Marizen Ramirez · University of California, Irvine · PhdFit
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Marizen Ramirez
· Professor of Environmental & Occupational HealthVerified
University of California, Irvine · Environmental & Occupational Health
Marizen Ramirez, MPH, PhD, is a Professor of Environmental & Occupational Health and the Associate Dean for Diversity, Equity & Inclusion at UC Irvine Wen Public Health. She holds a Ph.D. in Epidemiology from the University of California at Los Angeles and a B.A. in Molecular Cell Biology with an emphasis in Neurobiology and a minor in Music from the University of California at Berkeley. Throughout her career, she has held esteemed positions at multiple universities, including serving as an academic and the Associate Dean for Research at the University of Minnesota's School of Public Health, as well as the Leon S. Robertson Professor of Injury Prevention.
Her research and scholarship interests focus on injury and violence prevention. She is recognized for significant contributions to public health research, particularly in injury prevention. Dr. Ramirez has been involved in numerous studies and has received various honors and awards for her work, including the Faculty Teaching Award at the University of Iowa College of Public Health and the Abstract of the Year from the American Public Health Association's Public Health Law Section. Her work emphasizes community-engaged scholarship and aims to develop strategies to reduce injury and violence, with a focus on health equity and social determinants of health.
Journal of Studies on Alcohol and Drugs · 2026-04-29
article
OBJECTIVE: The 2018 Federal Farm Bill created a loophole allowing intoxicating hemp-derived tetrahydrocannabinol (THC) products to be manufactured and sold with limited regulations. Unless restricted by the state, these products are available across many retailer types. We assessed the likelihood of sales of hemp-derived THC products to underage individuals in one large city in Minnesota, USA which had a minimum purchase age of 21 but few other restrictions. METHOD: We conducted pseudo-underage purchase attempts at establishments that reported or were observed carrying hemp-derived THC products in 2023. Buyers, 21 or older but judged by a panel to look aged 18-20, attempted to purchase hemp-derived THC products without age identification. We assessed whether the availability and purchase rate differed by community economic advantage and establishment type. RESULTS: Approximately one-third (149/452) of establishments carried hemp-derived THC products. The overall pseudo-underage sales rate was 56% (70/125). Establishments in areas of higher (vs. lower) economic advantage were more likely to carry hemp-derived THC products (40% vs. 30%) but less likely to sell to a pseudo-underage individual (49% vs. 68%). Compared to establishments that primarily sell non-age-restricted items (e.g., gas stations, grocery stores), establishments that primarily sell age-restricted products (liquor stores, tobacco stores, hemp-dispensaries) were more likely to carry these products (69% vs. 20%) but equally as likely to sell to pseudo-underage individuals (54% vs. 57%). CONCLUSIONS: Our results suggest that underage people could easily access hemp-derived THC products. It is imperative that these products are considered in assessments on availability of cannabis.
American Journal of Preventive Medicine · 2026-01-28
articleOpen accessSenior author
INTRODUCTION: Job lock-when older workers cannot retire owing to financial or health insurance needs-is potentially an occupational safety issue. This study explored the longitudinal effect of job lock on work-related injuries to older workers, hypothesizing that job lock increases their injury rates. It then examined how this relationship varies across work arrangements. METHODS: Analysis using 2010-2022 Health and Retirement Study data for workers aged 55-64 years and ≥65 years compared work exposures in each wave with injuries reported in the next wave. Repeated-measures negative binomial regression estimated longitudinal effects of job lock (financial, health insurance, or both) on work-related injuries, exploring effect modification by work arrangements (full time, part time, partly retired, self-employed). Analysis was conducted in 2025. RESULTS: Workers aged 55-64 years overall had 51.8 work-related injuries per 1,000 person-years, compared with 44.3 work-related injuries per 1,000 person-years for workers aged ≥65 years. Among those aged 55-64 years, these rates were 48% higher with job lock for financial reasons (incidence rate ratio=1.48 [95% CI=1.04, 2.13]) and similarly for health insurance reasons. Potentially stronger effects were observed for workers in full time (incidence rate ratio=1.57 [95% CI=1.15, 2.16]) and possibly part-time roles (incidence rate ratio=1.72 [95% CI=0.86, 3.46]). After age 65 years, these data suggest that workers had a 29% higher injury rate from financial job lock (incidence rate ratio=1.29 [95% CI=0.66, 2.51]). CONCLUSIONS: Job lock was associated with higher work-related injury rates, particularly for those in full- or part-time roles before age 65 years. For self-employed, partly retired, or workers aged >65 years, job lock presented less clear injury risk, possibly from differences in job tasks or selection into safer roles. Further research should address mechanisms of job lock to elevate injury risks. Improving access to retirement resources earlier in workers' careers may help to address work-related injuries and economic challenges of aging.
Journal of Occupational and Environmental Medicine · 2025-02-07 · 1 citations
articleSenior author
OBJECTIVE: Older adults may pay healthcare-related costs for work injuries if Medicare covers claims over workers' compensation (WC). We assessed Medicare enrollee costs after a work-related injury by WC status. METHODS: We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for Medicare enrollees aged 65 years and older with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models. RESULTS: WC covered at least one Medicare claim for 16% of the 13,039 enrollees with work-related injuries. Over 90 days, mean Medicare out-of-pocket costs were lower with WC ($447) than without ($778). With WC, enrollees owed $1432 at the 90th percentile compared to $2465 without, an adjusted difference of $600 (95% CL, -767, -432). CONCLUSIONS: Although WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses.
OBJECTIVES: Work-related injuries are only partially captured for older workers in the USA, likely due to low sensitivity of traditional data sources, such as workers' compensation, to capture non-fatal incidents. Using claims from Medicare, the primary health insurance of most US adults after age 65, we identified and described work-related injuries among Medicare enrollees aged 65 years and older. METHODS: We identified injury claims from 2016 to 2019 Medicare inpatient and outpatient claims for aged 65+ Medicare fee-for-service enrollees. We then identified work-related injury claims using ICD-10-CM external cause codes and employment-related and workers' compensation codes used in Medicare claims processing. We calculated annual rates of work-related injuries among aged 65+ Medicare fee-for-service enrollees. We described demographics, injuries and their mechanisms, and healthcare encounter characteristics of Medicare enrollees with work-related injuries. RESULTS: From 2016 to 2019, the average annual rate of work-related injuries was 27.6 per 100 000 Medicare fee-for-service enrollees aged 65+. Injury claims were most often for outpatient emergency department (ED) visits (58%), followed by non-ED outpatient visits (20%) and hospitalisations (19%). Falls, transportation and machinery-related mechanisms of injury each accounted for approximately 20% of injuries. CONCLUSIONS: Using the mechanism of injury, employment-related and workers' compensation codes, Medicare claims can be used to identify work-related injuries. Most work-related injuries appear in outpatient settings, although hospitalisations involve the most extensive care. Future research should validate and expand these methods, drawing on the depth of information in Medicare claims data to explore costs and health outcomes of work-related injuries in older populations.
Occupational health equity scholarship has been growing over the past decade, including social-structural determinants of health research that centres the voices and experiences of historically marginalised communities. In our commentary, we focus on the intersection of work-related and non-work-related factors and how they impact the health of workers, their families and their communities through community-engaged research. Case studies include the implementation of mobile clinics that are developed alongside communities, community organising to examine and reduce health disparities among racially segregated workers, the development of research instruments and measures to study racism and discrimination, and a focus on how the distribution of employment opportunity is an important point of intervention to eliminate injury disparities.
Background The human-animal bond has been proposed as a factor in the psychological well-being of individuals. This study examines the distribution and characteristics of suicide precipitated by pet loss or concerns about their welfare. We hypothesise that decedents of suicide precipitated by the loss or welfare concern for animal companions will have characteristics that are significantly different from the general population of suicide decedents. Methods We analysed National Violent Death Reporting System suicide data 2003–2021. We categorised them into animal-bond-associated (ABA) and non-ABA (NABA). We compared the two groups across demographics and incident-related characteristics, including age, sex, race, ethnicity, sexual orientation, cause of death, precipitating factors and location. χ 2 and t-tests were conducted to assess differences between groups. Results 347 731 suicides were analysed, 346 976 were NABA and 755 were ABA. The ABA group was older (mean age 50.6 vs 46.3 years, p<0.0001) and more likely to be white (96.2% vs 87%, p<0.0001). This group also had higher proportions of suicides by poisoning (22.9% vs 14%, p<0.0001), presence of physical health problems (17.8% vs 8%, p<0.0001) and financial problems (17.8% vs 8%, p<0.0001). Suicides in the ABA group were more likely to occur at home (84.1% vs 73.1%, p<0.0001), leave a suicide note (43.7% vs 28.7%, p<0.0001) and disclose intent (25.1% vs 22%, p<0.04). Conclusion ABA suicides were more likely to disclose intent and employ less violent methods. Further research is needed to explore the mechanisms through which animal bonds may impact the nature and characteristics of suicide incidents. This can help inform tailored prevention strategies. Level of evidence Level III.
Objectives. To examine how Trauma Informed Care (TIC) and its components are defined and operationalized, and to examine the state of the evidence on effectiveness and potential harms of TIC approaches, frameworks, models, and components. Data sources. We searched Medline (Ovid)®, APA PsycInfo® (Ovid), CINAHL® (EBSCOHost), ERIC (EBSCOHost), and Scopus (Elsevier) for peer-reviewed articles published through July 19, 2024. Grey literature was also searched for Contextual Questions regarding TIC definitions and organizational and clinical components. Review methods. We used methods consistent with the Agency for Healthcare Research and Quality’s Evidence-based Practice Center Program Methods Guide. We prepared the review protocol with input from Key Informants, Technical Experts, and a public comment period in April 2023. Using predefined criteria and dual review, we selected intervention studies that enrolled adult or pediatric patients/clients regardless of identified trauma exposure or type of trauma exposure in any healthcare or social service setting in any country. Eligible studies included randomized controlled trials and comparative nonrandomized studies of interventions. We assessed risk of bias and strength of evidence for a prespecified list of patient/client health related outcomes. Results. From 4,379 unique references, we identified 12 eligible studies discussed in 16 publications. Study settings were varied: two studies in adult medical care settings, one in adult mental health service, one in primary prevention for children, one in adolescent medical care, four in residential child welfare, and three in non-residential child welfare. We did not combine data quantitatively due to variability of interventions. All studies were assessed as high risk of bias and evidence was insufficient to determine the effects of TIC on patient/client outcomes for all settings and comparisons. Studies did not collect information on harms, adverse events, or unintended consequences of TIC. TIC models vary considerably in their socioecological components from youth to adult services across settings and disciplines. There was a broad range of organizational and clinical components, with only some overlap within both organizational and clinical domains. A few TIC models described specific elements of cultural competency/humility. Conclusions. Evidence was insufficient to make any clear determinations on the effectiveness of TIC approaches across any patient/client health related outcome, but this does not mean the individual interventions described are not potentially useful. Rather, it means the evidence does not yet provide clear answers. Still, TIC is being widely implemented, and research on its effectiveness and potential harms seems to be neither informing nor keeping pace with related areas (e.g., evidence-based trauma treatments) or practice/implementation.
Occupational health equity scholarship has been growing over the past decade, including social-structural determinants of health research that centres the voices and experiences of historically marginalised communities. In our commentary, we focus on the intersection of work-related and non-work-related factors and how they impact the health of workers, their families and their communities through community-engaged research. Case studies include the implementation of mobile clinics that are developed alongside communities, community organising to examine and reduce health disparities among racially segregated workers, the development of research instruments and measures to study racism and discrimination, and a focus on how the distribution of employment opportunity is an important point of intervention to eliminate injury disparities.
BACKGROUND: Without a comprehensive national surveillance system in the USA, the agricultural sector faces numerous obstacles to accurate and complete injury reporting and surveillance. Secondary sources are increasingly being used to conduct surveillance but have not been thoroughly evaluated for their overlap and ability to capture various types of agricultural injuries. METHODS: Using two state-level systems which likely capture severe injuries, the (i) Iowa Trauma Registry (ITR) and (ii) Workers' Compensation (WC) records, we compared worker and injury characteristics found in these two data sources over a ten-year period (2005-2014) and developed a predictive model to determine which injuries are most likely captured in one data source vs the other. RESULTS: A total of 2398 unique injuries from ITR and 3419 unique injuries from WC were found. There was very little overlap between the two sources. In general, injuries among older agricultural workers (65+) had a higher probability of capture by the ITR, while injuries among younger agricultural workers were more likely captured by WC. Young agricultural workers injured in motor vehicle traffic incidents were more likely captured by WC, but after age 25, these injuries were more likely captured by the ITR. In contrast, more machinery injuries were captured by the ITR than WC across age. CONCLUSIONS: Neither of these secondary systems fully captured all injuries. Hence, comprehensive surveillance would require multiple data sources. However, future studies involving targeted research questions could select one data source, especially when surveillance resources are limited.
