Associations of Poor Housing with Mental Health Among North Carolina Latino Migrant Farmworkers

Poor housing conditions in adolescence and adult health outcomes: an outcome-wide longitudinal approach

BACKGROUND

While prior literature has documented the impact of housing quality on health, the long-lasting effects of poor housing conditions in adolescence on adult health remain understudied. This study employs an outcome-wide longitudinal approach to estimate the association between poor housing conditions in adolescence and a set of health outcomes in adulthood.

METHODS

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a large-scale, nationally representative sample of US adolescents, were used. This study analysed 15 health outcomes encompassing physical and mental/cognitive health, and health behaviours. The Bonferroni correction was applied to adjust the significance level of multiple testing of the associations.

RESULTS

After applying the Bonferroni correction, poor housing conditions in adolescence were associated with seven adult health outcomes. These conditions were particularly strongly and robustly linked to mental health issues, including depression, suicidal ideation and perceived stress. Additionally, poor housing conditions were related to physical health outcomes such as cardiovascular disease risk and self-rated health, as well as health behaviours such as smoking and unhealthy eating behaviour.

CONCLUSION

Poor housing conditions during adolescence can act as an early risk factor for adult health, particularly mental health. These findings support the adoption of a life course approach and strengthen the case for housing interventions aimed at improving health outcomes.

"You're Just Stuck in a Hole, Really": Mechanisms of Structural Racism Through Migrant Agricultural Worker Housing in Canada

Worldwide, migrant agricultural workers face poor housing conditions and related health challenges. A growing body of research has documented the substandard housing often occupied by this largely racialized population. Yet limited health research has examined mechanisms of structural racism that determine this group's poor housing and health. Drawing on interviews with 151 migrant farmworkers in Ontario and British Columbia, Canada, we documented the housing experiences faced by migrant agricultural workers and examined the role of structural racism in determining housing and health inequities. Our analysis identified four overlapping mechanisms by which migrants' housing and health were determined by structural racism: (1) scarcity, (2) segregation, (3) sacrifice, and (4) stagnation. These mechanisms both reinforced and normalized housing hardships, making it difficult for migrants to escape unsafe or inadequate housing. Our findings point to the need for immediate action to improve housing conditions for this population and to interrogate the racist design that keeps migrant workers at the margins of society.

Disordered alcohol and substance use in Irish farmers: A cross-sectional survey

PURPOSE

Farming is a high-pressure occupation. Populations of farmers face significant health risks, including injury, mental illness, and in some cases, heavy alcohol use. However, there is little research on farmers' use of substances beyond alcohol. This study examines factors relating to Irish farmers' disordered alcohol and substance use.

METHODS

In accordance with STROBE guidelines for cross-sectional research and reporting, we examined disordered alcohol and substance use in 351 Irish farmers using the Alcohol Use Disorders Identification Tool (AUDIT) and Drug Use Disorders Identification Tool (DUDIT).

FINDINGS

While 28% of farmers did not drink, 40% of those who did drink exceeded the AUDIT threshold for disordered use. Similarly, while 95% of farmers did not use substances, 78% of farmers who did use substances exceeded the DUDIT threshold for disordered use. Age was the most important risk factor for disordered alcohol and substance use and correlated with other main risk factors: lower income, no children, part-time farmer, and full-time off-farm roles. Disordered drinking was highest in farmers engaged in full-time education.

CONCLUSIONS

This population of Irish farmers report broadly healthy alcohol and substance use behaviors. Irish farmers may serve as a model group whose strengths can be utilized in interventions within and beyond the Irish farming community. Our results confirm the importance of analyzing demographic factors in farmers' drinking and identify younger farmers as especially at-risk for harmful alcohol and substance use.

Psychosocial Determinants of Mental Healthcare Use Among Mexican-origin Women from Farmworker Families in Southern California

Little is known about the contribution of psychosocial factors related to mental healthcare use among Mexican-origin women from farmworker families. Therefore, this study assessed relationships between acculturative stress, depressive symptoms, mental healthcare service use, and preferences for seeking care. Linear and logistic regression models and chi-square tests were performed to analyze survey data from 78 Mexican-origin women from farmworker families. Women were recruited in collaboration with promotoras and completed measures of acculturative stress, depressive symptoms, and mental healthcare use and preferences. Overall, 29.5% of the sample reported clinically significant depressive symptomatology. Acculturative stress was positively associated with depressive symptoms (b = 0.43, 95%CI = 0.27,0.59) after controlling for years in the U.S., primary language, and demographic characteristics. In addition, acculturative stress was associated with lower odds of mental healthcare use (OR = 0.96) after controlling for years in the U.S. and depressive symptoms. However, this association was no longer statistically significant when controlling for health insurance status and access to transportation. Mexican-origin women with high levels of acculturative stress were significantly more likely to seek care from a psychiatrist/psychologist than their peers (54.3% vs. 45.7%); however, this preference was not indicative of their use of mental healthcare services. Results suggest that acculturative stress is a risk factor for depressive symptoms and might contribute to a delay in seeking mental healthcare services in Mexican-origin women from farmworker families. Thus, interventions for this group should address aspects of acculturative stress as a strategy to increase mental health services use.

Latino Migrant Farmworker Youths' Perceptions of Access to Care in the Southeast: A Qualitative Approach

This study explored Latino Migrant Farmworker (LMFW) youths' perceptions regarding access to health care in the United States (U.S.). Twenty semi-structured audio-voice recorded interviews were conducted with LMFW youths (aged 15-20 years old) in Georgia and Florida. Thematic analysis was used to explore whether, and how, LMFW youths would seek health care in the U.S. as well as their personal views toward health care. Five distinct perceptions regarding accessing health care were delineated: (1) cultural-related views and attitudes toward health care, (2) transportation dependency, (3) English language as a barrier for communication, (4) lack of knowledge of available resources, and (5) embracing the obligation, and the necessity, of work. Some of LMFW youths' perceptions of seeking access to health care in the U.S. point to barriers related to social determinants of health. These barriers suggest the need for significant reform within the U.S. health care system to include farmworker youths' health needs and to promote cultural responsiveness among clinicians and rural health providers to better serve this vulnerable population.

A Small Randomized Controlled Trial of Three Remote Methods to Collect Mental Health Data from Migrant Farmworker Adults

There has been limited longitudinal study of the health of migrant farmworkers due to their migratory lifestyles and there are opportunities to test new remote data collection methods in this subpopulation. A small randomized controlled trial was conducted with 75 migrant farmworker families who were randomly assigned to one of three groups that participated by (1) telephone interview, (2) online survey, or (3) mobile app between June 2021-April 2022. Of 50 farmworker adults who completed the baseline survey, there was differential attrition with 21% of the telephone interview group, 18% of the online survey group, and 3.2% of the online app group completing the 2-month follow-up. Over this period, migrant farmworkers reported relatively few mental health problems but notable alcohol use problems. Online apps were less effective than traditional methods for remote data collection. Alcohol use problems among migrant farmworkers in the U.S. may be an issue that deserves further study.

An Analysis of the Availability of Health Education Materials for Migrant and Seasonal Farmworkers

Community health workers (CHWs) have reported a paucity of farmworker-specific education materials for use during health outreach to farmworkers. To improve our understanding of the availability of topically and culturally relevant health education materials for farmworkers, we identified 15 key health topics to examine across four major online health information services: MedlinePlus.gov, Migrant Clinicians Network, National Agricultural Safety Database, and National Center for Farmworker Health. We established inter-coder reliability and conducted coding for health education materials by topic and identified the percentage of materials specifically designed for farmworkers. The availability of materials ranged from, on the low end, accessing clinic services, having one health education material total across all four online services, to alcohol, tobacco, and other drugs, having 50 materials across the four online services. Online health information services ranged from 0.6% of the materials designed specifically for farmworkers (MedlinePlus.gov) to 42.9% (Migrant Clinicians Network). The findings from this study underscore the need to support community-based projects centering CHWs' roles as advocates and facilitators to develop educational materials for farmworker health outreach.

Gender-based inequalities in the effects of housing on health: A critical review

Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.

Innovative Cohort Process to Minimize COVID-19 Infection for Migrant Farmworkers During Travel to Iowa

Background: Migrant and seasonal farmworkers (MSFW) experience disproportionate infection, severe disease and death from COVID-19. This report describes an innovative process to address the safety of MSFW that utilized cohorting that eventually allowed for safe release to work in the fields on a large family farm in Iowa. Methods: Upon worker departure from Mexico, the employer arranged for bus seat assignments, mask use, and hand hygiene practice during the 3-day trip to Iowa. Upon arrival at the farm, surveillance testing and low-density housing cohorting based upon travel seat assignments allowed for early identification of infected workers and appropriate quarantine as per CDC guidelines. Upon completion of isolation or quarantine as appropriate, workers were released to congregate housing and work in the fields. Findings: Compared to a migrant farmworker COVID-19 outbreak without travel pre-planning, the cohorting process produced a 3.5% positivity rate compared to an earlier season July farmworker group on the same farm with a 12.7% positivity rate. Conclusions/Application to Practice: The success of this model points to the power of collaboration between farm employer, health care providers and workers to minimize worker infection and enable safe work in the fields. Increased state and federal support for MSFW protections could support infrastructure to proactively plan for prevention mechanisms to prevent the spread of known communicable disease. With support in place from the top down, employers, workers, and health care providers will be able to prioritize the management of infectious diseases and the needs of essential workers.

Substance use disorders in the farming population: Scoping review

PURPOSE

The purpose of this scoping review is to summarize the current knowledge base in order to make recommendations for prevention and treatment of substance use disorders among the farming populations.

METHODS

We conducted a scoping review of peer-reviewed articles published between January 1989 and September 2019. The search yielded 3,426 citations and the final review was conducted on 42 articles. The full review was conducted by 4 authors to extract information about the target population, data collection methods, and main results.

FINDINGS

There were 21 articles on farmers and 21 articles on farmworkers. The majority of the articles were about alcohol. Overall, farmers had higher prevalence of risky alcohol consumption patterns than nonfarmers. The prevalence of risky alcohol consumption was also high among farmworkers compared to the general population. Risk factors for risky alcohol consumption included male gender, lower socioeconomic status, and psychological problems (eg, depression). Recommendations for prevention and intervention of alcohol disorders included policy development and implementation to curb alcohol access by taxation, screening of alcohol-related problems, and alternative means of recreation instead of alcohol consumption.

CONCLUSIONS

This review confirmed that alcohol-related problems are prevalent among farmers and farmworkers. More population-based research is called for to understand the additional risk factors of alcohol disorders and the prevalence of other substance-related disorders. Also, interventions should be tailored to the unique culture of farmers and farmworkers.

Environmental Health Threats to Latino Migrant Farmworkers

Approximately 75% of farmworkers in the United States are Latino migrants, and about 50% of hired farmworkers do not have authorization to work in the United States. Farmworkers face numerous chemical, physical, and biological threats to their health. The adverse effects of these hazards may be amplified among Latino migrant farmworkers, who are concurrently exposed to various psychosocial stressors. Factors such as documentation status, potential lack of authorization to work in the United States, and language and cultural barriers may also prevent Latino migrants from accessing federal aid, legal assistance, and health programs. These environmental, occupational, and social hazards may further exacerbate existing health disparities among US Latinos. This population is also likely to be disproportionately impacted by emerging threats, including climate change and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Latino migrant farmworkers are essential to agriculture in the United States, and actions are needed to protect this vulnerable population.

Association between Household Crowding and Violent Discipline and Neglect of Children: Analysis of Multiple Indicator Cluster Surveys in 26 Low- and Middle-Income Countries

The influence of household crowding on physical and mental health has been well documented. However, research on the influence of household crowding on violent discipline and neglect of children is scarce. Therefore, we aimed to investigate whether household crowding was associated with violent discipline and neglect of children in low- and- middle-income countries (LMICs). Cross-sectional data for 280,005 and 73,030 children in 26 LMICs surveyed using the Multiple Indicator Cluster Survey were analyzed for (1) violent discipline and (2) neglect, respectively. In each country, we used logistic regression models to estimate the effects of household crowding on multiple forms of violent discipline and stimulation activities (as a proxy of the level of child neglect). Estimates were pooled using random effects meta-analyses. After adjusting for confounding variables, household crowding was associated with higher odds of any violent discipline (odds ratio (OR) = 1.09, 95% CI 1.03 to 1.15, p = 0.002) and lower odds of engaging in four or more stimulation activities (OR = 0.88, 95% CI 0.83 to 0.94, p < 0.001). The associations were stronger for urban children and children living in low- and lower-middle-income countries. The findings suggest that screenings and interventions aimed at reducing the effects of household crowding might be effective in preventing and controlling violent discipline and neglect of children in LMICs.

Associations between Objective and Subjective Housing Status with Individual Mental Health in Guangzhou, China

Housing is an important social determinant of mental health. However, few studies simultaneously measure the objective housing status (i.e., housing tenure, living space, housing conditions, and housing stability) and subjective housing status (i.e., housing satisfaction) as well as examine their effects on people's mental health (i.e., stress, anxiety, and depression). Thus, using a sample size of 1003 participants by two-stage random sampling survey in Guangzhou, China, this study applies multivariate ordinary least square regression models to comprehensively explore and compare the associations between objective and subjective housing status with mental health, and then analyze the moderating effects of subjective housing status on the relationships between objective housing status and mental health. The findings suggest that there are significant differences in people's mental health based on different housing status. The subjective housing status can better explain the variances in mental health than objective housing status. Also, subjective housing status may partly mitigate the adverse impacts of objective housing disadvantages on some aspects of an individual's mental health. Therefore, housing improvement policies and public health initiatives should be designed based on a comprehensive account of objective and subjective housing characteristics as well as their influences on specific aspects of mental health.

Migrant Workers and Psychological Health: A Systematic Review

Migrant workers show an increase in the incidence of serious, psychotic, anxiety, and post-traumatic disorders due to a series of socio-environmental variables, such as loss of social status, discrimination, and separations from the family. The purpose is to elaborate a systematic review and highlight the prevailing psychological pathologies of these workers and categories most at risk. Our research included articles published from 2009 to 2019 on the major databases (Pub Med, Cochrane Library, and Scopus) using a combination of some keywords. The online search indicated 1.228 references. Using inclusion and exclusion criteria, we analyzed 127 articles, in particular 12 reviews and 115 original articles. Principal emerging disorders from the research are depressive syndrome (poor concentration at work, feeling down, or anger and somatization), anxiety, alcohol or substance abuse, and poor sleep quality. This causes low life conditions, which is also due to marginalization from the social context and strenuous work; in fact, migrant workers may suffer verbal or physical abuse, and they are often employed in dangerous, unhealthy jobs. It is therefore essential to increase the role of occupational medicine and promote wellbeing for this vulnerable job category.

Key Risk Factors Affecting Farmers' Mental Health: A Systematic Review

Recently, concern has increased globally over farmers' mental health issues. We present a systematic review of the outcomes, locations, study designs, and methods of current studies on farmers' mental health. In particular, this review aims to fill an important gap in understanding of the potential key risk factors affecting farmers' mental health around the world. 167 articles on farmer mental health were included in a final systematic review using a standardized electronic literature search strategy and PRISMA guidelines. The four most-cited influences on farmers' mental health in the reviewed literature respectively were pesticide exposure, financial difficulties, climate variabilities/drought, and poor physical health/past injuries. The majority of studies were from developed countries, most specifically from the United States, Australia, and the United Kingdom. Comparative studies on the mental health of farmers and other occupational workers showed mixed results, with a larger portion identifying that psychological health disturbances were more common in farmers and farm-workers. Knowledge of farmer psychological disorder risk factors and its impacts are essential for reducing the burden of mental illness. Further research will be required on climate change impacts, developing country farmers' mental health, and information on how to reduce help-seeking barriers amongst farmers.

Exploring the Role of Depression as a Moderator of a Workplace Obesity Intervention for Latino Immigrant Farmworkers

We explored if and how depression moderated the treatment effect of Pasos Saludables, a successful pilot workplace obesity intervention for Latino immigrant farmworkers. The original randomized controlled study assigned 254 participants 2:1 to a 10-session educational intervention versus control. We assessed the relationship between change in BMI (primary outcome) and interaction of treatment allocation and baseline risk for depression. Baseline CES-D scores indicated that 27.3% of participants were at risk for depression. The interaction between treatment allocation and baseline risk for depression was significant (p = 0.004). In adjusted models among women, intervention participants with no indication of depression at baseline reduced their BMI by 0.77 on average (95% CI - 1.25, - 0.30) compared to controls. The reduction im BMI between the intervention group at risk for depression at baseline and either control was not significantly different from zero. Findings from our post-hoc, exploratory study indicate that depression may inhibit significant weight loss.

Elevated Depressive Symptoms Among Hired Crop Workers in the United States: Variation by Sociodemographic and Employment Characteristics

We present prevalence rates, along with demographic and economic characteristics associated with elevated depressive symptoms (EDS), in a nationally representative sample of hired crop workers in the United States. We analyzed in-person interviews with 3,691 crop workers collected in 2009-2010 as part of a mental health and psychosocial supplement to the National Agricultural Workers Survey. The prevalence of EDS was 8.3% in men and 17.1% in women. For men, multivariate analysis showed that EDS was associated with years of education, family composition, having a great deal of difficulty being separated from family, having fair or poor general health, ability to read English, fear of being fired from their current farm job, and method of payment (piece, salary, or a combination). Interactions were found between region of the country and family composition. Multivariate analyses for women showed that fear of being fired, fair or poor general health, having children ≤15 years of age, being unaccompanied by their nuclear family, expectation for length of time continuing to do farm work in the United States, and authorization status were associated with EDS. Interactions were found with Hispanic ethnicity and region of the country, as well as presence of the nuclear family and region. The present study identifies important risk factors in this first population-based assessment of EDS in a nationally representative sample of U.S. crop workers. The importance of social support from family, job insecurity, and high prevalence of EDS in female crop workers support the need for screening and outreach in this primarily rural group of men and women crop workers.