted, implemented, and sustained. The proposed framework is based on peer‐reviewed articles and gray public policy literature. Second, we used information from eleven semi‐structured interviews with key stakeholders conducted in previous research to identify more specific enablers and barriers of the three intersectoral policies selected according to predefined analytical categories used in the questionnaire.ResultsThe analysis showed three overall key findings. First, sound empirical evidence is essential for adopting a HiAP approach. Second, effective intersectoral mechanisms enhance implementation feasibility. Third, results‐based monitoring and evaluation contribute to the continuity of the analyzed intersectoral public policies. Finally, political support is needed throughout the policy process to maintain governance capacity and deliver results.ConclusionWe drew five global policy lessons that may be applicable in similar public policy settings in other countries. First, both technical and political enablers help set the intersectoral agenda. Second, effective communication is instrumental in convincing all stakeholders to address public health‐related policy issues. Third, political support at the highest level possible and the federal government's capacity are essential to implement sound policies. Fourth, several enablers exist for enhancing collaboration between ministries during implementation. Finally, monitoring and evaluation results are necessary for sustaining intersectoral policies beyond administrations.

Telomere Length is Associated with the Prevalence, Persistence, and Incidence of Sarcopenia

Telomere length (TL) shortening has been identified as a marker of aging and associated with adverse health outcomes, but evidence of its association with sarcopenia is inconclusive. Estimate the cross-sectional and prospective associations between TL and sarcopenia. We used data from Waves 3 and 4 (2017, 2021) of the Study on Global Aging and Adult Health in Mexico (SAGE-Mexico). The cross-sectional sample consisted of 1,738 adults aged 50 and older, and the longitudinal sample consisted of 1,437. Relative TL was determined by real-time quantitative polymerase chain reaction (qPCR) on DNA extracted from saliva samples and quantified as the telomere/single-copy gene (T/S) ratio. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP2). The mean salivary TL was 1.50 T/S units (95% CI: 1.49-1.52). The baseline prevalence of sarcopenia was 13.3% (95% CI: 9.8-16.8%). The incidence and persistence of sarcopenia were 6.8% (95% CI: 5.0-9.5%) and 7.0% (95% CI: 5.1-9.6%), respectively. The results showed that a one standard deviation decrease in TL was cross-sectionally associated with higher odds of sarcopenia (OR = 1.31; 95% CI: 1.03-1.67) and prospectively with a higher incidence (RRR = 1.55; 95% CI: 1.06-2.25) and persistence (RRR = 1.50; 95% CI: 1.01-2.24) of sarcopenia. Older adults with shorter TL had higher rates of incident and persistent sarcopenia. Implementation of interventions to delay the decline of TL in older adults is warranted. Further translational studies are needed to elucidate the effects of exercise or diet on DNA repair in the telomeric region and their associations with sarcopenia.

The giving tree: impacts of deforestation on birth outcomes in Mexico

ABSTRACT Deforestation adversely impacts human health through mechanisms such as increased air pollution, shifts in disease vector distributions, and changes in local climate. Although the influence of deforestation on human health is recognized, its effects on infant health outcomes have been insufficiently studied. This paper examines the effects of deforestation on infant health by analysing birth certificate data from 2011 to 2021 across Mexican municipalities, combined with satellite-derived annual deforestation rates. We show that increased deforestation leads to decreased birth weight, higher rates of low birth weight (LBW), and reduced Apgar scores. Specifically, an increase of one standard deviation in deforestation results in a reduction of average birth weight by 19 grams, an increase in the probability of LBW by 0.43% points, and an increase in the probability of a low Apgar score by 4.7% points. These effects are consistently observed even after controlling for different definitions of forest cover, excluding data during the COVID-19 pandemic, and limiting the analysis to municipalities with at least 2% forest coverage. This study provides critical evidence that deforestation directly impairs newborn health in Mexico, highlighting a significant and underappreciated environmental cost with long-term implications for human capital.

Height & income: Labor returns of health in Mexico from 2000 to 2018.

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys-a group of relatively standardized surveys-that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals' labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital-measured as adult height-may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor.

Elevation of miR-150-5p in Brain Microvascular Endothelial Cells as a Result of Prenatal Alcohol Exposure Is Mediated by Transcriptional Mechanisms

Fetal Alcohol Spectrum Disorders (FASD) encompass a variety of conditions impacting development in children exposed to alcohol in utero. Vascular alterations such as defective angiogenesis, blood brain barrier permeability, vessel reactivity, and blood flow have been found in various animal models of prenatal alcohol exposure (PAE). The underlying mechanisms of these vascular defects are not fully understood. Our lab previously showed that miR-150-5p was upregulated in brain microvascular endothelial cells (BMVECs) isolated from embryonic mouse cortices following moderate PAE. We identified downstream vascular targets of miR-150-5p in BMVECs and demonstrated that miR-150-5p inhibition could counter alcohol-mediated effects on BMVECS and the cortical microvasculature in vitro and in vivo, respectively. Here, we investigate upstream mechanisms that contribute to miR-150-5p elevation in BMVECs following PAE. We hypothesized that multiple mechanisms, including pathways at the transcriptional level, contribute to increased miR-150-5p abundance in BMVECs following ethanol (EtOH) exposure. Overall transcriptional activity at the miR-150 promoter was increased in BMVECs with EtOH treatment, and pri-miR-150, the primary transcript for miR-150-5p, was elevated in EtOH-treated BMVECs. Additionally, miR-150 promoter methylation was decreased in PAE cortices compared to saccharine-exposed controls (SAC). Current work aims to confirm the role of DNA methylation in transcriptional regulation of the miR-150 promoter in BMVECs and characterize DNA methyltransferase activity in BMVECs during PAE. We also assessed transcription factor binding at the miR-150 promoter and found that miR-150 promoter activation by several transcription factors was blunted with EtOH treatment. Current work involves the investigation of global transcription factor activation in BMVECs in PAE versus SAC. In summary, our research sheds light on multiple mechanisms of miR-150-5p regulation that may contribute to brain microvascular defects as a result of PAE. American Physiological Society Porter Physiology Development Fellowship University of New Mexico Health School of Medicine Department of Cell Biology and Physiology. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Technical Efficiency of Mexico's Public Health System in the Delivery of Obstetric Care, during 2012-2018.

The objective of this study was to evaluate the technical efficiency of Mexico's public health system in the delivery of obstetric care from 2012 to 2018. A multi-stage quantitative study of the public health institutions responsible for 95% of the system's obstetric services was conducted using data envelopment analysis. The efficiency of state-level productive units (decision-making units, or DMUs) was calculated and juxtaposed with the DMUs' maximum (0.82) and minimum (0.22) scores. Using the outcomes of the initial stage, the average technical efficiency of each institution at the national level was estimated and compared. The results were also utilized to estimate and compare the average efficiency of each state-level health system based on economic characteristics (state GDP per capita). Outputs included prenatal visits and deliveries, while inputs comprised gynecologists, exam rooms, and delivery rooms. Institutional efficiency ranged from 0.16 to 0.82, with an average of 0.417. The Ministry of Health (0.82) and the Mexican Social Security Institute (0.747) exhibited the highest efficiency scores, while the remaining institutions (Institute for Social Security and Services for State Workers [ISSSTE]; Mexican Petroleum [PEMEX]; the Secretary of National Defense [SEDENA]; and the Navy [SEMAR]) scored below the health system average. Of the 153 DMUs, 20% surpassed the maximum (0.82) and 40.6% fell below the minimum (0.22). These findings indicate that 80% of DMUs have unused operational capacity that could be utilized to enhance technical efficiency. No relationship was found between efficiency and the GDP of Mexico's 32 politico-administrative divisions. The efficiency gap between institutions (0.66) shows that while some DMUs are saturated (exhibiting high efficiency scores), the majority have unused operational capacity. Leveraging this untapped capacity could address the needs of vulnerable populations facing restricted access due to health system fragmentation.

A Cross-Sectional Analysis of Parental Behavior and Adolescent Mental Health in Mexico: Insights into Excessive Alcohol Intake, Tobacco Use, Suicidal Behavior, and Depressive Symptomatology.

Depression, suicidal behavior, excessive alcohol intake, and tobacco use are the main mental health problems in adolescents. To address these problems, it is necessary to understand the many factors associated with them, including parental factors. The aim of this study was to assess the associations between parental behavior and mental health problems in adolescents in Mexico. Data from the National Health and Nutrition Survey (ENSANUT) 2018-2019, representative for Mexico, were used. Households in which a parent-adolescent child pairing was identified (regardless of family type) were selected; n = 8758 households. The four outcomes of interest that were measured in the adolescents were: excessive alcohol intake, tobacco use, suicidal behavior, and depressive symptomatology. Logistic regression models using the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) were estimated. Adolescents whose parents used alcohol or tobacco and reported depressive symptoms and suicidal behavior were more likely to present these behaviors themselves (AOR = 1.47, 95% CI: 1.17-1.85; AOR = 2.26, 95% CI: 1.51-3.39; AOR = 2.61, 95% CI: 1.88-3.61; AOR = 1.74, 95% CI: 1.16-2.61, respectively). Child sexual abuse was also strongly associated with the four outcomes of interest in adolescents (AOR = 1.89, 95% CI: 1.06-3.36 for excessive alcohol intake; AOR = 2.97, 95% CI: 1.49-5.91 for tobacco use; AOR = 5.15, 95% CI: 3.27-8.09 for depressive symptoms; AOR = 6.71, 95% CI: 4.25-10.59 for suicidal behavior). The family constitutes the central nucleus of care for children and adolescents; therefore, any effort to promote adolescent mental health must necessarily involve their parents and family.

Intrinsic capacity trajectories and socioeconomic inequalities in health: the contributions of wealth, education, gender, and ethnicity

BackgroundLife-long health inequalities exert enduring impacts and are governed by social determinants crucial for achieving healthy aging. A fundamental aspect of healthy aging, intrinsic capacity, is the primary focus of this study. Our objective is to evaluate the social inequalities connected with the trajectories of intrinsic capacity, shedding light on the impacts of socioeconomic position, gender, and ethnicity.MethodsOur dynamic cohort study was rooted in three waves (2009, 2014, 2017) of the World Health Organization’s Study on Global AGEing and Adult Health in Mexico. We incorporated a nationally representative sample comprising 2722 older Mexican adults aged 50 years and over. Baseline measurements of socioeconomic position, gender, and ethnicity acted as the exposure variables. We evaluated intrinsic capacity across five domains: cognition, psychological, sensory, vitality, and locomotion. The Relative Index of Inequality and Slope Index of Inequality were used to quantify socioeconomic disparities.ResultsWe discerned three distinct intrinsic capacity trajectories: steep decline, moderate decline, and slight increase. Significant disparities based on wealth, educational level, gender, and ethnicity were observed. Older adults with higher wealth and education typically exhibited a trajectory of moderate decrease or slight increase in intrinsic capacity. In stark contrast, women and indigenous individuals were more likely to experience a steeply declining trajectory.ConclusionsThese findings underscore the pressing need to address social determinants, minimize gender and ethnic discrimination to ensure equal access to resources and opportunities across the lifespan. It is imperative for policies and interventions to prioritize these social determinants in order to promote healthy aging and alleviate health disparities. This approach will ensure that specific demographic groups receive customized support to sustain their intrinsic capacity during their elder years.

Capture and corporate cooptation: the role of the Mexican Foundation for Health in public health policy

IntroductionCorporate capture responds to efforts to strengthen regulation or prohibition of commercial determinants of health [tobacco, alcohol, sugar-sweetened beverages, ultra-processed products (UPFs), commercial milk formula, and pharmaceuticals], in an attempt to interfere with public health policies that threaten the commercial, economic, and political interests of major industries. This manuscript proposes the characterization of the corporate capture of public health in Mexico, exercised through the Mexican Foundation for Health (FUNSALUD).MethodologyAn analysis of FUNSALUD and its stakeholders was carried out under the framework of commercial determinants of health, using a qualitative methodology, and executed in five stages: document analysis from 1985 to 2021; identification and characterization of stakeholders; semi-structured interviews; classification of corporate strategies; and relationship mapping.ResultsActors in the pharmaceutical, food, tobacco, alcohol, commercial milk formula, and sugar-sweetened beverage industries were identified as corporate members of FUNSALUD. We identify six corporate strategies used to interfere in public health and food policies, highlighting the role of a revolving door bureaucracy in the case of the Ministry of Health.ConclusionThe Mexican Foundation for Health has functioned as a front organization created by the private sector to influence public policy decision-making, protect corporate interests, and oppose international recommendations to combat non-communicable diseases.

Cultural Sensitivity in Therapeutic Approaches: Addressing Mental Health Stigma in Mexico

This paper explores innovative strategies for addressing mental health stigma in the cultural context of Mexico. Drawing on insights from prevalent cultural norms, including machismo, collectivism, and religious beliefs, the study develops a comprehensive framework centered on community-based interventions, advocacy, and education. The examination of cultural factors influencing mental health stigma sets the stage for a nuanced understanding of the challenges individuals face in expressing vulnerability. Community-based interventions, such as tailored programs and collaborations with local institutions, emerge as crucial in dismantling stigma and fostering a supportive environment. Advocacy and education play pivotal roles in challenging stereotypes, dispelling myths, and promoting mental health literacy. The involvement of mental health professionals and collaboration with educational institutions enhance the effectiveness of these strategies. In conclusion, the proposed framework seeks to create a cultural shift towards a more compassionate and informed approach to mental health in Mexico. By fostering cultural sensitivity, challenging stigma at its roots, and empowering communities, these initiatives contribute to a future where mental health is viewed with understanding and support.

What security and for whom? The social construction of exclusion of migrants from citizen security and health security in Mexico

AbstractThis article explores the social construction of international migrants as a threat to public health and public safety in Mexico, specifically in the case of the Metropolitan Area of Monterrey, since relations within this new sense of “otherness” in this city cause issues for public health and citizen security as traditionally conceived. An in‐depth review of the secondary literature on citizen security and health security related to migration and of the Mexican legal framework was conducted, and public information requests were made to Mexican public agencies. If citizen and health security are complementary paradigms, migrants seem excluded from their application. Far from being considered holders of rights, they are primarily restricted in their exercise of rights because they are not “citizens.” These “newcomers” are perceived as “pathogenic agents” and “criminal illegal immigrants” rather than as deserving of these rights by the authorities, the media, and the majority population of Monterrey. These dynamics are likely to keep them not only on the fringes of “the city” but also in a very vulnerable position to fall victim to of all kinds of exploitation, resulting in a form of “management” of human mobility based on exclusion.

Predictors of Frailty Transitions in Mexican Older Adults.

Frailty is a dynamic state in older adults. Current evidence, mostly in high-income countries, found that improving frailty is more likely in mild states (prefrailty). We aimed to determine the probability of frailty transitions and their predictors. Participants were adults aged 50 years or over from the Study on Global Ageing and Adult Health in Mexico during 4 waves (2009, 2014, 2017, and 2021). We defined frailty with the frailty phenotype and we used multinomial logistic models to estimate the probabilities of frailty transitions and determine their predictors. For the 3 analyzed periods (2009-2014, 2014-2017, and 2017-2021), transition probabilities from frail to robust were higher for the younger age group (50-59 years) at 0.20, 0.26, and 0.20, and lower for the older age group (≥80 years), 0.03, 0.08 and 0.04. Transitioning from prefrail to robust had probabilities of 0.38, 0.37, and 0.35, for the younger age group, and 0.09, 0.18, and 0.10, for the older age group. The probabilities of transitioning to frail and to death were lower for the younger age group and for the robust at baseline; but higher for the older age group and for the frail at baseline. We identified age, disability, and diabetes as the most significant predictors of frailty transitions. These findings show that frailty has a dynamic nature and that a significant proportion of prefrail and frail individuals can recover to a robust or prefrail state. They also emphasize that prefrailty should be the focus of interventions.

Integration of Total Worker Health ® Training for Occupational Health and Safety Professionals With Efforts to Promote Worker Health, Safety, and Well-being in Mexico.

We sought to test whether a 2-week Total Worker Health (TWH) training mapped to TWH education competencies could be administered to a Mexican audience of occupational safety and health professionals and could lead to positive changes to knowledge and behaviors. This study used robust program evaluation methods collected before and after each of the nine training days and at the end of the course. Overall course quality received a mean score of 4.6 (SD = 0.6) and 98.8% of participants agreed that their TWH knowledge increased. All participants intended to make at least one change to their professional practice, most frequently helping companies assess their organizational culture to support health, safety, and well-being. This TWH training was well received and led to positive self-reported increase in knowledge and abilities to influence workers' health, safety, and well-being.