The Association of Complementary Therapy Use With Prescription Medication Adherence Among Older Community-Dwelling Adults

Medication adherence is a major health concern, particularly among older adults who have one or more chronic conditions. We examined the association between complementary therapy use and medication adherence among older community-dwelling adults. In a bi-ethnic sample of 165 adults aged 65 years and older, anthropometric variables, data on chronic medical conditions, and medication use were assessed. Medication adherence was modeled as a score (<50%, 50%-75%, and >75%) and complementary therapy use was categorized as a binary variable. Over half of the participants (50.3%) were female, and 47.3% were African American. Complementary therapy use was prevalent (87.9%) and did not differ by sex, ethnicity, income, and educational attainment. Medication adherence score was >75% in 84.8% of complementary therapy users and 80.0% of non-users ( p = .61). Despite a high use of complementary therapy in this population, there was no apparent association with low medication adherence.

Farmworker Housing in the United States and Its Impact on Health

Farmworkers in the United States occupy a range of housing, including both on- and off-farm family and communal dwellings. As the farmworker population is becoming more settled, housing needs are changing. Existing regulations designed originally for grower-supplied migrant housing may need to be expanded. Much of farmworker housing is in poor condition, and likely linked to negative mental and physical health outcomes of residents because of exposures to crowding; mold, mildew, and other allergens; pesticides; and structural deficiencies. The existing research literature, both on housing conditions and their associations with farmworker health, is sparse, and large areas of the country and significant domains of health are omitted. This paper reviews this literature and formulates research and policy recommendations for addressing these deficiencies.

Attitudes of older adults regarding disclosure of complementary therapy use to physicians

Many older adults use complementary therapies in health self-management but do not disclose this use to their physicians. This article examines factors affecting disclosure of complementary therapy use and considers ethnic and gender differences in disclosure. It is based on a systematic qualitative analysis of in-depth interviews conducted with 62 African American and White adults aged 65 and older. Twenty-three of the 39 older adults who acknowledge using complementary therapies disclose this to their physicians. Themes leading to disclosure are believing that physicians are supportive and the importance of sharing information. Themes for not disclosing complementary therapy use include physicians’ negative views, complementary therapy use affecting physicians’ incomes, and the need to protect cultural knowledge. African American women were least likely to discloseuse. Disclosure by older adults to their physicians is a complex decision process. Medical encounters, including decisions regarding information to disclose, are embedded in broader social structures.

Profiles of Food Security for US Farmworker Households and Factors Related to Dynamic of Change

OBJECTIVES

We recruited 248 farmworker families with preschool-aged children in North Carolina and examined food security indicators over 24 months to identify food security patterns and examine the dynamic of change over time.

METHODS

Participants in the Niños Sanos study, conducted 2011 to 2014, completed quarterly food security assessments. Based on responses to items in the US Household Food Security Survey Module, we identified different states of food security by using hidden Markov model analysis, and examined factors associated with different states. We delineated factors associated with changes in state by using mixed-effect ordinal logistic regression.

RESULTS

About half of the households (51%) consistently stayed in the most food-secure state. The least food-secure state was transient, with only 29% probability of this state for 2 consecutive quarters. Seasonal (vs migrant) work status, having immigration documents (vs not documented), and season predicted higher levels of food security.

CONCLUSIONS

Heterogeneity in food security among farmworker households calls for tailoring intervention strategies. The transiency and unpredictability of low food security suggest that access to safety-net programs could reduce low food security risk in this population.

Older adults' fears about diabetes: using common sense models of disease to understand fear origins and implications for self-management

This study examines older adults' fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients' actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and white older adults with diabetes. Analysis uses Leventhal's Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three identified fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focused self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focused attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults' fears about diabetes may improve their diabetes self-management practices.

Unreliable item or inconsistent person? A study of variation in health beliefs and belief-anchors to biomedical models

The reliability of an item designed to measure health belief is often confounded with response consistency at the person level. The study applied contemporary measurement methods to an inventory of common sense beliefs about diabetes and used a sample of N = 563 adults with diabetes to test the hypothesis that individuals whose beliefs are congruent with a biomedical model are more consistent in their responses. Item-level analysis revealed that the domains of Causes and Medical Management were the least reliable. Person-level analysis showed that respondents who held views congruent with the biomedical model were more consistent than people who did not.

Home Remedy Use Among African American and White Older Adults

Home remedy use is an often overlooked component of health self-management, with a rich tradition, particularly among African Americans and others who have experienced limited access to medical care or discrimination by the health care system. Home remedies can potentially interfere with biomedical treatments. This study documented the use of home remedies among older rural adults, and compared use by ethnicity (African American and white) and gender. A purposeful sample of 62 community-dwelling adults ages 65+ from rural North Carolina was selected. Each completed an in-depth interview, which probed current use of home remedies, including food and non-food remedies, and the symptoms or conditions for use. Systematic, computer-assisted analysis was used to identify usage patterns. Five food and five non-food remedies were used by a large proportion of older adults. African American elders reported greater use than white elders; women reported more use for a greater number of symptoms than men. Non-food remedies included long-available, over-the-counter remedies (e.g., Epsom salts) for which "offlabel" uses were reported. Use focused on alleviating common digestive, respiratory, skin, and musculoskeletal symptoms. Some were used for chronic conditions in lieu of prescription medications. Home remedy use continues to be a common feature of the health self-management of older adults, particularly among African Americans, though at lower levels than previously reported. While some use is likely helpful or benign, other use has the potential to interfere with medical management of disease. Health care providers should be aware of the use of remedies by their patients.

Aggression Among Male Migrant Farmworkers Living in Camps in Eastern North Carolina

The living and working arrangements of migrant farmworkers in North Carolina are shaped by grower provided housing, codified by the US Department of Labor's H-2A temporary worker program. Growers typically dictate all facets about residences, living conditions, and even food acquirements. Farmworker camps likely contribute to aggression because of the forced relationships among a small group of people that live, work and recreate together for extended time periods. Participants in the study consisted of 371 farmworkers living in 183 camps. The Revised Conflict Tactics Scale was used to assess aggression among migrant farmworkers. Results indicated that aggressive acts were prevalent among the farmworkers, but the frequency of aggressive acts was low. The most common aggressive act was minor psychological aggression. Results also indicated that alcohol misuse was a common characteristic for both victims and perpetrators and the majority of aggressive acts occurred later in the agricultural season.

Assessing Assay Variability of Pesticide Metabolites in the Presence of Heavy Left-Censoring

Assessing assay variability for field samples in environmental research is challenging, since a quantitative assay is typically constrained by a lower limit of detection. The purpose of this paper is to compare three parametric models for assessing assay variability using duplicate data subject to heavy left-censoring. Efron information criterion (EIC) and Bayesian information criterion (BIC) are used to aid in model selections. Distributional parameter estimates are obtained using maximum likelihood estimation for bivariate lognormal, bivariate zero-inflated lognormal, and bivariate 3-component mixture models. We illustrate a practical application using duplicate pesticide data from the Community Participatory Approach to Measuring Farmworker Pesticide Exposure (PACE3) study. Furthermore, a simulation study is conducted to empirically evaluate the performance of the three models. The results from PACE3 indicate that the bivariate zero-inflated lognormal model is fairly competitive based on EIC or BIC. Further, total variability for the lognormal component can be decomposed into between-subject and within-subject variance based on this model. Assay variability estimates such as within-subject coefficient variation, minimum detectable change, and probability of k-fold difference can be easily derived under the bivariate zero-inflated lognormal model. Additionally, the assay variability is rather large for the PACE3 data. Therefore, apparent longitudinal change in pesticide exposure should be examined cautiously in the context of substantial assay variability.

Work Safety Climate, Safety Behaviors, and Occupational Injuries of Youth Farmworkers in North Carolina

OBJECTIVES

The aims of this project were to describe the work safety climate and the association between occupational safety behaviors and injuries among hired youth farmworkers in North Carolina (n = 87).

METHODS

We conducted personal interviews among a cross-sectional sample of youth farmworkers aged 10 to 17 years.

RESULTS

The majority of youths reported that work safety practices were very important to management, yet 38% stated that supervisors were only interested in "doing the job quickly and cheaply." Few youths reported appropriate work safety behavior, and 14% experienced an injury within the past 12 months. In bivariate analysis, perceptions of work safety climate were significantly associated with pesticide exposure risk factors for rewearing wet shoes (P = .01), wet clothes (P = .01), and shorts (P = .03).

CONCLUSIONS

Youth farmworkers perceived their work safety climate as being poor. Although additional research is needed to support these findings, these results strengthen the need to increase employer awareness to improve the safety climate for protecting youth farmworkers from harmful exposures and injuries.

Work safety culture of youth farmworkers in North Carolina: a pilot study

OBJECTIVES

We analyzed aspects of the behavioral, situational, and psychological elements of work safety culture of hired youth farmworkers in North Carolina.

METHODS

Data were from interviewer-administered questionnaires completed with 87 male and female hired farmworkers aged 10 to 17 years in North Carolina in 2013. We computed means, SDs, and Cronbach α values for the perceived work safety climate and safety perception summary scores.

RESULTS

Hired youth farmworkers in North Carolina described a negative work safety culture. Most engaged in unsafe general and unsafe work behaviors, few received training, and many were sexually harassed at work. They had mixed safety attitudes and knew that their employment was precarious. They reported a poor perceived work safety climate characterized by the perception that their supervisors "are only interested in doing the job fast and cheaply." However, we could not detect statistically significant associations between work safety culture and injuries among these farmworkers.

CONCLUSIONS

Increased scrutiny of agriculture as a suitable industry for workers as young as 10 years and additional regulations to protect hired youth farmworkers, if not to remove them from this environment, are warranted. Additional research is needed.

Design Considerations for Patient Portal Adoption by Low-Income, Older Adults

This paper describes the results of an interview study investigating facilitators and barriers to adoption of patient portals among low-income, older adults in rural and urban populations in the southeastern United States. We describe attitudes of this population of older adults and their current level of technology use and patient portal use. From qualitative analysis of 36 patient interviews and 16 caregiver interviews within these communities, we derive themes related to benefits of portals, barriers to use, concerns and desired features. Based on our initial findings, we present a set of considerations for designing the patient portal user experience, aimed at helping healthcare clinics to meet U.S. federally-mandated 'meaningful use' requirements.

Older adults' use of care strategies in response to general and upper respiratory symptoms

This study examined the use of complementary and medical treatments, both individually and in combination, to address common general and upper respiratory symptoms. Data for the analysis were collected from a series of 18 daily diary questionnaires administered to community-living older African American and white adults living in rural counties in North Carolina. Participants reported symptoms experienced on each diary day and the treatment strategies they used each day in response to the particular symptom(s). Older adults used diverse categories of strategies to treat symptoms; treatment strategies were used inconsistently across symptoms. Use of only complementary strategies, only medical conventional strategies, or both complementary and medical strategies to treat any one symptom rarely corresponded to the use of the same strategy to address other symptoms. Future research would benefit from analyzing how older adults use health care strategies across symptom categories.

African American and Latino low income families' food shopping behaviors: promoting fruit and vegetable consumption and use of alternative healthy food options

Minority families often reside in neighborhoods with few supermarkets or alternative healthy food options (e.g., farmers markets, community gardens), making fresh produce difficult to obtain. This qualitative study identified factors influencing fruit and vegetable shopping and use of alternative healthy food options. Forty-eight minority women with children completed interviews regarding food shopping habits and use of and attitudes toward alternative healthy food options. Interviews were subjected to thematic analysis. Produce shopping was motivated by costs and family preferences. For African American women, poor cooking skills restricted the variety of fruits and vegetables purchased. Latinas were receptive to alternative healthy food options, but did not use them because these sources were inconvenient. African American women were not receptive to them. Improving cooking skills and perceptions of acceptable foods may be as important as increased access to promote greater consumption of fruits and vegetables.

Perceptions of housing conditions among migrant farmworkers and their families: implications for health, safety and social policy

INTRODUCTION

In the USA, migrant farmworkers are a vulnerable group due to their low socioeconomic status, risk of occupational exposures and injury, lack of social mobility, lack of adequate access to health services and dependency on employer for provided housing. Previous reports have documented migrant farmworker housing conditions to be variable, but poor overall. This paper explores the perceptions of housing conditions among migrant farmworkers in rural North Carolina, and develops an understanding of potential impacts of their housing on health and safety.

METHODS

This study used qualitative descriptive data and directed content analysis to analyse semi-structured interviews and photographs that were data elements of a larger community-based participatory research study designed to document housing quality and health among North Carolina farmworkers.

RESULTS

Many of the study participants described poor housing conditions that were reflected in the photographic analysis of the houses and camps. Specific problems described by the participants include exposure to pesticides, safety issues, pests, water supply and air quality, temperature and moisture.

CONCLUSIONS

This study describes migrant farmworkers' perceptions of housing quality and numerous potential impacts on health and safety. Research, social policy and practice-based implications derived from this research could serve to improve the health status of these individuals and their families. This study suggests there is much room for sustained advocacy and action, given that many of the farmworkers' descriptions and photographs depicted housing conditions below accepted standards of living. Access to adequate and safe employer-provided housing for migrant farmworkers should be considered a basic human right.

Diabetes symptoms and self-management behaviors in rural older adults

AIMS

To evaluate the demographic and health correlates of reporting diabetes symptoms, and the relationship between diabetes symptoms and self-management behaviors in rural older adults.

METHODS

Cross-sectional interviews were conducted with 489 African American, American Indian, and white female and male adults 60 years and older. Participants with diabetes were recruited from eight North Carolina counties. Participants completed the 34-item Diabetes Symptom Checklist (DSC). Associations of demographic and health characteristics with reported symptoms were evaluated. Multivariate linear regression models were used to examine the associations of DSC scores and diabetes self-management.

RESULTS

Participants had low scores on the DSC. They largely practiced appropriate diabetes self-management behaviors (self-foot checks, fruit and vegetable consumption, and self-monitoring blood glucose). Correlates of DSC included women having higher scores for hypoglycemia, psychological total, and fatigue dimensions. Neuropathic pain and vision dimensions were significantly associated with educational attainment. Most DSC dimensions were associated with ethnicity or economic status. Taking oral diabetes medicine was correlated with hyperglycemia; insulin use was associated with most DSC dimensions. HbA1c was not associated with any DSC dimension; diabetes duration >10 years was correlated with all dimensions except neuropathic pain and vision. Higher levels of psychological fatigue were significantly associated with fewer self-management behaviors.

DISCUSSION/CONCLUSIONS

Demographic and health characteristics are associated with reported symptoms. Fatigue is a symptom negatively associated with diabetes self-management behavior in older adults. Health care providers are uniquely positioned to assess patient symptoms and potential relationships with successful diabetes management.

Work safety climate, personal protection use, and injuries among Latino residential roofers

BACKGROUND

This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries.

METHODS

Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate.

RESULTS

The mean work safety climate score was 26.5 (SD = 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury.

CONCLUSIONS

Supervisors promoting safety may increase the PPE use and decrease injuries.

Airway obstruction among Latino poultry processing workers in North Carolina

This analysis was conducted to evaluate the prevalence of airway obstruction among Latino poultry processing workers. Data were collected from 279 poultry processing workers and 222 other manual laborers via spirometry and interviewer-administered questionnaires. Participants employed in poultry processing reported the activities they perform at work. Participants with forced expiratory volume in 1 second (FEV1) or FEV1/forced expiratory volume (FVC) below the lower limits of normal were categorized as having airway obstruction. Airway obstruction was identified in 13% of poultry processing workers and 12% of the comparison population. Among poultry processing workers, the highest prevalence of airway obstruction (21%) occurred among workers deboning chickens (prevalence ratio: 1.75; 95% confidence interval: 0.97, 3.15). These findings identify variations in the prevalence of airway obstruction across categories of work activities.

Job characteristics and work safety climate among North Carolina farmworkers with H-2A visas

ABSTRACT Migrant farmworkers are a vulnerable population. Migrant farmworkers with H-2A visas are the only agricultural workers with temporary work permits. Little research has directly focused on the job characteristics and work safety of workers with H-2A visas. This analysis (1) describes their personal and job characteristics, job hazards, and stressors; (2) describes their perceived work safety climate; and (3) examines associations of perceived work safety climate with job characteristics, job hazards, and stressors. Data are from a cross-sectional component of a larger study of farmworker pesticide exposure; in 2012 interviews were conducted with 163 migrant farmworkers with H-2A visas in North Carolina. The sample was limited to men aged 30 to 70 years. Migrant farmworkers with H-2A visas experience the same hazards as do other farmworkers. Their mean score on the Perceived Work Safety Climate Scale 25.5 (SD = 3.7) is similar to that of other farmworkers and other immigrant workers. Perceived work safety climate is associated with hours worked per week (P = .02), precarious employment (P < .001), planting and cultivating (P = .002), topping tobacco (P = .0012), and stress (P = .02). Perceived work safety climate is particularly important for migrant farmworkers with H-2A visas because their labor contracts limit their options to change employers. Additional research on the status of work safety climate among agricultural workers is needed, as well as on the factors that affect work safety climate and on the safety characteristics that are affected by work safety climate. Policy changes that lead to improved work safety climate should be considered.

Work organization and health among immigrant women: Latina manual workers in North Carolina

OBJECTIVES

We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life.

METHODS

We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009-2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life.

RESULTS

Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor's power and safety climate) was associated with fewer depressive symptoms and better MCS.

CONCLUSIONS

Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.

Nutritional strategies of Latino farmworker families with preschool children: identifying leverage points for obesity prevention

Obesity and overweight are significant problems for children in the US, particularly for Hispanic children. This paper focuses on the children in families of immigrant Hispanic farmworkers, as farm work is the portal though which many immigrants come to the US. This paper (1) describes a model of the nutritional strategies of child feeding in farmworker families; and (2) uses this model to identify leverage points for efforts to improve the nutritional status of these children. In-depth interviews were conducted in Spanish with 33 mothers of 2-5 year old children in farmworker families recruited in North Carolina in 2010-2011. The purposive sample was balanced by farmworker status (migrant or seasonal), child age, and child gender. Interviews were transcribed and translated. Multiple coders and a team approach to analysis were used. Nutritional strategies centered on domains of procuring food, using food, and maintaining food security. The content of these domains reflected environmental factors (e.g., rural isolation, shared housing), contextual factors (e.g., beliefs about appropriate food, parenting style), and available resources (e.g., income, government programs). Environmental isolation and limited access to resources decrease the amount and diversity of household food supplies. Parental actions (parental sacrifices, reduced dietary variety) attempt to buffer children. Use of government food sources is valuable for eligible families. Leverage points are suggested that would change nutritional strategy components and lower the risk of overweight and obesity. Further prospective research is needed to verify the nutritional strategy identified and to test the ability of leverage points to prevent childhood obesity in this vulnerable population.

Employer differences in upper-body musculoskeletal disorders and pain among immigrant Latino poultry processing workers

Between-employer differences in working conditions may lead to variable injury rates. The objective of this paper is to assess the difference in the prevalence of epicondylitis, rotator cuff syndrome, and low back pain among immigrant Latino poultry workers at plants of three different employers. Data were collected from a cross-sectional study among 286 poultry processing workers. Community-based sampling was used to recruit participants in western North Carolina. Rotator cuff syndrome (26.7%) and low back pain (27.9%) were more prevalent among employees of one specific employer. Multivariate analysis showed significant associations of low back pain and rotator cuff syndrome with age, task performed in the processing line, and employer. Employer is a major predictor of musculoskeletal disorders and pain. Line speed and work pace may account for these differences and provide an opportunity for regulation and intervention to protect the health of workers.

Physical activity of preschool-aged Latino children in farmworker families

OBJECTIVE

To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families and delineate sources of variation in sedentary and MVPA.

METHOD

Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their children's characteristics and their physical and social environments.

RESULTS

Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA.

CONCLUSIONS

Preschool-aged Latino children in farmworker families are sedentary, engaging in little MVPA.

The effects of work organization on the health of immigrant manual workers: A longitudinal analysis

This analysis uses a longitudinal design to examine the associations of work organization and health outcomes among Latino manual workers. Participants included 247 Latino workers who completed baseline and 1-year follow-up interviews and clinical examinations. Health outcome measures were epicondylitis, rotator cuff syndrome, back pain, and depressive symptoms. Independent measures were measures of job demand, job control, and job support. Workers commonly experienced rotator cuff syndrome (6.5%), back pain (8.9%), and depressive symptoms (11.2%); fewer experienced epicondylitis (2.4%). Psychological demand was associated with rotator cuff syndrome; awkward position and decision latitude were associated with back pain. Decreased skill variety but increased decision latitude was associated with elevated depressive symptoms. Work context factors are important for health outcomes among vulnerable workers. Further research is needed to expand upon this work, particularly cultural perspectives on job support.

Comorbidity of tinea pedis and onychomycosis and evaluation of risk factors in Latino immigrant poultry processing and other manual laborers

OBJECTIVES

Latino immigrant workers experience elevated rates of skin disease that result from their working and living conditions. Working in manual occupations exposes workers to a variety of challenges, including occlusive shoes, vigorous physical activity, and wet conditions. These challenges predispose workers to fungal infection. The objectives of this article are to examine the comorbidity of tinea pedis and onychomycosis and to identify possible risk factors among Latino immigrant poultry and nonpoultry workers in western North Carolina.

METHODS

Data were obtained from a cross-sectional study conducted between June 2009 and November 2010 in rural western North Carolina among 518 manual Latino immigrant workers to assess their occupational injuries. Participants completed a face-to-face interview and a dermatologic examination.

RESULTS

Nearly one-third of the participants (32%) were diagnosed as having onychomycosis and more than one-third (37.8%) were diagnosed as having tinea pedis. There was a greater prevalence of tinea pedis in men than women (71.3% vs 28.7%, respectively). Of the 518 participants, 121 (23.5%) had both conditions. Participants who reported the use of occlusive shoes as "always" or "most of the time" had a higher prevalence of comorbid onychomycosis and tinea pedis than the rest of the group.

CONCLUSIONS

Comorbidity of tinea pedis and onychomycosis is common among immigrant Latino men and women who perform manual labor. Further studies confirming the presence and type of dermatophyte should be conducted.

Lifetime and current pesticide exposure among Latino farmworkers in comparison to other Latino immigrants

BACKGROUND

Pesticide exposure poses a health risk for farmworkers. This analysis documents lifetime and current pesticide exposure of North Carolina Latino migrant farmworkers, with comparison to non-farmworker Latino immigrants.

METHODS

During May to October 2012, 235 Latino farmworkers and 212 Latino non-farmworkers completed interviews with items to construct measures of lifetime, current residential and occupational pesticide exposure.

RESULTS

Farmworkers experience levels of lifetime and residential pesticide exposure that are consistently greater than among non-farmworkers. Farmworkers report a large number of occupational pesticide exposures. Lifetime exposure and current residential pesticide exposure are related to social determinants. Education is inversely related to lifetime pesticide exposure for farmworkers and non-farmworkers; farmworkers with H-2A visas report greater residential pesticide exposure than those without H-2A visas.

CONCLUSIONS

Occupational safety policy needs to consider these patterns of lifetime exposure when setting standards. Health care providers should be aware of the lifetime and current exposure of this vulnerable population.

Muscle intrusion as a potential cause of carpal tunnel syndrome

INTRODUCTION

The aim of this study was to determine whether there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS).

METHODS

Five hundred thirteen manual laborers (1026 wrists) were evaluated with ultrasound to determine whether those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. One hundred ninety of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine whether muscle intrusion at baseline predicted the development of CTS.

RESULTS

Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P=0.026) and flexed (P=0.018) positions than those without CTS. Baseline muscle intrusion did not predict development of CTS at 1 year.

CONCLUSIONS

Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year.

Occupational safety beliefs among Latino residential roofing workers

BACKGROUND

This analysis describes beliefs about work safety and personal protective equipment (PPE) among Latino roofing workers, it delineates their perceptions of work environment characteristics that affect work safety and PPE use, and it describes how they experience work injuries and the consequences of these injuries.

METHODS

In-depth interviews were completed with 10 current and former Latino residential roofers. Interview transcripts were subjected to systematic qualitative analysis.

RESULTS

Participants' valued productivity over safety, and this had a negative influence on their safety behavior and reduced their PPE use. They understood that roofing was hazardous. They limited use of PPE when they felt it reduced productivity and when it was uncomfortable. Work environment characteristics that affected safety included company size, the physical demands of the job, lack of training, the need for work, general life stress, and distractions at work. An injury had to result in lost work time to be considered significant. Access to health care is limited by employers not providing Workers' compensation.

DISCUSSION

Future research is needed to substantiate these descriptive results and to delineate factors that are associated with safety behavior and use of PPE. Interventions, based on a lay health educator model, are needed to improve safety in this population. Safety regulations need to be evaluated and their enforcement needs to be improved.

Relationship between nonprescribed therapy use for illness prevention and health promotion and health-related quality of life

OBJECTIVES

This study describes the nonprescribed therapy use (prayer, over-the-counter medications [OTC's], home remedies, vitamins, herbs and supplements, and exercise) for health promotion among rural elders. It also delineates the association of such therapy use with physical and mental health-related quality of life (HRQoL).

METHOD

The sample (N = 200) consisted of African American and White elders from south-central North Carolina. Participants completed baseline interviews and repeated measures of nonprescribed therapy use over a 6-month follow-up.

RESULTS

Prayer had the highest percentage (80.7%) of use for health promotion followed by OTC (54.3%); vitamins only (49.3%); herbs and supplements (40.5%); exercise (31.9%); and home remedies (5.2%). Exercise was significantly associated with better physical HRQoL (p < .05). However, elders who used nonprescribed therapies had poorer mental HRQoL than nonusers, adjusting for potential confounders.

CONCLUSION

This analysis suggests that use of some nonprescribed therapies for health promotion is associated with poorer mental HRQoL.

Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers

BACKGROUND

Manual labor employment occurs in environments with exposures likely to impact skin-related quality of life (SRQOL).

OBJECTIVES

The objectives of this paper are to (1) document the dimensions of SRQOL, (2) examine its association with skin symptoms, and (3) identify the predictors of SRQOL in Latino manual workers.

METHODS

A population-based survey of 733 Latino manual workers obtained Dermatology Life Quality Index (DLQI) and skin symptoms in the prior year.

RESULTS

Two-thirds of workers were employed in production. Skin symptoms in prior year were reported by 23%. Impaired SRQOL was reported by 23%. In multivariate analyses, reduced SRQOL was associated with age, occupation, childhood indigenous language use, and experience of skin symptoms in the prior year.

CONCLUSIONS

Despite overall high SRQOL exposures in some immigrant occupational groups produce reduce SRQOL. This rural, immigrant population faces significant obstacles to obtaining dermatological care; efforts are needed to improve their SRQOL.

Association between housing quality and individual health characteristics on sleep quality among Latino farmworkers

Although poor sleep quality and associated sleep disorders are associated with increased risk of job injury and multiple mental and physical health problems, scant research has examined sleep quality among Latino farmworkers. Interviews were conducted with 371 male Latino farmworkers working in North Carolina during the 2010 agricultural season. Data on housing quality and sleep quality were collected. Access to air conditioning was significantly and positively associated with good sleep quality. This association remained when other housing characteristics and individual health indicators were controlled. Good sleep quality was associated with low levels of pain, depression, and anxiety. Poor sleep quality among Latino farmworkers was associated with poorer indicators of health. One important indicator of housing quality, air conditioning, was associated with better sleep quality. Further research is required to delineate how to improve the adequacy of farmworker housing to improve sleep quality and other health indicators.

Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina

BACKGROUND

This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries.

METHODS

Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics.

RESULTS

Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS.

CONCLUSIONS

Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

One-year incidence of carpal tunnel syndrome in Latino poultry processing workers and other Latino manual workers

OBJECTIVE

To determine the incidence of carpal tunnel syndrome (CTS) over 1 year in Latino poultry processing workers.

METHODS

Symptoms and nerve conduction studies were used to identify Latino poultry processing workers (106 wrists) and Latinos in other manual labor occupations (257 wrists) that did not have CTS at baseline, and these individuals were then evaluated in the same manner 1 year later.

RESULTS

Based on wrists, the 1-year incidence of CTS was higher in poultry processing workers than non-poultry manual workers (19.8% vs. 11.7%, P = 0.022). Poultry workers had a higher odds (1.89; P = 0.089) of developing CTS over 1 year compared to non-poultry manual workers.

DISCUSSION

Latino poultry processing workers have an incidence of CTS that is possibly higher than Latinos in other manual labor positions. Latino poultry workers' high absolute and relative risk of CTS likely results from the repetitive and strenuous nature of poultry processing work.

Patterns and Stability over Time of Older Adults' Diabetes-related Beliefs

OBJECTIVES

We sought to identify coherent profiles of diabetes beliefs within discrete domains (ie causes, symptoms, consequences, self management, and medical management), and delineate consistency of belief profiles over one month.

METHODS

Diabetes beliefs of rural-dwelling older adults were assessed with the Common Sense Model of Diabetes Inventory at baseline (N = 593) and one month later (N = 563).

RESULTS

A discrete number of belief patterns were identified in each belief domain using latent class analysis. Belief patterns varied by the extent to which more popular or folk notions of diabetes encroached on biomedical understandings of the disease. Belief patterns were generally stable over time.

CONCLUSIONS

A manageable number of belief patterns can be identified and used to strengthen patient-centered care and, potentially, enhance diabetes management.

Pesticides present in migrant farmworker housing in North Carolina

BACKGROUND

Migrant farmworkers are exposed to pesticides at work. Housing provided to migrant farmworkers may also expose them to pesticides, increasing their health risks. This analysis (1) describes the presence of organophosphorous (OP) and pyrethroid pesticides in North Carolina migrant farmworker houses, and (2) delineates associations of farmworker camp characteristics with pesticide detection and concentration.

METHODS

In 2010, 186 migrant farmworkers camps in NC were recruited (participation rate of 82.3%); pesticide wipe samples for 176 houses were analyzed. Tobacco is the predominant hand-harvested crop in this region. Two farmworkers per camp completed interviews; a third assisted with a housing inspection. Gas chromatography-mass spectrometry was used to detect OP and pyrethroid pesticides. Covariates of pesticide detection and concentration were determined with ANOVA and Tobit regression.

RESULTS

OPs were found in 166 of 176 houses (average of 2.4/house); pyrethroids were found in 171 houses (average of 4.3/house). The number of different OPs detected in each camp and concentrations of these OPs were not associated with camp and housing characteristics. The number of different pyrethroids detected in each camp and concentrations of these pyrethroids were associated with camps having residents with H2-A visas, a posted North Carolina Department of Labor Certificate of Inspection, no barracks, fewer residents, no bedroom weather protection or floor violations, and no roaches.

CONCLUSIONS

Farmworkers are exposed to pesticides where they live. Policy on removing pesticides from farmworker houses is needed. Reducing pesticides in farmworker houses will reduce one health risk confronted by this vulnerable population.

Pesticide exposures to migrant farmworkers in Eastern NC: detection of metabolites in farmworker urine associated with housing violations and camp characteristics

BACKGROUND

The purpose of this paper is to present and evaluate descriptively bivariate associations between urinary metabolites of pesticides and herbicides and migrant camp conditions, violations, and personal worker behaviors at home for farmworkers who do not apply pesticides.

METHODS

We studied 183 migrant farmworker camps in eastern North Carolina in 2010. Data and urine samples were collected from 371 men. Predictor measures included violations in six domains of housing regulations and nonviolation characteristics and personal behaviors that might impact urinary metabolites.

RESULTS

Cockroaches and bathroom violations were predictive of increased exposure to pyrethroids and cyfluthrin/chlorpyrifos, respectively. Changing and storing clothing and shoes in sleeping rooms increased the number of detects for the diazinon metabolite.

CONCLUSIONS

Farmworkers had exposures to multiple chemicals. No single housing domain was identified as critical to mitigating housing-related exposure; specific attention should be paid to changing and storing soiled clothing in sleeping rooms, and insect infestations.

Barriers and facilitators for promotoras' success in delivering pesticide safety education to Latino farmworker families: La Familia Sana

Despite widespread use of lay health advisor (LHA) programs, factors related to success of LHAs remain largely unexamined. This study describes experiences and personal transformations of LHAs (promotoras de salud) in a pesticide safety education program targeting farmworker families in North Carolina, using postintervention in-depth interviews conducted with 17 LHAs. LHAs identified assets and barriers that affected their success. LHAs also described increases in self-efficacy and empowerment resulting in perceived improvements in ability to teach and impact their community. Such positive changes are essential benefits to the LHAs. Evaluations that address these topics are needed to better understand continuity and attrition in LHA programs.

A qualitative analysis of how elders seek and disseminate health information

This study documents older adults' sources of health information, describes the purposes for health information seeking, and delineates gender and ethnic variation in health information seeking. Sixty-two African American and White adults aged 65 and older completed qualitative interviews describing their use of complementary therapies. Interviews identified how individuals obtained and shared health information. Friends, not family, were the dominant source of health information. Participants ranged from active seekers to passive consumers of health information. Information seeking was common for benign symptoms. More women than men discuss health information with others. Friends are the primary source of health information for rural older adults. There is substantial passivity in the pursuit of health information. Identifying health information sources of rural older adults can support the dissemination of information to those who share it with others.

Job design and ethnic differences in working women's physical activity

OBJECTIVE

To document the role job control and schedule control play in shaping women's physical activity, and how it delineates educational and racial variability in associations of job and social control with physical activity.

METHODS

Prospective data were obtained from a community-based sample of working women (N = 302). Validated instruments measured job control and schedule control. Steps per day were assessed using New Lifestyles 800 activity monitors.

RESULTS

Greater job control predicted more steps per day, whereas greater schedule control predicted fewer steps. Small indirect associations between ethnicity and physical activity were observed among women with a trade school degree or less but not for women with a college degree.

CONCLUSIONS

Low job control created barriers to physical activity among working women with a trade school degree or less. Greater schedule control predicted less physical activity, suggesting women do not use time "created" by schedule flexibility for personal health enhancement.

Self-reported sleep difficulties and self-care strategies among rural older adults

This study examined the use of self-care strategies to address difficulty sleeping among community-dwelling older adults. Data were collected from a series of 18 questionnaires administered to 195 rural African American and white older adults in North Carolina. Participants reported whether they had experienced difficulty sleeping and strategies used to respond to the symptom. The most widely used strategies included ignoring the symptom, staying in bed or resting, and praying. Herb and supplement use were not reported. Ethnicity, income, and education were associated with use of specific self-care strategies for sleep. This variation suggests that older adults may draw on cultural understandings to interpret the significance of difficulty sleeping and influence their use of self-care strategies, including complementary and alternative medicine use. This information may enable health care providers to communicate with the older patients about sleep difficulty strategies to minimize sleep problems.

Assessment of a short diabetes knowledge instrument for older and minority adults

PURPOSE

The purpose of the study was to assess the performance of a Short Diabetes Knowledge Instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.

RESEARCH DESIGN AND METHODS

A sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least 2 years prior, was recruited from 8 North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.

RESULTS

Three items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.

CONCLUSIONS

The SDKI (13-item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.

Correlates of physician trust among rural older adults with diabetes

OBJECTIVES

To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes.

METHODS

563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale.

RESULTS

Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders.

CONCLUSIONS

Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.

Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers

INTRODUCTION

The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially.

METHODS

We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound.

RESULTS

A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist.

CONCLUSIONS

The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.

Feasibility of using a community-supported agriculture program to improve fruit and vegetable inventories and consumption in an underresourced urban community

Introduction

Direct-to-consumer marketing efforts, such as community-supported agriculture (CSA), have been proposed as a solution for disparities in fruit and vegetable consumption. Evaluations of such efforts have been limited. The objective of this study was to test the feasibility of a CSA intervention to increase household inventory of fruits and vegetables and fruit and vegetable consumption of residents of an underresourced community.

Methods

For this randomized, controlled feasibility study, we recruited 50 low-income women with children. Intervention (n = 25) participants were offered 5 educational sessions and a box of fresh produce for 16 weeks; control participants were not offered the sessions nor were they included in the produce delivery. We collected data on participants’ home inventory of fruits and vegetables and on their consumption of fruits and vegetables at baseline (May 2012) and postintervention (August and September 2012).

Results

Of 55 potential participants, 50 were enrolled and 44 were reached for follow-up. We observed a significant increase in the number of foods in the household inventory of fruits and vegetables in the intervention group compared with the control group. The intervention group reported greater increases in fruit and vegetable consumption; however, these did not reach significance. Intervention participants picked up produce 9.2 (standard deviation = 4.58) of 16 weeks; challenges included transportation and work schedules. Most participants (20 of 21) expressed interest in continued participation; all stated a willingness to pay $10 per week, and some were willing to pay as much as $25 per week.

Conclusion

CSA is a feasible approach for providing fresh fruits and vegetables to an underresourced community. Future studies should evaluate the impact of such a program in a larger sample and should take additional steps to facilitate participation.

Cognitive function is a risk for health literacy in older adults with diabetes

AIMS

Cognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy.

METHODS

The sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA.

RESULTS

Cognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively.

CONCLUSIONS

These results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.

Occupational health outcomes for workers in the agriculture, forestry and fishing sector: implications for immigrant workers in the southeastern US

BACKGROUND

Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic.

METHODS

We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US.

RESULTS

Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries.

CONCLUSION

As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

Use of Complementary Therapies for Health Promotion Among Older Adults

This article describes the types of complementary therapies used by older adults for health promotion, and delineates the predisposing, enabling, and need factors associated with their use. One-hundred ninety-five African American and White participants (age 65+) completed a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. Complementary therapies for health promotion included home remedies, specific foods or beverages, herbs, supplements, vitamins, over-the-counter (OTC) medicine, prayer, exercise, and being active. Although gender, ethnicity, education, and trust in doctors were associated with the use of complementary therapies for health promotion, health information seeking was the predisposing factor most often associated. The enabling factors were also associated with their use. Health information seeking, which reflects a wellness lifestyle, had the most consistent associations with complementary therapy use for health promotion. This health self-management for health promotion may have positive effects on future medical expenditures.

Personal protective equipment and work safety climate among Latino poultry processing workers in Western North Carolina, USA

BACKGROUND

Job-appropriate personal protective equipment (PPE) is important for decreasing the high rates of occupational injury experienced by poultry processing workers.

OBJECTIVES

This analysis describes the job-appropriate PPE provided to poultry processing workers by their employers and the PPE used by these workers, and it delineates the association of work safety climate with job-appropriate PPE.

METHODS

Data are from a cross-sectional study of 403 Latino poultry processing workers in North Carolina.

RESULTS

Most poultry processing workers are not provided with nor use job-appropriate PPE; however, more workers use PPE than are provided. The provision and use of PPE differs by employer. Work safety climate was associated with use of job-appropriate PPE.

CONCLUSIONS

Poultry processing workers should be provided with job-appropriate PPE. Workers' use of PPE is an indicator of safety climate. Further research about work safety climate and other work organization characteristics and job safety characteristics is needed.

"Causes" of pesticide safety behavior change in Latino farmworker families

OBJECTIVE

To identify the source of behavior change resulting from a health education intervention focused on pesticide safety.

METHODS

Data were from the La Familia Sana demonstration project, a promotora-delivered pesticide safety education intervention conducted with immigrant Latinos (N = 610).

RESULTS

The La Familia Sana program produced changes in 3 sets of pesticide safety behaviors. Changes in the conceptual targets of the intervention and promotora attributes explained 0.45-6% and 0.5-3% of the changes in pesticide-related behavior, respectively.

DISCUSSION

The conceptual targets of the La Familia Sana program explained the greatest amount of change in pesticide-related behavior. Promotora attributes also contributed to intervention success.