Job demands and pesticide exposure among immigrant Latino farmworkers

Structural and Social Determinants of Inequitable Environmental Exposures in the United States

American Indian (AI)/Alaskan Natives, African Americans, and Latino Americans have disproportionally high exposure to harmful environmental conditions as a consequence of unjust laws and policies, systemic racism, residential segregation, and discrimination. In this review, we draw connections between historical policies and social movements in the United States' history that have been rooted in racism and classism, leading to social isolation and marginalization of AIs, African Americans, and Latino Americans. We then discuss the structural factors that stem from the aforementioned inequities and that contribute to the inequitable distribution of environmental hazards.

Job Demand-Control and Hypertension in African Americans and Non-African Americans

OBJECTIVES

The aim of this study was to determine if occupational stress is a social determinant of elevated hypertension among African Americans.

METHODS

Currently employed, full-time adults from the Midlife in the United States Refresher and Midlife in the United States Milwaukee Refresher studies reported data on demographics, job characteristics, and medical history.

RESULTS

African American workers reported less job control and greater physical job demands than non-African Americans. Both physical and psychological job demands were independently associated with greater odds of high blood pressure. Job strain was associated with high blood pressure and differed by race ( P < 0.05).

CONCLUSIONS

The elements of the job-demand control model differed by race and were most relevant for African Americans when exposed to high job demands and low job control. However, there was no evidence of differential vulnerability for either psychological demands, control, or physical demands for African Americans.

Rural Latino health and the built environment: a systematic review

Objective: This study systematically reviewed literature examining the influence of the rural built environment on Latinos' health outcomes and behaviour in the United States. A secondary aim of the study was to identify strategies developed to address challenges in the rural built environment affecting Latinos' health.Design: This study followed the reporting guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Articles included in the final analysis clearly linked Latino health outcomes to characteristics of the rural built environment.Results: Of the nearly 2,500 articles identified in the initial search, the final review included approximately 146 full-text sources. The majority of the articles focused on aspects of Latinos' physical (n = 68), behavioural (n = 43), and mental health (n = 23).Conclusions: Rural Latino neighbourhoods in the United States possess limited access to health care, internet, transportation, and recreation infrastructure, which negatively impacts health outcomes and behaviours. Strategies developed to mitigate these issues include but are not limited to: the use of telecommunications to distribute health information; the use of community health workers and mobile clinics to increase awareness and availability of select health services; the use of worksite trainings and adaptations to the workplace; and the promotion of safety net programmes, such as the Supplemental Nutrition Programme for Women, Infants and Children (WIC). This review supports the need for a more robust research agenda documenting the health experiences of rural Latinos of various nationalities, age groups, and genders.

Immigration, Mental Health and Psychosocial Well-being

Anthropological approaches to "immigrant mental health" as an object of ethnographic inquiry can illuminate how psychosocial well-being - or decline - and the therapeutic realm of mental health is always enacted by a variety of institutions and social actors. The ways that mental health is understood and approached across different geographical and social settings are constitutive of a range of cultural meanings, norms, and social relations. The authors in this special section provide crucial insights into the landscape of immigrant mental health and how the experience of multiple exclusions influences collective psychosocial well-being. They also illustrate the extent to which narratives shape the production of knowledge around immigration and health, engendering direct effects on public policy, social imaginaries, and community health. Future research in the anthropology of immigration and mental health will need to further elucidate the structural underpinnings and racial capitalist origins of psychosocial decline.

The Impact of Work Demand and Gender on Occupational and Psychosocial Stress in Hispanic Farmworkers

Hispanic farmworkers experience hazardous work conditions, language barriers, poverty, and limited healthcare access that increase their risk for health problems. We sought to characterize occupational and lifestyle stressors in farmworker couples and to examine the impact of seasonal work demand and gender on health outcomes. We administered surveys to 31 couples (N = 62) in May (low work demand) and September (high work demand) of 2012. Measures included acculturation, perceived stress, depressive symptoms, quality of life, decision latitude, support (supervisor, co-worker), and work-family conflict. This population did not report significant differences in stress in low and high work demand times. Women reported more work-family conflict (F = 19.06, p 0.0001; F = 11.28, p = 0.0015) and less supervisor support (F = 6.56, p = 0.0135). Women experienced more conflict between work and family and less support at work. This group reported low depressive symptomology and moderate levels of stress; a subset reported elevated levels.

Cardiovascular disease risk factors among Latino migrant and seasonal farmworkers

Migrant and seasonal (MS) farmworkers are an important component of the US economy. Their unique occupational health concerns have garnered research, but chronic disease research in this population is lacking. It is unclear whether health differences exist between migrant (those who migrate to and travel a distance from the home environment and thus live in temporary housing for the purpose of employment) and seasonal workers (those who work in the agricultural industry on a seasonal basis, whose long-term home environments are often near work locations and thus may be considered more "settled"), since most research presents MS farmworkers as a homogenous group. This study explored potential differences in cardiovascular disease risk factors, (i.e., diabetes, current smoking, obesity, hypertension, and hypercholesterolemia) by sex and MS status among a sample of 282 English- and Spanish- speaking Latino MS farmworkers in the Midwest using cross-sectional survey and clinical laboratory data. Results showed that in multivariate logistic regression analyses, migrant workers (odds ratio [OR] = 2.15) had a higher likelihood of being obese compared with seasonal workers (P < .05). MS farmworkers did not differ in likelihood of smoking, diabetes, hypertension, or hypercholesterolemia. In adjusted analyses, females were more likely to be obese (OR = 3.29) and have diabetes (OR = 4.74) compared with males (P < .05); and males were more likely to be current smokers (OR = 7.50) as compared with females (P < .05). This study provides insight into chronic health concerns among this predominantly Latino farmworker population and suggests that future prevention and intervention research may need to focus on sex differences rather than MS farmworker status.

A Critical Caring Theory of Protection for Migrants and Seasonal Farmworkers

Pesticide exposures represent inequities among a vulnerable population of migrant and seasonal farmworkers. A social justice theory synthesized from an environmental health research framework, a middle range theory of critical caring, and literature on pesticide exposure is presented as a situation-specific public health practice theory. Concepts from the physiological, epistemological, vulnerability, and health protection domains are related to concepts of critical caring revealing protective strategies for vulnerable populations exposed to pesticides. The key concepts are risk exposure, community assessment, transpersonal health promotion, community competence, and controllability. Protection from exposure involves raising awareness, critically assessing communities, educating for empowerment, building capacity, and advocating to ensure social justice. Critical caring protection is provided in a mutually respectful relationship that promotes responsibility at the individual and population levels.

Spanish-Language Consumer Health Information Technology Interventions: A Systematic Review

Background

As consumer health information technology (IT) becomes more thoroughly integrated into patient care, it is critical that these tools are appropriate for the diverse patient populations whom they are intended to serve. Cultural differences associated with ethnicity are one aspect of diversity that may play a role in user-technology interactions.

Objective

Our aim was to evaluate the current scope of consumer health IT interventions targeted to the US Spanish-speaking Latino population and to characterize these interventions in terms of technological attributes, health domains, cultural tailoring, and evaluation metrics.

Methods

A narrative synthesis was conducted of existing Spanish-language consumer health IT interventions indexed within health and computer science databases. Database searches were limited to English-language articles published between January 1990 and September 2015. Studies were included if they detailed an assessment of a patient-centered electronic technology intervention targeting health within the US Spanish-speaking Latino population. Included studies were required to have a majority Latino population sample. The following were extracted from articles: first author’s last name, publication year, population characteristics, journal domain, health domain, technology platform and functionality, available languages of intervention, US region, cultural tailoring, intervention delivery location, study design, and evaluation metrics.

Results

We included 42 studies in the review. Most of the studies were published between 2009 and 2015 and had a majority percentage of female study participants. The mean age of participants ranged from 15 to 68. Interventions most commonly focused on urban population centers and within the western region of the United States. Of articles specifying a technology domain, computer was found to be most common; however, a fairly even distribution across all technologies was noted. Cancer, diabetes, and child, infant, or maternal health were the most common health domains targeted by consumer health IT interventions. More than half of the interventions were culturally tailored. The most frequently used evaluation metric was behavior/attitude change, followed by usability and knowledge retention.

Conclusions

This study characterizes the existing body of research exploring consumer health IT interventions for the US Spanish-speaking Latino population. In doing so, it reveals three primary needs within the field. First, while the increase in studies targeting the Latino population in the last decade is a promising advancement, future research is needed that focuses on Latino subpopulations previously overlooked. Second, preliminary steps have been taken to culturally tailor consumer health IT interventions for the US Spanish-speaking Latino population; however, focus must expand beyond intervention content. Finally, the field should work to promote long-term evaluation of technology efficacy, moving beyond intermediary measures toward measures of health outcomes.

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.

Job control, psychological demand, and farmworker health: evidence from the national agricultural workers survey

OBJECTIVE

Improve understanding of the potential occupational health impact of how agricultural jobs are organized. Exposure to low job control, high psychological demands, and high job strain were hypothesized to have greater risk for poor self-rated physical health and elevated depressive symptoms.

METHODS

Cross-sectional data (N = 3691) obtained using the Work Organization and Psychosocial Factors module of the US National Agricultural Workers Survey fielded in 2009-2010.

RESULTS

More than one fifth (22.4%) of farmworkers reported fair/poor health, and 8.7% reported elevated depressive symptoms. High psychological demand was associated with increased risk of fair/poor health (odds ratio, 1.73; 95% confidence interval, 1.4 to 2.2) and elevated depressive symptoms (odds ratio, 2.6; 95% confidence interval, 1.9 to 3.8).

CONCLUSIONS

The organization of work in field agriculture may pose risks for poor occupational health outcomes among a vulnerable worker population.

Evaluating Job Demands and Control Measures for Use in Farm Worker Health Surveillance

Workplace stress likely plays a role in health disparities; however, applying standard measures to studies of immigrants requires thoughtful consideration. The goal of this study was to determine the appropriateness of two measures of occupational stressors ('decision latitude' and 'job demands') for use with mostly immigrant Latino farm workers. Cross-sectional data from a pilot module containing a four-item measure of decision latitude and a two-item measure of job demands were obtained from a subsample (N = 409) of farm workers participating in the National Agricultural Workers Survey. Responses to items for both constructs were clustered toward the low end of the structured response-set. Percentages of responses of 'very often' and 'always' for each of the items were examined by educational attainment, birth country, dominant language spoken, task, and crop. Cronbach's α, when stratified by subgroups of workers, for the decision latitude items were (0.65-0.90), but were less robust for the job demands items (0.25-0.72). The four-item decision latitude scale can be applied to occupational stress research with immigrant farm workers, and potentially other immigrant Latino worker groups. The short job demands scale requires further investigation and evaluation before suggesting widespread use.

Does the perception of psychosocial factors increase the risk of pesticide exposure among seasonal Hispanic farmworkers?

BACKGROUND

Migrant farmworkers are prone to several psychosocial stressors.

OBJECTIVE

To investigate the effect of perceived psychosocial factors on pesticide exposure among seasonal migrant Hispanic farmworkers in North Carolina, USA.

METHODS

A cross-sectional interview survey of 187 seasonal migrant farmworkers of Mexican descent, identified from labor camps located in rural counties in North Carolina, was conducted using nonprobability purposive sampling approach. Multivariable ordinal logistic regression analysis was used to determine the relationship between perceived control over the harmful effects of pesticide exposure, lack of social support, and the impact of anxiety on perception of pesticide exposure.

RESULTS

More than 20% (n=39) of farmworkers reported frequent or constant contact with pesticides while working in the fields. More than 68% of farmworkers reported they believe they have control over avoiding harmful effects of pesticide exposure; the odds of pesticide exposure were 55% lower in this group (adjusted OR: 0.45; 95% CI: 0.22-0.91). No significant relationship was observed between farmworkers perception of lack of social support and presence of anxiety with odds of on-field pesticide exposure.

CONCLUSION

The study results suggest that perception of control is an important predictor of reduced pesticide exposure among seasonal migrant farmworkers.

Health status and needs of Latino dairy farmworkers in Vermont

Vermont is a new Latino destination where many Spanish-speaking migrants have found work on dairy farms. One hundred twenty Latino workers were surveyed on 59 Vermont dairy farms to develop a demographic profile and evaluate their self-assessed health status and barriers to care. The study found, similar to other studies, the majority of workers were young, male Mexicans. However, the workers in this study, as compared to others, originated farther south in Mexico and there were significant regional differences in educational attainment. Workers defined health in terms of their ability to work and the majority believed themselves to be in good health. The majority felt that moving to the United States has not changed their health status. The most common health issue reported was back/neck pain, followed by dental and mental health issues. Workers are both physically and linguistically isolated and reported isolation as the most challenging aspect of dairy farm work. Fear of immigration law enforcement was the primary barrier to care. Community-based initiatives, including partnerships with colleges and universities, outreach to farm employers and the adoption of "bias-free policing" are strategies that can increase access to health care for Latino dairy farmworkers in the United States.

Occupational injury and work organization among immigrant Latino residential construction workers

BACKGROUND

Rates of occupational injury among immigrant workers are widely believed to be underestimated. The goal of this study was to enhance understanding of the burden of occupational injury and the work organization factors underlying injury among immigrant Latino residential construction workers.

METHODS

Prospective data were obtained from a community-based sample of Latino residential construction workers (N = 107) over a 3-month period.

RESULTS

Twenty-eight participants were injured, resulting in an injury incidence rate of 55.0/100 FTE (95% CI = 41.4-71.6) during the 3-month observation period. The injury rate involving days away from work during the observation period was 3.9/100 FTE (CI = 0.2-7.2). Injuries were elevated among roofers relative to framers and general construction workers. Roofers had elevated exposure to a variety of deleterious work organization factors.

CONCLUSIONS

Although imprecise given the small sample, our results suggest a threefold to fourfold underestimate of the injury burden to immigrant Latino construction workers. Work organization may contribute to elevated rates of non-fatal occupational injury, particularly among roofers.

A cross-sectional exploration of excessive daytime sleepiness, depression, and musculoskeletal pain among migrant farmworkers

In this study the authors estimated the prevalence of elevated daytime sleepiness, depressive symptoms, and musculoskeletal pain among Latino migrant farmworkers, and examined the relationship among these symptoms. Data are from a cross-sectional survey of migrant farmworkers (N = 300) conducted in eastern North Carolina in 2009. Eleven percent of Latino farmworkers reported elevated levels of daytime sleepiness, 28% reported elevated levels of depressive symptoms, and 5% reported moderate to severe musculoskeletal pain on a daily or weekly basis. Depressive symptoms and daytime sleepiness were positively associated. Depression and daytime sleepiness may increase risk of injury; further research regarding sleep issues is warranted.

Depressive symptoms and sleepiness among Latino farmworkers in eastern North Carolina

Depression and sleepiness are both risk factors for occupational accidents and unintentional injury. Relatively little is known about the experiences of these risk factors in the immigrant Latino farmworker population. This analysis uses prospective panel data from a sample of Latino farmworkers in eastern North Carolina that were collected at monthly intervals during the 2008 agricultural season to (1) describe depressive symptoms and daytime sleepiness among immigrant Latino farmworkers across the agricultural season; (2) delineate associations of depressive symptoms with sleepiness across time; and (3) determine whether depressive symptoms precede sleepiness, or if sleepiness precedes depressive symptoms. Results indicated that 45% of farmworkers experienced elevated depressive symptoms across the season, whereas 20% experienced elevated sleepiness. Elevated depressive symptoms were more common among farmworkers living in barracks, and less common among those living in trailers. Sleepiness was more common among women than men. There was no evidence that depressive symptoms contributed to sleepiness, or that sleepiness contributed to depressive symptoms. The pattern of results suggests that a substantial proportion of Latino farmworkers experience levels of depressive symptoms or sleepiness that places them at risk for occupational accident or unintentional injury. The results also suggest that depressive symptoms and sleepiness do not cause each other; rather, the association of depressive symptoms with sleepiness hints at the possibility of a common physiologic mechanism such as circadian disruption.