The “public charge” rule assesses whether an immigrant to the U.S. is likely to become dependent on government assistance, particularly for potential use of cash-benefit programs or long-term institutionalization at government expense. Being deemed a public charge can make an applicant for legal status inadmissible. Although the rule applies to specific immigration determinations, its effects may impact health outcomes. This systematic review synthesized evidence on public charge policy and health-related outcomes among U.S. Latino populations. Following PRISMA guidelines and a PROSPERO-registered protocol (CRD42024507861), we searched PubMed, Web of Science, and Scopus for peer-reviewed studies published in English or Spanish from January 1996 through February 20, 2026. Eligible studies included U.S.-based Latino populations, examined the public charge rule as exposure, and reported health-related outcomes, health behaviors, healthcare access, or use of health or social programs. Two reviewers independently screened titles and abstracts, with disagreements resolved by consensus and, when needed, a third reviewer. Data were extracted using a standardized PECO-based form and narratively synthesized. Of 157 citations identified, 19 studies met inclusion criteria. Studies examined program utilization and access (n = 13, 68

Background:Healthcare contributes substantially to climate change, and pharmaceuticals account for a meaningful share of this footprint across manufacturing, distribution, prescribing, and disposal. However, climate-health education and prescribing practices are often addressed separately, leaving limited guidance for integrating climate change, pharmaceuticals, and prescribing patterns within a single framework. This scoping review synthesizes evidence on the intersection of these domains, with attention to how these concepts are incorporated into health professions education (HPE) and clinical practice. Methods:A comprehensive literature search strategy of six databases (PubMed, Embase, CINAHL, ERIC, Health Source: Nursing Academic, and Web of Science) identified peer-reviewed studies published between January 1988 and December 2025 in English or Spanish. Eligible studies addressed climate change in relation to pharmaceutical use or prescribing patterns and included an educational or practice-based component; animal studies, studies without interventions, and non-prescribing studies were excluded. Searches were conducted in December 2023 and updated in April 2025. Data were extracted on study characteristics, clinical domain, educational approach, and directional relationships mapped to the MAMS model dyads (Climate ↔ pharmaceuticals; pharmaceuticals ↔ prescribing patterns; climate ↔ prescribing patterns). Results:From 4,247 citations, 28 studies met inclusion criteria. Studies were conducted across multiple regions, most commonly the United States (n = 6), United Kingdom (n = 5), Australia (n = 5), and Canada (n = 4), with additional single country and multinational collaborations. Clinical domains varied, with the largest representation in anesthesia and perioperative care (n = 8), followed by pharmacy and pharmacology (n = 5), primary care (n = 3), and fewer in other specialties. Studies used single and multi-educational domains, most commonly framework development (n = 16), followed by curricular integration (n = 6). Outcomes included reductions in anesthetic or inhaler related emissions, behavior change, knowledge or awareness, attitudes or satisfaction, and identification of barriers and facilitators. Although individual MAMS dyads were frequently examined, no study operationalized all three domains in an integrated bidirectional tri-dyadic manner. Conclusion:Existing literature on climate-conscious prescribing education is expanding but remains clinically concentrated and largely conceptual, with limited evaluation of instructional strategies. No study operationalized a fully bidirectional, tri-dyadic approach linking climate change, pharmaceuticals, and prescribing patterns, underscoring the need for integrated, outcomes-oriented frameworks to guide HPE and practice change.

ABSTRACT:Climate change is the greatest threat to global health. As climate change worsens, heat waves will be longer, more intense, and more frequent. Increased health risks from climate change and heat waves include heat-related illness (HRI). HRI increases ED visits, hospitalizations, and mortality. Healthcare providers should be aware of the impact of medications on risk for HRI. This article elucidates signs and symptoms, populations at risk, drugs and mechanisms that increase risk, and patient education to reduce risk.

ObjectiveTo improve water access while working and contribute to fewer heat-related illnesses (HRI), backpack hydration systems were provided to over 200 farmworkers to use during the 2022 growing season. Acceptability of the water intake intervention was assessed among farmworkers in eastern North Carolina, USA.MethodsWith a pre-established community-university partnership, the acceptability of the intervention was assessed using a cross-sectional survey. The backpack brand selected included a 3-liter water bladder and attached drinking hose. Data analysis included descriptive and correlation statistics.ResultsAmong 47 male, migrant farmworkers, most (90%) reported the hydration backpack to be acceptable or completely acceptable to workplace fluid intake. Most (53%) reported using the backpack some of the time, compared to 28% who used it often. The participants reported an average of 4.8 (SD 2.2) liters of water intake from the backpack on a typical workday. Most reported the backpack improved the quantity and frequency of their water consumption.ConclusionThis study was an important first step in implementation of hydration backpack systems as an HRI-preventative intervention among farmworkers. Future interventional studies could assess the efficacy of the backpacks on health outcomes, including incidence of dehydration and symptoms of HRI.

ABSTRACT Climate change is the greatest threat to global health. As climate change worsens, heat waves will be longer, more intense, and more frequent. Increased health risks from climate change and heat waves include heat-related illness (HRI). HRI increases ED visits, hospitalizations, and mortality. Healthcare providers should be aware of the impact of medications on risk for HRI. This article elucidates signs and symptoms, populations at risk, drugs and mechanisms that increase risk, and patient education to reduce risk.

Brady, Jessica BSN, RN; Mizelle, Elizabeth PhD, RN-BC, CNE; Modly, Lori DNP, CPNP-PC, RN; Smith, Anna BSN, RN, CCRN; Bradford, Emma MSN, RN; Mac, Valerie PhD, RN, FNP-C, ENP-C; Ferranti, Erin PhD, MPH, RN; Smith, Daniel PhD, AGPCNP-BC, CNE Author Information

Background Data management is the key to the success of all projects and research. The ability to safely store, manipulate, and decipher data in real time is invaluable. Currently data management standards in public health are non-existent. Since the invention of computers real-time data retrieval and analysis has been possible but underutilized by researchers in the field. Historically, most small research studies and field-based projects have utilized spreadsheets for data management, which often proves problematic as the project grows. However, a viable and superior alternative exists in relational databases, such as REDCap. Relational databases allow for easier concatenation of multiple legacy datasets, facilitate data entry with surveys that incorporate branching logic, and allow for real time data entry in the field without the need for WIFI. Methods One example of a public health project being transitioned from spreadsheet data management to a relational database is the Farmworker Family Health Program based out of the Lillian Carter Center for Global Health & Social Responsibility at Emory University's Nell Hodgson Woodruff School of Nursing. The data management transition from spreadsheets to REDCap has provided the team with unique insight into the data that has been collected in the 30 years the program has been running. Conclusion Through this case study, we identify the need for and recommend that those in public health nursing utilize relational databases when collecting data during research studies or as electronic medical records for field clinics.

To examine the health status of Hispanic agricultural workers in Florida and Georgia. Health data from agricultural workers in the Farm Worker Family Health Program (June 2019) and research studies in Florida (May 2015 and May 2019) were examined. Data from 728 agricultural workers were collected through sociodemographic questionnaire and clinical data. In the Florida sample, 83% were overweight or obese, 70% elevated blood pressure, 60% met the definition of prediabetes. In Georgia, 64% were overweight or obese and 67% had elevated blood pressure. Weak correlations were observed between BMI and systolic blood pressure (unadjusted r = 0.20), diastolic blood pressure (unadjusted r = 0.19), and glucose (unadjusted r = 0.14). Adjusting for age and gender did not show statistically significant correlation between BMI and systolic and diastolic blood pressure or glucose. While BMI has been shown to be strongly associated with high blood pressure and impaired glucose, we found a weak correlation among agricultural workers. Given the common and high use of pesticides and elevated rates of hypertension, impaired glucose, and adiposity in agricultural workers, the public health impact of this relationship may require and lead to occupational reform that protects the health of agricultural workers. Future studies should assess occupational and environmental factors and lifestyle differences between agricultural workers and the general population to better understand these discrepancies in health status.

Wands, LisaMarie PhD, RN, CHSE, CNE; Modly, Lori DNP, RN, CPNP-PC; Coombe, Ashley PhD, RN, CNE Author Information