Our Work

Since their introduction to the marketplace only a decade ago, electronic cigarettes (more commonly called vapes) have been rapidly adopted for use by youth, creating a public health epidemic. In the U.S., from 2017 to 2018, vaping by youth increased by 78 percent. Now, more than 3.6 million middle and high school students – roughly one in five high school students and one in twenty middle school students – have vaped in the past year.1 Vapes are the most commonly used tobacco delivery product among youth and show youth usage rates substantially higher than any other drugs of abuse.

Childhood tooth decay is a significant public health problem in the United States (U.S.) and one of the country’s greatest unmet health needs (Boyles, 2011). Not only can tooth decay produce lasting physical pain and emotional suffering for children afflicted with it, but it also has substantial societal ramifications, such as costing U.S. taxpayers hundreds of millions of dollars annually, mostly because of emergency room care for preventable tooth pain (Pettinato, Webb, & Seale, 2000; The Pew Center on the States, 2012). And though all children are susceptible to tooth decay, it is disproportionately evident in specific demographic groups. Indeed, Latino children and children living in poverty have greater amounts of tooth decay, more severe tooth decay, and more untreated decay (National Institute of Dental and Craniofacial Research [NIDCR], 2011).

Health nonprofits increasingly use promotores de salud (promotores) to connect low-income Latinos with health services, provide health education, and empower clients with positive coping skills (Vega, Rodriguez, & Gruskin, 2009). Because promotores typically come from the communities in which they serve, they are culturally competent peers who can help many Latinos overcome the language barriers and institutional distrust that limit their willingness to seek services (Elder, Ayala, Parra-Medina, & Talavera, 2009; Nemcek & Sabatier, 2003).

In recent years, local nonprofit community-based health providers who serve Latino populations have increasingly turned to promotores, or community lay health workers, to facilitate their service provision. Promotores work in a variety of capacities at nonprofits: as front-line service providers who supply basic services and as health educators who give valuable information on important health topics. The rationale is that promotores’ lay status as community members allows them to connect with Latinos in culturally competent and sensitive ways, thereby creating trustworthy relationships between nonprofit providers and Latinos. These relationships can help overcome Latinos’ mistrust of the mainstream medical system and reduce other barriers to care.

From primary and preventive care provision to health education, community-based nonprofit organizations are key components in health service delivery in the United States, particularly in low-income areas. But community-based nonprofits are tasked with more than treating the physical and mental health conditions of their clients. They must navigate complex community environments where client characteristics and institutional factors combine to make providing quality health care difficult and costly. For example, local nonprofit health providers in low-income, Latino communities not only treat clients who suffer from significant health disparities, compared with the general U.S. population, but they must also overcome their clients’ language barriers, relatively low rates of health insurance, and pervasive mistrust of the mainstream medical system (Huerta, 2003; Hirota et al., 2006; Centers for Disease Control and Prevention, 2007). These compounding factors raise service costs, stress organizational resources and staff, and prompt local nonprofits to search for innovative, cost-effective, and culturally sensitive methods to treat those in need.