Hearing loss in migrant agricultural workers

Social Determinants of Health and Hearing Loss in U.S. Adults

OBJECTIVES

Social determinants of health (SDH) are nonmedical, societal factors that influence health. There is limited information on the current relationship between SDH and hearing loss (HL) in the United States. This study aims to compare the odds of HL among US adults by race/ethnicity, education level, income-to-poverty level ratio, health insurance coverage, and health care access.

STUDY DESIGN

Cross-sectional study.

METHODS

The 2015-2020 National Health and Nutrition Examination Survey data were analyzed to compare odds ratios (ORs) for HL, defined as pure tone average over 25 dB HL in at least one ear, by SDH categories using sample weights. Adjusted ORs were calculated using logistic regression models controlling for sex, age, race/ethnicity, education level, income-to-federal-poverty level, health care insurance coverage and access, and loud noise, pesticide, and cigarette exposure.

RESULTS

A total of 6028 participants were included. Non-Hispanic Black participants had half the odds of HL as Non-Hispanic White participants (OR 0.52, p < 0.05). Lower education level correlated with higher odds of HL: those without a high school diploma had double the odds of HL compared with college graduates or above (OR 2.05, 1.91, p < 0.05). The income-to-federal-poverty level ratio of 1.3 to less than 2 had higher odds of HL than the 4+ group (OR 1.45, p < 0.05). Use of multiple health care locations was associated with nearly three times the odds of HL than the group using one location (OR 2.87, p < 0.05).

CONCLUSION

SDH are associated with HL. Further investigation is needed into the mechanism of disparities for targeted prevention and treatment for hearing care equity.

LEVEL OF EVIDENCE

IV Laryngoscope, 134:2848-2856, 2024.

Hearing Difficulties Among Farmworkers in the México-US Southwest Border Region

Migrant and seasonal farmworkers are a vulnerable population with a potentially high risk for hearing loss due to farm-related noise exposures. Occupational noise-induced hearing loss (NIHL) is permanent, and it is associated with an increased risk for injuries on the job, as well as communication difficulties, isolation, and depression. The México/US border region is one of the most productive agricultural regions in the country, however, no known studies have explored hearing loss among farmworkers in this area. This pilot study was a first step toward measuring and addressing hearing loss and noise exposure among this region's farmworkers. We conducted a cross-sectional survey to estimate the prevalence of subjective hearing difficulties among Yuma County, Arizona farmworkers. Survey interviews took place during a late-night farmworker health fair from 2 am to 6 am to accommodate local farms' labor schedules. Multivariable regression adjusted for demographic and work covariates estimated subjective hearing loss prevalence ratios. Among 132 farmworker participants, 36% reported they have or might have hearing loss, and 62% reported no hearing loss. Subjective hearing loss prevalence was lower in farmworkers who report not working in noise compared to prevalence in farmworkers who work in noise [prevalence ratio, 0.44 (95% CI 0.23-0.82)]. This report contributes to understanding the perception of hearing-related health and occupational exposures among farmworkers in the México-US Southwest border region. The information from this line of research will inform appropriate safety measures known to lower the risk of experiencing occupational NIHL.

Noise exposure and hearing loss among tractor drivers in India

BACKGROUND

Tractors emit high intensity noise and prolonged exposure to high intensity noise causes hearing loss to the drivers.

OBJECTIVE

The aim of this study was to measure noise intensity at the tractor drivers' ear level and hearing loss among tractor drivers.

METHODS

Noise intensity was measured on 6 models of tractors which were operated with 5 different tillage implements. In order to assess hearing loss, audiometric test was performed at 7 frequencies, i.e. 250, 500, 1000, 2000, 4000, 6000, and 8000 Hz, among 30 tractor drivers and 30 control group subjects. All the selected tractor drivers and control group subjects were also interviewed to obtain personal information and noise exposure details.

RESULTS

The tractor drivers were exposed to noise intensity in the range of 91.7-97.5 dB(A). Audiogram analysis shows that the hearing threshold levels were significantly (p < 0.05) higher among the tractor drivers as compared with the control group subjects. The effect was significantly (p < 0.05) more on the left ear as compared with the right ear among the tractor drivers. Increase in age has significant (p < 0.05) effect on the hearing threshold levels on the left ear. Prevalence of high frequency hearing loss was 50% among tractor drivers as compared with 10% among control group subjects. Hearing loss was significantly (p < 0.05) more in the low frequency as compared with the high frequency among the tractor drivers.

CONCLUSION

Indian tractor operators are exposed to high noise levels which may result in hearing loss. It is recommended that hearing conservation programs should be initiated to prevent noise hazards and hearing loss among the tractor drivers.

Virtual audiometric testing using smartphone mobile applications to detect hearing loss

Objective

The COVID-19 pandemic drove the need for remote audiometric testing in the form of mobile applications for hearing assessment. This study sought to determine the accuracy of two smartphone-based hearing assessment applications, Mimi and uHear, against the gold standard of in-clinic audiometric testing.

Methods

One hundred patients that presented to clinic for hearing assessment were randomly assigned to take either the Mimi or uHear hearing test alongside standard audiometric testing. Hearing thresholds measured using mobile applications were compared to those from audiometric testing to assess validity. Patient satisfaction was measured using a questionnaire that queried if the app met the user's need, if they would recommend the app to others, and how likely they were to use the app again.

Results

Using Mimi, there were no differences in average hearing levels measured at any frequency when compared to standard audiometric testing. uHear overestimated hearing loss at 500 and 1000 Hz (p < .001 for both) by 5-10 Hz, and underestimated hearing loss at 6000 Hz (p < .001) by 5-10 Hz compared to standard audiometric testing. When stratified by level of hearing impairment, uHear overestimated impairment in those with normal hearing (p < .001). Mimi had higher sensitivity (0.971) and specificity (0.912) for hearing loss (defined as a pure tone average for 500, 1000, 2000, and 4000 Hz greater than 25 dB) than uHear (0.914 and 0.780, respectively). However, uHear outranked Mimi on all three questions in the satisfaction questionnaire (p = .01, p = .03, and p = .02, respectively).

Conclusion

Mimi appears to be a reasonable substitute for standard audiometric testing when individuals cannot present to clinic for gold standard testing; however, the Mimi user experience can be improved.

Level of evidence

Level II.

Coexposure to Solvents and Noise as a Risk Factor for Hearing Loss in Agricultural Workers

OBJECTIVE

This study addressed the relationship of hearing loss and coexposure to solvents and noise among farmers and ranchers in central United States.

METHODS

The surveillance study included surveys to stratified random samples of operations in 2018 and 2020 (n = 34,146), requesting information on injuries, illnesses, exposures, and preventive measures. Responses (n = 7495) were analyzed using hierarchical multinomial logistic regression, adjusting for personal and work characteristics.

RESULTS

Nearly 60% of respondents exposed to both solvents and noise reported hearing loss. The exposures increased the adjusted odds of moderate/severe hearing loss as follows: solvents alone, (odds ratio [OR], 1.49; 95% confidence interval [CI], 0.93-2.38), noise alone (OR, 4.42; 95% CI, 3.39-5.76), and coexposure to both noise and solvents (OR, 6.03; 95% CI, 4.67-7.78).

CONCLUSIONS

Solvent exposure, along with noise, should be considered in hearing conservation programs among farmers and ranchers.

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.

Occupational Noise-Induced Hearing Loss among Migrant Workers in Kuwait

Although the effect of hearing loss on years lived with disability (YLD) is quite substantial, occupational hearing loss among migrant workers is significantly under-studied. In Kuwait, where nearly two-thirds of the population are migrant workers, the burden of occupational noise-induced hearing loss (ONIHL) is unknown. The objective of the study was to assess the prevalence of ONIHL among migrant workers in Kuwait and explore workplace and individual risk factors that are associated with ONIHL. We obtained data of annual physical exams for the year 2018 conducted by the Shuaiba Industrial Medical Center (SIMC) for all industrial workers in the area. We applied univariate and multivariate logistic regression models to estimate the effects of individual and occupational characteristics on ONIHL. A total of 3474 industrial workers visited the SIMC for an annual exam. The vast majority were men (99%) and non-Kuwaitis (98%) with a median age of 38 years. A total of 710 workers were diagnosed with ONIHL with a prevalence of 20.4%. Age, years of experience, and self-reported exposure to noise were associated with statistically significant higher odds of ONIHL. When adjusted for age, years of experience, and other individual level factors, type of industry was not a statistically significant predictor of ONIHL. The study uncovers the significant burden of hearing loss among the migrant worker subpopulation in Kuwait, an area of occupational health that is often underestimated or unrecognized. Although laws and regulations are in place to prevent and control noise in the workplace, the onus is on local authorities to ensure the necessary training and controls aimed to reduce noise exposure.

The Significance of Audiometric Notching in Individuals With a History of Noise Exposure: A Systematic Review

OBJECTIVES

The diagnosis of noise-induced hearing loss (NIHL) is reliant on the appraisal of audiometric data. A notch, dip or bulge, centered at the 4-kHz frequency is considered to be pathognomonic. However, guidelines applied to assist the diagnosis of NIHL often allow for a notch centered between the 3- and 6-kHz frequencies. The primary outcome of this review is to document the relationship between audiometric notching at particular frequencies and the populations in which they have been identified.

DESIGN

We included all population-based studies, cohort, cross-sectional, case-control, case-series, and case reports of adults and children, with exposure to noise and with a notch, dip or bulge. The review has been registered with Prospero (Registration: CRD42017079901) and prepared in line with the PRISMA guidelines.

RESULTS

We included 84 articles in the final systematic review. There were a total of 1,438,987 individuals, aged 7 to 80 years old. The studies were conducted in 26 different countries. Fourteen studies identified notching at 3 kHz, 63 studies identified notching at 4 kHz, and 47 studies identified notching at 6 kHz. The Newcastle-Ottawa risk assessment tool was performed on 82 of the studies emphasizing the high risk of bias in observational studies.

CONCLUSIONS

The overwhelming outcome of this systematic review demonstrates that the relationship between noise exposure and a 3- to 6-kHz audiometric notch is not straight-forward. A handful of articles have displayed a clear association between an individual's noise exposure and an audiometric notch. Unilateral notches, notches observed at 3 kHz and notches in the absence of continued high-intensity noise exposure must be scrutinized thoroughly. The ambiguous nature of NIHL directs its continued interest.

Occupational health and safety in agriculture. A systematic review

Introduction: The prevalence of occupational diseases in the agricultural sector is higher than in other industries, since agricultural workers are at higher risk of exposure to different chemicals and pesticides, and are more prone to occupational accidents.Objective: To conduct a review of recent literature on occupational health and risk in agriculture.Materials and methods: A literature search was conducted in PubMed, SciencieDirect and Scopus using the following search strategy: type of articles: original research papers; language: English; publication period: 2006-2016; search terms: "agricultural health", "agrarian health", "risk factors", "epidemiology", "causality" and "occupational", used in different combinations ("AND" and "OR").Results: The search yielded 350 articles, of which 102 met the inclusion criteria. Moreover, 5 articles were found in grey literature sources and included in the final analysis. Most research on this topic has been conducted in the United States, which produced 91% (97/107) of the articles included.Conclusions: Most studies on health and safety in agriculture focused primarily on the harmful effects of occupational exposure to agrochemicals and pesticides, and the consequences of occupational accidents. However, since more than 90% of these studies come from the United States, a more comprehensive approach to health in agriculture is required, since what is reported here may be far from the reality of other regions, especially Latin America.

Prevalence of hearing loss among noise-exposed workers within the agriculture, forestry, fishing, and hunting sector, 2003-2012

BACKGROUND

The purpose of this study was to estimate the prevalence of hearing loss among noise-exposed US workers within the Agriculture, Forestry, Fishing, and Hunting (AFFH) sector.

METHODS

Audiograms for 1.4 million workers (17 299 within AFFH) from 2003 to 2012 were examined. Prevalence, and the adjusted risk for hearing loss as compared with the reference industry (Couriers and Messengers), were estimated.

RESULTS

The overall AFFH sector prevalence was 15% compared to 19% for all industries combined, but many of the AFFH sub-sectors exceeded the overall prevalence. Forestry sub-sector prevalences were highest with Forest Nurseries and Gathering of Forest Products at 36% and Timber Tract Operations at 22%. The Aquaculture sub-sector had the highest adjusted risk of all AFFH sub-sectors (PR = 1.70; CI = 1.42-2.04).

CONCLUSIONS

High risk industries within the AFFH sector need continued hearing conservation efforts. Barriers to hearing loss prevention and early detection of hearing loss need to be recognized and addressed.

A Preliminary Study of a Spanish Graphic Novella Targeting Hearing Loss Prevention

PURPOSE

This preliminary study developed a digital graphic novella targeting hearing protection beliefs of Spanish-speaking agricultural workers. Researchers used pretest-posttest interview surveys to establish if the novella had an immediate influence on the participants' beliefs about noise-induced hearing loss and usage of hearing protection devices.

METHOD

Researchers developed a digital graphic novella directed to increase knowledge about noise-induced hearing loss and increase the proper use of hearing protection devices. The novella was tailored to meet the specific linguistic and literacy needs of Spanish-speaking agricultural workers. Thirty-one Spanish-speaking farmworkers of Mexican nationality participated. This study included an interview survey with specific questions on noise-induced hearing loss, myths, and hearing protection device usage. A pretest-posttest design was applied to measure the graphic novella's immediate influence on workers.

RESULTS

The posttest scores on Hearing Protection Beliefs statements were significantly better than pretest scores, with a large effect size observed.

CONCLUSION

Digital media may be an effective way to overcome language and literacy barriers with Spanish-speaking workers when providing health education and prevention efforts.

Evaluation of the Auditory Pathway in Traffic Policemen

Background:

Traffic policemen working at heavy traffic junctions are continuously exposed to high level of noise and its health consequences.

Objective:

To assess the hearing pathway in traffic policemen by means of brainstem evoked response audiometry (BERA), mid-latency response (MLR), and slow vertex response (SVR).

Methods:

In this observational comparative study, BERA, MLR, and SVR were tested in 35 male traffic policemen with field posting of more than 3 years. 35 age-matched men working in our college served as controls.

Results:

Increase in the latencies of waves I and III of BERA, and IPL I-III were observed. Compared to controls, the MLR and SVR waves showed no significant changes in studied policemen.

Conclusion:

We found that chronic exposure of traffic policemen to noise resulted in delayed conduction in peripheral part of the auditory pathway, ie, auditory nerve up to the level of superior olivary nucleus; no impairment was observed at the level of sub-cortical, cortical, or the association areas.

Prevalence of Hazardous Occupational Noise Exposure, Hearing Loss, and Hearing Protection Usage Among a Representative Sample of Working Canadians

OBJECTIVE

The aim of this study was to estimate the prevalence of hearing loss (HL), self-reported occupational noise exposure, and hearing protection usage among Canadians.

METHODS

In-person household interviews were conducted with 3666 participants, aged 16 to 79 years (1811 males) with 94% completing audiometry and distortion-product otoacoustic emission (DPOAE) evaluations. Occupational noise exposure was defined as hazardous when communicating with coworkers at an arm's length distance required speaking in a raised voice.

RESULTS

An estimated 42% of respondents reported hazardous occupational noise exposure; 10 years or more was associated with HL regardless of age, sex or education. Absent DPOAEs, tinnitus, and the Wilson audiometric notch were significantly more prevalent in hazardous workplace noise-exposed workers than in nonexposed. When mandatory, 80% reported wearing hearing protection.

CONCLUSIONS

These findings are consistent with other industrialized countries, underscoring the need for ongoing awareness of noise-induced occupational HL.

Effects of interventions on use of hearing protectors among farm operators: A randomized controlled trial

OBJECTIVE

The purpose of this study was to compare the effectiveness of three interventions designed to promote hearing protector device (HPD) use.

DESIGN

Randomized controlled trial.

STUDY SAMPLE

Farm operators (n = 491) were randomly assigned to one of five intervention groups: (1) interactive web-based information with mailed assortment of HPDs; (2) Interactive web-based information only; (3) static web-based information with mailed assortment of HPDs; (4) Static web-based information only; or (5) mailed assortment of HPDs only. Data were analysed using a mixed model approach.

RESULTS

HPD use increased among all participants, and increased more among participants receiving the mailed HPDs (with or without information) compared to participants receiving other interventions. Participants receiving the interactive web-based information had comparable increased use of HPDs to those receiving the static web-based information. Participants receiving the mailed HPDs had more positive situational influences scale scores than other participants. Program satisfaction was highest among mailed and web-based information groups.

CONCLUSIONS

A mailed assortment of hearing protectors was more effective than information. Interactive and static information delivered via web were similarly effective. Programs interested in increasing HPD use among farmers should consider making hearing protectors more available to farmers.

Protocol of a randomized controlled trial of hearing protection interventions for farm operators

Background

Hearing loss and tinnitus are prevalent in America, and noise-induced hearing loss is a leading cause of hearing loss. Noise-induced hearing loss has negative impact on quality of life, physical and emotional functioning, social life, and employment. In addition, noise-induced hearing loss results in heavy social and economic burdens on families and communities from all ethnic and socioeconomic groups. Farmers are a group that is particularly high risk for noise-induced hearing loss, and is underserved by programs designed to limit that risk. They are among the most noise-exposed group of workers, and experience the second highest prevalence of noise-induced hearing loss among all occupational categories. In agriculture, 1.5 million workers (43.3%) report exposure to hazardous noise. Although use of hearing protection devices (HPDs) would protect them from noise-induced hearing loss, use among farmers is low.

Methods/Design

The purpose of this project is to compare the effectiveness of several approaches to influencing hearing protector use. Approaches include: a) an interactive, predictors-based intervention delivered via the Internet; b) a static informational web site; and c) a mailed sampler of hearing protectors. The goals are to further develop an intervention to promote farmers’ use of HPDs, and compare the effectiveness of the interventions delivered in various combinations. Participants will include 701 farmers. Sites will be affiliates of a major farmer organization. Data will be collected at baseline, 6, and 12 months. A random intercept mixed model will be used to explore the fixed effects of the three NIHL prevention interventions over time while adjusting for age and gender. This project will involve a partnership between the University of Michigan and a major farmer organization to accomplish project aims.

Discussion

Results of this study will be used to inform future research-to-practice studies to increase hearing protector use. Increased use of hearing protectors is expected to reduce rates of noise-induced hearing loss and other negative effects of high noise exposure, and improve quality of life in this high-risk and underserved group.

Trial registration

Clinicaltrials.gov NCT01454895 Registered 14 October, 2011.

Avaliação do sistema auditivo em agricultores expostos à agrotóxicos

Objetivos avaliar o sistema auditivo periférico, por meio de audiometria tonal, em agricultores residentes em área de intenso uso de agrotóxicos no Estado do Rio de Janeiro. Métodos foram avaliados 70 indivíduos, de ambos os gêneros, moradores de Campos dos Goytacazes, com idade variando entre 25 e 59 anos, sendo 35 agricultores e 35 não agricultores. Todos os indivíduos tiveram sua audição periférica avaliada, por meio de audiometria tonal nas frequências de 250, 500, 1.000, 2.000, 3.000, 4.000, 6.000 e 8.000Hz. Foram excluídos indivíduos com alteração de orelha externa e média e/ou com alguma queixa otológica. Além disso, foi realizada anamnese com questões relacionadas à saúde, situação sócio-econômica, educação e exposição ao agrotóxico. Foi considerada perda auditiva, os limiares maiores ou iguais a 25dB em qualquer das frequências testadas. Resultados o Odds Ratio de perda auditiva foi 3,67 vezes (IC95%: 2,08-6,48) maior entre agricultores (94,3%), quando comparados aos não agricultores (25,7%). Além disso, a maior parte das alterações auditivas foi observada nas frequências mais agudas. Conclusão o presente estudo sugere que a atividade agrícola e possivelmente a exposição a agrotóxicos aumenta o risco de perda auditiva.

Acculturation and disability rates among Filipino-Americans

Filipinos are the fastest growing Asian subgroup in America. Among immigrants, higher acculturation (adaptation to host society) predicts disability outcomes and may relate to disability prevalence among older Filipinos. We conducted a secondary analysis of the 2006 American Community Survey using a representative sample of older Filipinos (2,113 males; 3,078 females) to measure functional limitations, limitations in activities of daily living, blindness/deafness and memory/learning problems. Filipino males who were Americans by birth/naturalization had higher odds of blindness/deafness (OR 2.94; 95% CI = 1.69, 5.12) than non-citizens. Males who spoke English at home had higher odds of blindness/deafness (OR 1.82; 95% CI = 1.05, 3.17) and memory/learning problems (OR 2.28; 95% CI = 1.25, 4.15), while females had higher odds of memory/learning problems (OR 1.75; 95% CI = 1.13, 2.73). Acculturation is associated with greater odds of disabilities for Filipino men. Males may be more sensitive to acculturation-effects than females due to culturally prescribed roles and gender-specific experiences at the time of immigration.

Overview of immigrant worker occupational health and safety for the agriculture, forestry, and fishing (AgFF) sector in the southeastern United States

BACKGROUND

Manual labor in the Agriculture, Forestry, and Fishing (AgFF) Sector is provided primarily by immigrant workers. Limited information is available that documents the demographic characteristics of these manual workers, the occupational illnesses, injuries and fatalities they experience; or the risk factors to which they are exposed.

METHODS

A working conference of experts on occupational health in the AgFF Sector was held to address information limitations. This paper provides an overview of the conference. Other reports address organization of work, health outcomes, healthcare access, and safety policy.

CONTENTS

This report addresses how best to define the population and the AgFF Sector, occupational exposures for the sector, data limitations, characteristics of immigrant workers, reasons for concern for immigrant workers in the AgFF Sector, regulations, a conceptual model for occupational health, and directions for research and intervention.

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.

Exploratory study of the occupational health and health-seeking of migrant and seasonal farmworkers on the U.S.-Mexico border

The U.S. migrant and seasonal farmworker (MSFW) workforce is aging. Aging causes functional changes that can affect work performance and increase injury/accident risk. It also has been linked with deferred health-seeking. The exploratory study was conducted to investigate occupational injuries and health-seeking in Hispanic MSFW on the U.S.-Mexico border. Data were collected using an abbreviated Spanish-version of the California Agricultural Worker Health Survey. Nearly 60% of the 141 participants were middle-aged or older. Musculoskeletal injuries and those consistent with agrochemical and environmental exposures were common. Farmworkers aged >40 years were 2.5-5 times more likely than younger MSFW to report persistent single and multiple injuries involving the knees, shoulder, feet, and hands. Except for neck and back injuries, few received any medical treatment. Although many self-treated with traditional home remedies, few used CAM practitioners. The study findings highlight the multiple workplace health and health-seeking challenges faced by aging immigrant MSFW.

Effects of a low intensity intervention to increase hearing protector use among noise-exposed workers

BACKGROUND

Farm operators experience exposure to high noise and high prevalence of noise-induced hearing loss, but use of hearing protection in this worker group is low. The purpose of this study was to test a brief intervention to increase farm operators' use of hearing protection.

METHODS

In this one-group pre- and post-test study, a random sample of 32 members of a farmers' organization was supplied a variety of hearing protectors. Participants received an assortment of hearing protectors by mail with manufacturer's instructions for use.

RESULTS

Mean pre-intervention hearing protector use when in high noise in this group was 23% (SD 29). Of the 32 participants, 27 (84%) were exposed to hazardous noise during the study period. Post-intervention mean use of HPDs was 64%, an increase of 41% (t = 5.26, P < 000).

CONCLUSION

Results of this study suggest that overall, hearing protectors were acceptable to farm operators, and that a brief mailed intervention is feasible.

Overcoming language and literacy barriers in safety and health training of agricultural workers

The workforce in all areas of United States agriculture and forestry is becoming increasingly diverse in language, culture, and education. Many agricultural workers are immigrants who have limited English language skills and limited educational attainment. Providing safety and health training to this large, diverse, dispersed, and often transient population of workers is challenging. This review, prepared for the 2010 Agricultural Safety and Health Council of America/National Institute for Occupational Safety and Health conference, "Be Safe, Be Profitable: Protecting Workers in Agriculture," is divided into five sections. First, we describe the occupational and demographic characteristics of agricultural workers in the United States to highlight their safety and health training needs. Second, we summarize current research on the social and cultural attributes of agricultural workers and agricultural employers that affect the provision of safety and health training. Worker and employer attributes include language, literacy, financial limitations, work beliefs, and health beliefs. Third, we review current initiatives addressing safety and health training for agricultural workers that consider worker language and literacy. These initiatives are limited to a few specific topics (e.g., pesticides, heat stress); they do not provide general programs of safety training that would help establish a culture of workplace safety. However, several innovative approaches to health and safety training are being implemented, including the use of community-based participatory approaches and lay health promoter programs. Fourth, the limited industry response for safety training with this linguistically diverse and educationally limited workforce is summarized. Finally, gaps in knowledge and practice are summarized and recommendations to develop educationally, culturally, and linguistically appropriate safety and health training are presented.

A community intervention to decrease antibiotics used for self-medication among Latino adults

PURPOSE

Recent evidence in Latino communities indicates substantial self-medication with antibiotics obtained without a prescription (WORx). We implemented and evaluated a culturally sensitive educational intervention to decrease antibiotic self-medication.

METHODS

We conducted a community-based intervention with preintervention and postintervention measures in the intervention community (Charleston, South Carolina) as well as a postintervention measure in a control community (Greenville, South Carolina) 200 miles away. The 9-month culturally sensitive intervention included multiple media sources (pamphlets, radio, newspapers). We evaluated the use of antibiotics WORx in the United States, as well as the likelihood of importing antibiotics, by surveying Latino adults in the intervention (n = 250) and in the control community (n = 250).

RESULTS

Most adults in the intervention community (69%) and the control community (60%) reported some exposure to messages about the inappropriate use of antibiotics, and 25.9% in the intervention community and 8.6% in the control community reported seeing our patient education pamphlets. A substantial proportion of Latino adults in both the intervention (31%) and control communities (20%) have obtained antibiotics WORx in the United States. In multivariate analyses, exposure to an educational message was not a significant predictor of having acquired antibiotics WORx in the United States in past 12 months. The primary predictor of respondents' having acquired antibiotics WORx in the United States was whether they had bought antibiotics WORx outside the United States.

CONCLUSIONS

Novel approaches are needed to decrease the use of antibiotics WORx in Latino communities, as focusing only on education may not be sufficient to change behaviors common in their home countries.

Perceptions of environmental and occupational health hazards among agricultural workers in Washington State

This study describes agricultural workers' perceptions of environmental and occupational health issues. Interviews were conducted with 389 agricultural workers in the Yakima Valley of central Washington State in the summers of 2004 and 2005. Undergraduate students from the community conducted interviews in Spanish or English. Environmental and occupational health issues were ranked by frequency of concern, and differences by demographics were evaluated using multivariate analyses. In both 2004 and 2005, agricultural workers expressed high levels of concern about working in hot weather, agricultural injuries, pesticides, and pediatric asthma. Agricultural workers' perceptions of environmental and occupational health issues differed by specific demographics, particularly age and ethnicity. Consideration should be given to these issues when designing research studies, creating educational materials, and developing interventions related to environmental and occupational hazards among agricultural workers.

Perceptions of Environmental and Occupational Health Hazards among Agricultural Workers in Washington State

This study describes agricultural workers' perceptions of environmental and occupational health issues. Interviews were conducted with 389 agricultural workers in the Yakima Valley of central Washington State in the summers of 2004 and 2005. Undergraduate students from the community conducted interviews in Spanish or English. Environmental and occupational health issues were ranked by frequency of concern, and differences by demographics were evaluated using multivariate analyses. In both 2004 and 2005, agricultural workers expressed high levels of concern about working in hot weather, agricultural injuries, pesticides, and pediatric asthma. Agricultural workers' perceptions of environmental and occupational health issues differed by specific demographics, particularly age and ethnicity. Consideration should be given to these issues when designing research studies, creating educational materials, and developing interventions related to environmental and occupational hazards among agricultural workers.

Sensory impairment among older US workers

We used 1997-2004 National Health Interview Survey data to evaluate the prevalence of sensory impairment among US workers 65 years and older. Hearing impairment prevalence was 3 times that of visual impairment (33.4% vs 10.2%), and 38% of older workers reported experiencing either impairment. Farm operators, mechanics, and motor vehicle operators had the highest prevalence of sensory impairment. Workplace screening and accommodations, including sensory protection devices for older workers, are warranted given the greater risk for injuries among the sensory impaired.

Health care utilization among migrant Latino farmworkers: the case of skin disease

CONTEXT

Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources.

PURPOSE

Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers.

METHODS

Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms.

FINDINGS

Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year.

CONCLUSIONS

The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.

Occupationally-acquired noise-induced hearing loss: a senseless workplace hazard

OBJECTIVES

Occupational noise-induced hearing loss (ONIHL) describes an acquired hearing deficiency directly attributable to excessive workplace noise exposure. Data suggest that excessive noise attributes to approximately 37% of all adult causes of hearing loss and remains a significant contributor to employment-related morbidity internationally. Typically insidiously-acquired, often without frank progressive symptomatology, regional medical agencies continue to struggle with this potentially debilitating condition. The aim of the study was to provide a synopsis of the current understanding of ONIHL, its impact on individual workers and the wider international community, and to identify barriers to more uniform adoption of personal hearing protection.

MATERIALS AND METHODS

A review of the contemporary literature was performed using defined keyword searches and OVID, PubMed, and Google Scholar as primary electronic search engines.

RESULTS

A number of published works were identified, describing aspects of the relationship between workplace-related noise exposure and subsequent development of employee hearing impairment, which demonstrate an overwhelming gender imbalance, with up to 97% of affected individuals being male. Industry-specific associations (e.g., mining, manufacturing and heavy construction) were well documented, as were links to toxin-specific exposures, in the recognized development of hearing loss. However, evidence of integration of appraisal of the topically-current area of genetic susceptibility was often lacking. Much discordance still exists among international agencies in the prescriptive regulation and enforcement of "safe" exposure limits.

CONCLUSIONS

Despite a high level of public awareness regarding the importance of hearing preservation and increasingly stringent international occupational health, safety and welfare requirements mandating provision of safer work environments, ONIHL continues to be a significant occupational hazard. ONIHL is permanent and may cause significant disability, for which there currently exists no cure, but is largely overtly-preventable. The impact of ONIHL on the global transition toward dominant communication-rich white-collar employment roles is difficult to quantitate, but is likely to be substantive upon the afflicted individual. In the mainstream setting, exposure-avoidance strategies aimed to reduce the incidence of ONIHL remain the focus of public health and occupational medicine approaches.