Clinical, Health-Related Quality of Life, and Gait Differences Among Obesity Classes in Adults With Knee Osteoarthritis

OBJECTIVE

The purpose of this study was to determine whether clinical, health-related quality of life (HRQL), and gait characteristics in adults with knee osteoarthritis (OA) differed by obesity category.

METHODS

This cross-sectional analysis of 823 older adults (mean age 64.6 years, SD 7.8 years) with knee OA and overweight or obesity compared clinical, HRQL, and gait outcomes among obesity classifications (overweight or class I, body mass index [BMI] 27.0-34.9; class II, BMI 35.0-39.9; class III BMI ≥40.0).

RESULTS

Patients with class III obesity had worse Western Ontario McMasters Universities Arthritis Index knee pain (0-20) than the overweight or class I (mean 8.6 vs 7.0; difference 1.5; 95% confidence interval [CI] 1.0-2.1; P < 0.0001) and class II (mean 8.6 vs 7.4; difference 1.1; 95% CI 0.6-1.7; P = 0.0002) obesity groups. The Short Form 36 physical HRQL measure was lower in the class III obesity group compared to the overweight or class I (mean 31.0 vs 37.3; difference -6.2; 95% CI -7.8 to -4.7; P < 0.0001) and class II (mean 31.0 vs 35.0; difference -3.9; 95% CI -5.6 to -2.2; P < 0.0001) obesity groups. The class III obesity group had a base of support (cm) during gait that was wider than that for the overweight or class I (mean 14.0 vs 11.6; difference 3.3; 95% CI 2.6-4.0; P < 0.0001) and class II (mean 14.0 vs 11.6; difference 2.4; 95% CI 1.6-3.2; P < 0.0001) obesity groups.

CONCLUSION

Among adults with knee OA, those with class III obesity had significantly higher pain levels and worse physical HRQL and gait characteristics compared to adults with overweight or class I or class II obesity.

Salivary Cotinine Levels of Hired Latino Youth Tobacco Workers in North Carolina

BACKGROUND

Limited research has examined the health implications for youth working in United States tobacco production. Agricultural labor is hazardous, yet youth are legally permitted to be hired as farmworkers. Many youth farmworkers are members of the vulnerable Latino farmworker community. In North Carolina, youth work in many agricultural crops including tobacco.

METHODS

A sample of 152 Latino youth farmworkers ages 12-20 years (M = 16.7, SD = 2.0) across 19 North Carolina counties completed a cross-sectional survey and provided saliva samples in 2019. Surveys detailed personal and work characteristics. Saliva samples were analyzed for salivary cotinine and reported in geometric means (ng/ml). Bivariate associations were used to delineate the relationship between personal and work characteristics with salivary cotinine levels.

RESULTS

Cotinine levels ranged from 0.05 to 313.5 ng/ml. Older age and working in tobacco were significantly associated with higher salivary cotinine levels. For every one year increase in age, there was a 31% increase in mean salivary cotinine levels (b = 1.31; 95% CI = [1.15-1.50]; p < .0001). Youth tobacco workers' (n = 15) salivary cotinine levels were 890% higher than those not working in tobacco (n = 137) (13.26, 95% CI = [5.95-29.56] ng/ml compared to 1.34, 95% CI = [1.03-1.75] ng/ml (p < .0001)).

CONCLUSIONS

Latino youth tobacco workers are exposed to nicotine through their work. This exposure presents serious risk of Green Tobacco Sickness (acute nicotine poisoning) and other health concerns given the growing evidence for risk of epigenetic changes negatively affecting long-term cognitive function. Policy is urgently needed to protect this vulnerable population of adolescent workers.

Comparing Longitudinal Measures of Cholinesterase as Biomarkers for Insecticide Exposure Among Latinx Children in Rural Farmworker and Urban Nonfarmworker Communities in North Carolina

OBJECTIVE

In a 2-group prospective design, this study compared seasonal cholinesterase levels of Latinx children in rural farmworker families and comparable urban children to assess the impact of environmental exposure to cholinesterase-inhibiting insecticides.

METHODS

Quarterly blood samples and passive dosimeter wristbands were collected over 2 years in 8-year-old children (74 rural, 62 urban). Laboratory analysis assessed total cholinesterase, acetylcholinesterase, and butyrylcholinesterase from blood samples, and insecticides from wristbands.

RESULTS

In spring and summer, total cholinesterase and acetylcholinesterase levels were depressed in rural children compared with winter and fall. Butyrylcholinesterase was depressed in rural children in fall compared with spring and summer. Adjustment for insecticide exposure did not affect these associations.

CONCLUSIONS

Environmental exposures to cholinesterase-inhibiting insecticides have measurable biochemical effects on blood cholinesterases in rural children from farmworker families.

Understanding Latinx Child Farmworkers' Reasons for Working: A Mixed Methods Approach

Agricultural labor is extremely hazardous, yet young children are legally permitted to work on farms. This paper contextualizes and describes Latinx hired child farmworkers’ stated reasons for working. We conducted a mixed-methods study using in-depth interviews ( n = 30) and survey interviews ( n = 202) with Latinx child farmworkers aged 10 to 17 in North Carolina. Our qualitative thematic analysis identified children’s salient reasons for working, including supporting family, contextual factors that lead to farm work, and occupying summer time. Statistical analysis showed that children’s primary reasons for working included buying clothes (91.1%) and school supplies (64.7%), with few differences by gender, age, or other characteristics. The findings demonstrate that most Latinx children view farm work as a necessary but temporary experience that financially supports their families. We discuss the implications for protecting Latinx child workers by reducing their structural vulnerability in order to facilitate healthy development.

Neuroanatomical differences in Latinx children from rural farmworker families and urban non-farmworker families and related associations with pesticide exposure

Exposure to pesticides in humans may lead to changes in brain structure and function and increase the likelihood of experiencing neurodevelopmental disorders. Despite the potential risks, there is limited neuroimaging research on the effects of pesticide exposure on children, particularly during the critical period of brain development. Here we used voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) from magnetic resonance images (MRI) to investigate neuroanatomical differences between Latinx children (n = 71) from rural, farmworker families (FW; n = 48) and urban, non-farmworker families (NFW; n = 23). Data presented here serves as a baseline for our ongoing study examining the longitudinal effects of living in a rural environment on neurodevelopment and cognition in children. The VBM analysis revealed that NFW children had higher volume in several distinct regions of white matter compared to FW children. Tract-based spatial statistics (TBSS) of DTI data also indicated NFW children had higher fractional anisotropy (FA) in several key white matter tracts. Although the difference was not as pronounced as white matter, the VBM analysis also found higher gray matter volume in selected regions of the frontal lobe in NFW children. Notably, white matter and gray matter findings demonstrated a high degree of overlap in the medial frontal lobe, a brain region predominantly linked to decision-making, error processing, and attention functions. To gain further insights into the underlying causes of the observed differences in brain structure between the two groups, we examined the association of organochlorine (OC) and organophosphate (OP) exposure collected from passive dosimeter wristbands with brain structure. Based on our previous findings within this data set, demonstrating higher OC exposure in children from non-farmworker families, we hypothesized OC might play a critical role in structural differences between NFW and FW children. We discovered a significant positive correlation between the number of types of OC exposure and the structure of white matter. The regions with significant association with OC exposure were in agreement with the findings from the FW-NFW groups comparison analysis. In contrast, OPs did not have a statistically significant association with brain structure. This study is among the first multimodal neuroimaging studies examining the brain structure of children exposed to agricultural pesticides, specifically OC. These findings suggest OC pesticide exposure may disrupt normal brain development in children, highlighting the need for further neuroimaging studies within this vulnerable population.

Pesticide Exposure among Latinx Children in Rural Farmworker and Urban Non-Farmworker Communities: Associations with Locality and Season

This study uses repeated measures to document the pesticide exposure of rural and urban Latinx children (age eight at baseline), and to compare these children in terms of the frequency and concentration of their exposure to a large set of pesticides, accounting for season. We used silicone wristbands worn for one week up to ten times at quarterly intervals from 2018 to 2022 to assess pesticide exposure in children from rural farmworker (n = 75) and urban non-farmworker (n = 61) families. We determined the detection and concentrations (ng/g) of 72 pesticides and pesticide degradation products in the wristbands using gas chromatography electron capture detection and gas chromatography mass spectrometry. The most frequently detected pesticide classes were organochlorines, pyrethroids, and organophosphates. Controlling for season, organochlorine or phenylpyrazole detections were less likely for rural children than for urban children. Detections of organochlorines, pyrethroids, or organophosphates were lower in spring and summer versus winter. Controlling for season, urban children had greater concentrations of organochlorines, while rural children had greater concentrations of pyrethroids and Chlorpyrifos. Pesticide concentrations were lower in winter and spring compared with summer and fall. These results further document that pesticides are ubiquitous in the living environment for children in vulnerable, immigrant communities.

Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers

BACKGROUND

The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer.

METHODS

A qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes.

RESULTS

Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child.

CONCLUSIONS

Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families.

Developing Infographics to Present Research Findings from CBPR to Latinx Farmworker Community Members

BACKGROUND

Community-based participatory research (CBPR) facilitates vulnerable communities and scientists collaborating to address pertinent health issues. For Latinx farmworkers, the employment of children and their resulting morbidity and mortality in the hazardous farm environment is a concern. Communicating child farmworker research results to farmworkers and service providers must take into account their language, literacy, and educational characteristics.

OBJECTIVES

We describe the collaborative development and dissemination of research findings on child farmworkers by a CBPR partnership with the Latinx farmworker community.

METHODS

Key points for communication with infographics were abstracted from peer-reviewed research papers. An iterative process sought community partners' input as the research partners developed the infographics.

LESSONS LEARNED

We developed infographics on heat-related illness, education, and musculoskeletal impacts of child labor, guided by published criteria for effective infographics. Efforts to disseminate finished infographics needed greater rigor.

CONCLUSIONS

Infographics provide a means to communicate CBPR findings to community members.

Study of an Educational Telenovela to Teach Genomics among Latino Farmworkers and Nonfarmworkers: Lessons Learned

BACKGROUND

Genomic knowledge is becoming increasingly relevant to health care. Development of linguistically and culturally appropriate educational resources for Latino adults with limited education and English skills is needed.

OBJECTIVES

The effectiveness of a telenovela was analyzed and lessons learned provided.

METHODS

The team developed a telenovela to convey key genomics concepts and delivered it to 100 Latino farmworkers and nonfarmworkers in North Carolina. Participants completed a pretest measuring genomic knowledge and self-efficacy, viewed the telenovela, then completed a post-test. Twenty-four participants repeated the post-test 6 months later. Changes in genomic knowledge and self-efficacy were calculated.

RESULTS

Overall, genomic knowledge and self-efficacy increased significantly after viewing the telenovela. Responses to two items indicated that the emphasis on epigenetics overshadowed other genomic mechanisms. Six-month follow-up results were not significantly different from the pretest.

CONCLUSIONS

Increased attention to graphic design principles, presentation across multiple sessions, and supplemental activities may increase telenovelas' impact.

Effect of Diet and Exercise on Knee Pain in Patients With Osteoarthritis and Overweight or Obesity: A Randomized Clinical Trial

IMPORTANCE

Some weight loss and exercise programs that have been successful in academic center-based trials have not been evaluated in community settings.

OBJECTIVE

To determine whether adaptation of a diet and exercise intervention to community settings resulted in a statistically significant reduction in pain, compared with an attention control group, at 18-month follow-up.

DESIGN, SETTING, AND PARTICIPANTS

Assessor-blinded randomized clinical trial conducted in community settings in urban and rural counties in North Carolina. Patients were men and women aged 50 years or older with knee osteoarthritis and overweight or obesity (body mass index ≥27). Enrollment (N = 823) occurred between May 2016 and August 2019, with follow-up ending in April 2021.

INTERVENTIONS

Patients were randomly assigned to either a diet and exercise intervention (n = 414) or an attention control (n = 409) group for 18 months.

MAIN OUTCOMES AND MEASURES

The primary outcome was the between-group difference in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain score (range, 0 [none] to 20 [severe]; minimum clinically important difference, 1.6) over 18 months, tested using a repeated-measures mixed linear model with adjustments for covariates. There were 7 secondary outcomes including body weight.

RESULTS

Among the 823 randomized patients (mean age, 64.6 years; 637 [77%] women), 658 (80%) completed the trial. At 18-month follow-up, the adjusted mean WOMAC pain score was 5.0 in the diet and exercise group (n = 329) compared with 5.5 in the attention control group (n = 316) (adjusted difference, -0.6; 95% CI, -1.0 to -0.1; P = .02). Of 7 secondary outcomes, 5 were significantly better in the intervention group compared with control. The mean change in unadjusted 18-month body weight for patients with available data was -7.7 kg (8%) in the diet and exercise group (n = 289) and -1.7 kg (2%) in the attention control group (n = 273) (mean difference, -6.0 kg; 95% CI, -7.3 kg to -4.7 kg). There were 169 serious adverse events; none were definitely related to the study. There were 729 adverse events; 32 (4%) were definitely related to the study, including 10 body injuries (9 in diet and exercise; 1 in attention control), 7 muscle strains (6 in diet and exercise; 1 in attention control), and 6 trip/fall events (all 6 in diet and exercise).

CONCLUSIONS AND RELEVANCE

Among patients with knee osteoarthritis and overweight or obesity, diet and exercise compared with an attention control led to a statistically significant but small difference in knee pain over 18 months. The magnitude of the difference in pain between groups is of uncertain clinical importance.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02577549.

Change and Continuity in Preventive Practices Across the COVID-19 Pandemic Among Rural and Urban Latinx Immigrant Worker Families

BACKGROUND

(1)The COVID-19 pandemic has put essential workers at high risk for contracting the disease. This study documents situational compliance with public health recommendations such as masking and social distancing among rural and urban Latinx families, with the goal of understanding change over time in COVID-19 risk reduction behaviors.

METHODS

(2)Respondents for 67 rural families and 44 urban families responded to repeated telephone surveys at three time points in the first year of the pandemic, providing data on use of masks and social distancing by themselves and family members while interacting with others at home, work, and in the community. Cumulative logistic regression models were employed to compare changes in risk behaviors between rural and urban groups over time.

RESULTS

(3)While group descriptive results indicated behaviors that posed low risk at each time point, regression models revealed greater change between time points for rural than urban residents. Rural residents also had gendered patterns.

CONCLUSIONS

(4)Patterns of change appear to reflect structural issues such as seasonal labor demand and gender roles more than pandemic fatigue or changing public health recommendations. The findings suggest that structural factors play a role in individuals complying with public health prevention measures for COVID-19.

ReUnidos: Farmworker Skin Cancer Health Navigation Program

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Background: Farmworkers are at increased risk for skin cancer because of occupational exposure to sun and pesticides. In 2017/2018, Farmworker Justice conducted the Unidos community mobilization project to raise skin-cancer awareness and promote skin-cancer care access in farmworker communities. Unmet needs were identified in follow-up care coordination for patients who screened positive for a suspicious skin lesion. We undertook this ReUnidos study to document the incidence of skin cancer in the farmworker community and to evaluate the benefits of a health-navigator program to facilitate follow-up care. Methods: Participants (primarily Latinx) are screened in the community setting by volunteer dermatologists. Those who screen positive for suspected skin cancer are invited to participate in the study. They are assigned a trained navigator who addresses the importance of evaluating the lesion, the details of the diagnostic process, and any questions the subjects have. The navigators also help arrange travel, scheduling of appointments, interpretation services, and any other supports needed during the care journey. Data are collected on the number of biopsies performed, diagnoses, time from screening to diagnosis, skin cancer staging, time to treatment, as well as satisfaction with and perceived effectiveness of the navigator program. Outcome measures are extracted from chart review and final semi-structured interviews of both subjects and navigators. The project seeks to screen 1,000 community members. Approximately 2% are expected to screen positive for a suspicious lesion and require follow-up care. Results: To date, 16 health navigators have been trained and 6 screening events have been conducted in Northern San Diego County by Vista Community Clinic. A total of 126 adult participants have been screened, with 47% identifying as farmworkers. One participant screened positive for a potential skin cancer and has consented to the study. Conclusions: Community-based screenings linked to health-navigation programs may be effective tools to increase access to skin-cancer care among farmworkers. A telemedicine screening model is also being investigated for a second site in upstate New York to expand rural skin screening access. This model may also be useful in care coordination for other malignancies in farmworker communities such as lung cancer and lymphoma, which have also been linked to occupational pesticide exposure.[Table: see text]

Mental models about heredity among immigrant Latinx adults with limited education from Mexico and Central America

An understanding of genetics is becoming increasingly relevant to receiving medical care. It is important for health care providers and educators, including genetic counselors, to understand patients' perceptions about trait transmission and their interpretation of terms used in biomedicine. Knowledge about the patient perspective about trait transmission is important when health care providers are not fluent in the patient's language. Sixty Latinx immigrant adults (30 men and 30 women) who were born in Mexico or Central America (MCA) and living in North Carolina were interviewed about their heredity beliefs. By design, most participants had limited education. Eight percent had a least a high school education; 45% had less than a seventh grade education. Semi-structured, in-depth interviews were conducted to examine how participants think and discuss trait transmission. The translated transcripts were systematically analyzed using a case-based approach, supplemented by theme-based coding. Five lay mental models of heredity were identified that varied in terms of involvement of genes. Four of the five heredity mental models encompass genes; four out of five mental models do not link DNA to heredity. The centrality of blood, whether used metaphorically or literally, varies widely across the models. One model references God and depicts that heredity involves blood and/or genes, but not DNA. The mental models of heredity for most adult immigrants with limited education do not include DNA. Trait transmission by blood appears to have a more prominent role in lay mental models held by Mexicans than Central Americans. Increased patient knowledge about genetics can facilitate shared decision-making as genetics becomes increasingly relevant to medical care. Efforts to educate people can be most effective when we first understand the layperson's conceptions or mental models. Health care providers and educators should be aware that MCA adults with limited formal education hold diverse mental models about heredity.

Comparing impact of pesticide exposure on cognitive abilities of Latinx children from rural farmworker and urban non-farmworker families in North Carolina

Pesticide exposure remains a health hazard despite extensive study into adverse effects. Children in vulnerable populations, such as Latinx children in farmworker families, are particularly at risk for exposure. Several studies have demonstrated the detrimental cognitive effects of prenatal exposure to pesticides, particularly organophosphates (OPs) within this high-risk group. However, results from studies investigating the cognitive effects of early childhood pesticide exposure are equivocal. Most studies examining the effects of pesticide exposure have used correlative analyses rather than examining populations with expected high and low exposure. The current study compares 8-year-old children from rural families of farmworkers and urban, non-farmworker families. We used the Weschler Intelligence Scale for Children - Fifth Edition (WISC-V) to assess cognitive performance in these children. We designed this study with the expectation that children from farmworker families would have greater exposure to agricultural pesticides than urban, non-farmworker children. This assumption of exposure to agricultural pesticides was confirmed in a recent report that assessed exposure probabilities using life history calendars. However, data from passive wristband sampling of acute (1-week) pesticide exposure from these same children indicate that both study populations have considerable pesticide exposure but to different chemicals. As expected the children of farmworkers had greater OP exposure than non-farmworker children, but the non-farmworker children had greater exposure to two other classes of insecticides (organochlorines [OCs] and pyrethroids). Our analyses considered these findings. A comparison of the cognitive scores between groups revealed that children from farmworker families had slightly higher performance on the Visual-Spatial Index (VSI) and Verbal Comprehension Index (VCI) when compared to children from non-farmworker families. Regression analyses where pesticide exposure was included as covariates revealed that OC exposure accounted for the largest portion of the group differences for both VSI and VCI. However, a post-hoc moderation analysis did not find significant interactions. The main study outcome was that the non-farmworker children exhibited lower WISC-V scores than the children from farmworker families, and the analyses incorporating pesticide exposure measures raise the hypothesis the that pervasive and persistent nature of a variety of pesticides may have adverse effects on the neurodevelopment of young Latinx children whether living in rural or non-farmworker environments.

Altered Default Mode Network Associated with Pesticide Exposure in Latinx Children from Rural Farmworker Families

Pesticide exposure has been associated with adverse cognitive and neurological effects. However, neuroimaging studies aimed at examining the impacts of pesticide exposure on brain networks underlying abnormal neurodevelopment in children remain limited. It has been demonstrated that pesticide exposure in children is associated with disrupted brain anatomy in regions that make up the default mode network (DMN), a subnetwork engaged across a diverse set of cognitive processes, particularly higher-order cognitive tasks. This study tested the hypothesis that functional brain network connectivity/topology in Latinx children from rural farmworker families (FW children) would differ from urban Latinx children from non-farmworker families (NFW children). We also tested the hypothesis that probable historic childhood exposure to pesticides among FW children would be associated with network connectivity/topology in a manner that parallels differences between FW and NFW children. We used brain networks from functional magnetic resonance imaging (fMRI) data from 78 children and a mixed-effects regression framework to test our hypotheses. We found that network topology was differently associated with the connection probability between FW and NFW children in the DMN. Our results also indicated that, among 48 FW children, historic reports of exposure to pesticides from prenatal to 96 months old were significantly associated with DMN topology, as hypothesized. Although the cause of the differences in brain networks between FW and NFW children cannot be determined using a cross-sectional study design, the observed associations between network connectivity/topology and historic exposure reports in FW children provide compelling evidence for a contribution of pesticide exposure on altering the DMN network organization in this vulnerable population. Although longitudinal follow-up of the children is necessary to further elucidate the cause and reveal the ultimate neurological implications, these findings raise serious concerns about the potential adverse health consequences from developmental neurotoxicity associated with pesticide exposure in this vulnerable population.

Depressive Symptoms of Latinx Women in Rural Farmworker and Urban Non-Farmworker Families in North Carolina

BACKGROUND

Mental health among low-income Latinx women in the United States (US), including those in farmworker families, is a health equity concern. This analysis (1) describes the depressive symptoms among Latinx women in rural farmworker families and urban non-farmworker families and (2) delineates immigration and acculturation, family composition and disruption, and financial characteristics associated with depressive symptoms experienced by these women.

METHODS

Data are from a 2019-2020 cross-sectional survey of 66 rural farmworker and 52 urban non-farmworker women with a child participating in a study of pesticide exposure and neurocognitive development. Depressive symptoms were measured with the CES-D Short Form.

RESULTS

The median (25th-75th percentiles) depressive symptom score reported was 2.0 (1.0-4.0), with 10 (8.5%) women having depressive symptom scores of 10 or greater. In bivariate analysis, among immigration and acculturation characteristics, women born in the USA and who spoke English fluently had lower depressive symptom scores. Among family composition and disruption characteristics, married women, and those with two adults in the household had lower depressive symptom scores. No financial status characteristic had statistically significant associations with depressive symptom score. In multivariate analysis, rural farmworker women had an expected median score one point lower than did urban non-farmworker women.

CONCLUSION

Addressing mental health among immigrant women, particularly those in farmworker families, is a complex undertaking. Rural versus urban locality provides a context for mental health. Determining the proximal determinants of locality requires further analysis.

Self-Reported Physical Demands Associated With Crops and Job Tasks Among Latinx Hired Child Farmworkers

OBJECTIVE

Physical demands of work performed by Latinx hired child farmworkers are poorly understood. This paper describes crops, tasks performed, and the most common dimensions of physical demands of work in this population.

METHODS

Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis focused on job characteristics for the past week and included factor analysis of an 18-item questionnaire on physical work demands.

RESULTS

The most common crops and tasks reported were topping/suckering tobacco and picking sweet potatoes or berries. Three factors (awkward postures, repetitive motion, strenuous work) accounted for 53% of the variance in physical demands.

CONCLUSIONS

Follow-up of hired child farmworkers should be undertaken to understand the long-term effects of physical work demands on their health.

Structural Vulnerability and Occupational Injury Among Latinx Child Farmworkers in North Carolina

Children as young as ten-years-old can legally work as hired farm labor in the United States. In North Carolina, many hired children are part of the Latinx farmworker community. Agriculture is a hazardous industry, and child workers experience high rates of injury, illness, and mortality. As part of a community-based participatory research study, we draw from thirty in-depth interviews with Latinx child farmworkers aged ten to seventeen to describe their experiences of personal and observed workplace injury and close calls. Nearly all child workers had experienced or observed some form of injury, with several reporting close calls that could have resulted in severe injury or fatality. Overall, children reported a reactive approach to injury prevention and normalized pain as part of the job. Highlighting Latinx child farmworkers' structural "vulnerability, this analysis contextualizes understanding of workplace injury among this largely hidden population. We offer policy recommendations to protect and support these vulnerable workers.

Pesticide exposure among Latinx child farmworkers in North Carolina

BACKGROUND

Although pesticides have adverse effects on child health and development, little research has examined pesticide exposure among child farmworkers. This analysis addresses two specific aims: (1) describes pesticide exposure among Latinx child farmworkers in North Carolina, and (2) delineates factors associated with this pesticide exposure.

METHODS

In 2018 (n = 173) and 2019 (n = 156) Latinx child farmworkers completed interviews and wore silicone wristbands for a single day to measure pesticide exposure. Wristbands were analyzed for 70 pesticides.

RESULTS

Most Latinx child farmworkers were exposed to multiple pesticides; the most frequent were pyrethroids (69.9% in 2018, 67.9% in 2019), organochlorines (51.4% in 2018, 55.1% in 2019), and organophosphates (51.4% in 2018, 34.0% in 2019). Children were exposed to a mean of 2.15 pesticide classes in 2018 and 1.91 in 2019, and to a mean of 4.06 pesticides in 2018 and 3.34 in 2019. Younger children (≤15 years) had more detections than older children; children not currently engaged in farm work had more detections than children currently engaged in farm work. Migrant child farmworkers had more detections than nonmigrants. For specific pesticides with at least 20 detections, detections and concentrations were generally greater among children not currently engaged in farm work than children currently engaged.

CONCLUSIONS

Children who live in farmworker communities are exposed to a plethora of pesticides. Although further research is needed to document the extent of pesticide exposure and its health consequences, sufficient information is available to inform the policy needed to eliminate this pesticide exposure in agricultural communities.

Musculoskeletal injury symptoms among hired Latinx child farmworkers in North Carolina

BACKGROUND

Although children 10-17 years can be hired to work in agriculture, little research has addressed possible musculoskeletal injuries. Children may be at particular risk for these injuries because of the repetitive and load bearing nature of work tasks. Existing research relies on child workers to self-report musculoskeletal injuries.

METHODS

In 2017, 202 Latinx child farmworkers ages 10-17 employed across North Carolina completed survey interviews. In 2018, 145 of these children (94 [64.8%] current farmworkers) completed a physical examination and second interview. The examination obtained findings for upper and lower extremity as well as back injuries.

RESULTS

Positive indicators for musculoskeletal symptoms were few in either current or former child farmworkers. The knee was most common site for positive indicators with 15.4% of children having at least one. Combining all anatomical sites, 29.0% of children had at least one positive indicator, with no significant difference between current and former farmworkers. Overall, boys had significantly more indicators of knee injuries than girls (21.3% vs. 4.1%), indicators of ankle injuries were found only in the youngest workers (9.5% of children 11-13 years), and significantly fewer current farmworkers had indicators of lower back injuries than former farmworkers (6.4% vs. 17.7%).

CONCLUSIONS

Expectations of injuries come from previous studies using child farmworker self-reports, adult farmworker injury rates, and sports medicine pediatric findings. Hired child farmworkers may not perform activities as repetitious and load-bearing as children in sports training or adult farmworkers. Additional research using physical examination is needed to confirm these findings.

Pesticide exposure among Latinx children: Comparison of children in rural, farmworker and urban, non-farmworker communities

Personal pesticide exposure is not well characterized among children in vulnerable, immigrant communities. We used silicone wristbands in 2018-2019 to assess pesticide exposure in 8 year old Latinx boys and girls in rural, farmworker families (n = 73) and urban, non-farmworker families (n = 60) living in North Carolina who were enrolled in the PACE5 Study, a community-based participatory research study. We determined the detection and concentrations (ng/g) of 75 pesticides and pesticide degradation products in the silicone wristbands worn for one week using gas chromatography electron capture detection and employed gas chromatography mass spectrometry. Differences by personal and family characteristics were tested using analysis of variance or Wilcoxon Rank Sum tests when necessary. Pesticide concentrations above the limit of detection were analyzed, and reported as geometric means and 95% confidence intervals (CI). The most frequently detected pesticide classes were organochlorines (85.7%), pyrethroids (65.4%), and organophosphates (59.4%), with the most frequently detected specific pesticides being alpha-chlordane (69.2%), trans-nonachlor (67.7%), gamma-chlordane (66.2%), chlorpyrifos (54.9%), cypermethrin (49.6%), and trans-permethrin (39.1%). More of those children in urban, non-farmworker families had detections of organochlorines (93.3% vs. 79.5, p = 0.0228) and pyrethroids (75.0% vs. 57.5%, p = 0.0351) than did those in rural, farmworker families; more children in rural, farmworker families had detections for organophosphates (71.2% vs. 45.0%, p= 0.0022). Children in urban, non-farmworker families had greater concentrations of alpha-chlordane (geometric mean (GM) 18.98, 95% CI 14.14, 25.47 vs. 10.25, 95% CI 7.49, 14.03; p= 0.0055) and dieldrin (GM 17.38, 95% CI 12.78 23.62 vs. 8.10, 95% CI 5.47, 12.00; p= 0.0034) than did children in rural, farmworker families. These results support the position that pesticides are ubiquitous in the living environment for children in vulnerable, immigrant communities, and argue for greater effort in documenting the widespread nature of pesticide exposure among children, with greater effort to reduce pesticide exposure.

Use of complementary and alternative medicine in Norway: a cross-sectional survey with a modified Norwegian version of the international questionnaire to measure use of complementary and alternative medicine (I-CAM-QN)

Background

In recent decades complementary and alternative medicine (CAM) has been widely used worldwide as well as in Norway, where CAM is offered mainly outside the national health care service, mostly complementary to conventional treatment and fully paid for by the patients. With few exceptions, previous research has reported on frequency and associations of total CAM use in Norway rather than on single therapies and products. Therefore, in this present study we will map the use of CAM more precisely, including types of services, products, and self-help practices and further include reasons for use and helpfulness of the specific therapies used based on a modified Norwegian version of the I-CAM-Q (I-CAM-QN).

Method

Computer assisted telephone interviews using I-CAM-QN were conducted with 2001 randomly selected Norwegians aged 16 and above using multistage sampling in January 2019 with age and sex quotas for each area. Weights based on sex, age, education, and region corrected for selection biases, so that results are broadly representative of the Norwegian population. Descriptive statistics were carried out using Pearson’s Chi-square tests and t-tests to identify group differences.

Result

CAM use was reported by 62.2% of the participants during the prior12 months. Most participants had used natural remedies (47.4%), followed by self-help practices (29.1%) and therapies received from CAM providers (14.7%). Few of the participants had received CAM therapies from physicians (1.2%). Women were generally more likely to use CAM than men, younger people more likely than older, and participants with lower university education and income more likely than participants without university education, with higher university education and higher income. Mean number of visits per year to the different CAM providers ranged from 3.57 times to herbalists to 6.77 times to healers. Most of the participants found their use of CAM helpful.

Conclusion

This study confirms that CAM is used by a considerable segment of the Norwegian population. We suspect that the number of participants reporting CAM use is greater when specific therapies are listed in the questionnaire as a reminder (as in the I-CAM-QN) compared to more general questions about CAM use. The CAM modalities used are mainly received from CAM providers operating outside public health care or administered by the participants themselves.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-021-03258-6.

Communication and information needs about complementary and alternative medicine: a qualitative study of parents of children with cancer

BACKGROUND

Many parents choose support such as Complementary and Alternative Medicine (CAM) for themselves and their children who have cancer. The aim of this paper is to describe, how parents who have children with cancer communicated with conventional health care providers about CAM, and what types and sources of information they would like to receive about CAM when the child was ill.

METHOD

This focused ethnography draws from in-depth, semi-structured interviews conducted with 22 families in Norway with 24 adult participants (two couples), including two individuals who had had cancer themselves. Four domains were explored in the data analysis: the use of CAM, advice from laypeople about CAM, communication with conventional health care providers about CAM, and parents' information needs about CAM.

RESULTS

Many of the participants had personal experiences with CAM before the child received the cancer diagnosis. The health care providers did not raise the question about CAM in the consultations. However, when the parents raised the question, they were mostly met in a positive way. The participants did not receive any information about CAM at the hospital, which they would have appreciated. Instead, they received recommendations about CAM from laypersons, which were mostly rejected, as the advice was not in line with their health values/philosophy.

CONCLUSION

The reason participants did not disclose CAM use is that physicians did not ask them about it. However, positive communication about conventional treatment facilitated fruitful conversations about CAM. The participants wanted information about CAM from authoritative sources, primary from health care providers at the hospital and the Children's Cancer Society. They demand information about risks and benefits when using CAM as well as whether CAM can improve the immune system, fight the cancer, and improve the quality of life of the family. An evidence-based decision aid is warranted to enable health care providers and parents of children with cancer to make well-informed decisions about CAM.

COVID-19 Pandemic Among Immigrant Latinx Farmworker and Non-farmworker Families: A Rural-Urban Comparison of Economic, Educational, Healthcare, and Immigration Concerns

COVID-19 has revealed social and health inequities in the United States. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice. Policy implications are highlighted.

Hired Latinx Child Farmworkers in North Carolina: Educational Status and Experience Through a Social Justice Lens

We examine the educational experience of Latinx hired child farmworkers in North Carolina, using a social justice framework. Qualitative (n = 30) and quantitative (n = 202) data collected among children ten to seventeen years of age revealed elevated rates of grade retention and dropout status. Children reported disruption to their schooling caused by international and interstate migration and intrastate movement. Few worked during school time; nevertheless, children reported missed participation in educational enrichment opportunities and little integration into school life. Schools often failed to accommodate language difficulties and problems caused by migration, and an atmosphere of racism prevailed. Educational programs for children in farmworker families were established during the 1960s. However, they do not meet the needs of hired child farmworkers. Policies to reduce child employment in agriculture and to meet their educational needs are necessary to ensure the education needed for future health and well-being. We discuss the applied implications of findings.

"It's Worse to Breathe It Than to Smoke It": Secondhand Smoke Beliefs in a Group of Mexican and Central American Immigrants in the United States

This analysis describes beliefs about secondhand smoke and its health effects held by Mexican and Central American immigrants in North Carolina. Data from 60 semistructured, in-depth interviews were subjected to saliency analysis. Participant discussions of secondhand smoke centered on four domains: (1) familiarity and definition of secondhand smoke, (2) potency of secondhand smoke, (3) general health effects of secondhand smoke, and (4) child health effects of secondhand smoke. Secondhand smoke was generally believed to be more harmful than primary smoke. Mechanisms for the potency and health effects of secondhand smoke involved the smell of secondhand smoke, secondhand smoke being an infection and affecting the immune system, and personal strength being protective of secondhand smoke. Understanding these health beliefs informs a framework for further health education and intervention to reduce smoking and secondhand smoke exposure in this vulnerable population.

COVID-19 Pandemic Among Immigrant Latinx Farmworker and Non-farmworker Families: A Rural-Urban Comparison of Economic, Educational, Healthcare, and Immigration Concerns

COVID-19 has highlighted social and health injustices in the US. Structural inequalities have increased the likelihood of immigrants contracting COVID-19, by being essential workers and through poverty that forces this population to continue working. Rural and urban immigrant families may face different concerns. Using a telephone survey in May 2020 of 105 Latinx families in an existing study, quantitative and qualitative data were gathered on work and household economics, childcare and education, healthcare, and community climate. Analyses show that, although rural and urban groups experienced substantial economic effects, impacts were more acute for urban families. Rural workers reported fewer workplace protective measures for COVID-19. For both groups, fear and worry, particularly about finances and children, dominated reports of their situations with numerous reports of experiencing stress and anxiety. The experience of the pandemic is interpreted as an example of contextual vulnerability of a population already experiencing structural violence through social injustice.

Work Safety Culture of Latinx Child Farmworkers in North Carolina

Background

Little research has addressed the safety environment of child farmworkers. This analysis examines the work safety culture experienced by Latinx child farmworkers in North Carolina.

Methods

Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis included measures of the behavioral, situational, and psychological elements of work safety culture.

Results

The work culture on North Carolina farms employing Latinx child farmworkers places limited value on safety. Behaviorally, many did not wear appropriate work clothing (e.g., 47.5% wore gloves, 37.1% wore boots). Situationally, few received safety training for tools (40.6%), machinery (24.3%), or pesticides (26.0%); about one-third (33.7%) had worked piece-rate; and many did not have field sanitation services available (e.g., 37.1% had water for washing, 19.8% had soap). Safety attitudes were mixed, and work safety climate was low, with 21.8% stating that their supervisor was only interested in doing the job fast and cheaply. Greater safety training, field sanitation services, and work safety climate were associated with working in western North Carolina, migrant workers, limited English fluency, and working in tomatoes. Wearing appropriate work clothing, not working piece-rate, fewer unsafe work attitudes were associated with working in eastern North Carolina, seasonal worker, speaking English, and working in tobacco.

Conclusions

This research makes it apparent that efforts are needed to improve safety culture wherever child farmworkers are employed. Current policy is not providing a safe environment for children working on farms in the United States.

Trends in use of dental care provider types and services in the United States in 2000-2016: Rural-urban comparisons

BACKGROUND

The authors conducted a study to assess recent trends in dental care provider mix (type of dental professionals visited) and service mix (types of dental procedures) use in the United States and to assess rural-urban disparities.

METHODS

Data were from the 2000 through 2016 Medical Expenditure Panel Survey. The sample was limited to respondents who reported at least 1 dental visit to a dental professional in the survey year (N = 138,734 adults ≥ 18 years). The authors estimated rates of visiting 3 dental professionals and undergoing 5 dental procedures and assessed the time trends by rural-urban residence and variation within rural areas. Multiple logistic regression was used to assess the association between rural and urban residence and service and provider mix.

RESULTS

A decreasing trend was observed in visiting a general dentist, and an increasing trend was observed in visiting a dental hygienist for both urban and rural residents (trend P values < .001). An increasing trend in having preventive procedures and a decreasing trend in having restorative and oral surgery procedures were observed only for urban residents (trend P values < .001). The combined data for 2000 through 2016 showed that rural residents were less likely to receive diagnostic services (adjusted odds ratio [AOR], 0.82; 95% confidence interval [CI], 0.72 to 0.93) and preventive services (AOR, 0.87; 95% CI, 0.78 to 0.96), and more likely to receive restorative (AOR, 1.11; 95% CI, 1.02 to 1.21) and oral surgery services (AOR, 1.23; 95% CI, 1.11 to 1.37).

CONCLUSIONS

Although preventive dental services increased while surgical procedures decreased from 2000 through 2016 in the United States, significant oral health care disparities were found between rural and urban residents.

PRACTICAL IMPLICATIONS

These results of this study may help inform future initiatives to improve oral health in underserved communities. By understanding the types of providers visited and dental services received, US dentists will be better positioned to meet their patients' oral health needs.

Occupational Injuries of Latinx Child Farmworkers in North Carolina: Associations With Work Safety Culture

OBJECTIVE

This paper examines the association of occupational injuries with work safety culture among Latinx child farmworkers.

METHODS

Interviews were conducted in 2017 with 202 Latinx farmworkers aged 10 to 17 years.

RESULTS

Occupational injuries were common among the child farmworkers: for example, 66.8% reported any work injury and 45.5% reported heat-related illness. Work safety culture was inadequate; for example, most did not receive safety training, one-third reported having worked piece-rate; only a few field sanitation services were available, and perceived work safety climate was low. Work safety culture had a mixed association with occupational injuries, with safety training and a better perceived work safety climate having a direct association with occupational injuries.

CONCLUSIONS

Policy is needed to reduce child farmworker injuries. Strategies to improve the predictive value of the work safety culture model are required.

Rural-Urban Differences in Dental Service Utilization and Dental Service Procedures Received Among US Adults: Results From the 2016 Medical Expenditure Panel Survey

PURPOSE

To assess rural-urban differences in dental service use and procedures and to explore the interaction effects of individual- and county-level factors on having dental service use and procedures.

METHODS

Data were from the 2016 Medical Expenditure Panel Survey (MEPS). We assessed rural-urban differences in 3 outcome variables: number of dental visits (1, 2, or 3+ visits), preventive care procedures (Yes/No), and treatment procedures (Yes/No). The study sample included 8,199 adults ≥ 18 years of age who reported at least 1 dental visit in the past year. Sampling weights embedded in MEPS were incorporated into all the analyses.

FINDINGS

A significant interaction between residential location and race/ethnicity (P = .030) suggested limited access to dental visits for minority groups, especially for blacks in the more rural areas. Adults from a more rural area were less likely to have received a preventive procedure (AOR = 0.55, 95% CI: 0.35-0.87) than those from an urban area. Adults of racial/ethnic minority groups, with lower SES, and without dental insurance were less likely to have received a preventive procedure (all P < .01) but were more likely to have received a treatment procedure (all P < .05).

CONCLUSIONS

The study showed rural adults were less likely to have received preventive dental procedures than their urban counterparts. Racial/ethnic minority groups living in a more rural area had even more limited access to dental services. Innovative service delivery models that integrate telehealth and community-based case management may contribute to addressing these gaps in rural communities.

Security and Privacy Risks Associated With Adult Patient Portal Accounts in US Hospitals

IMPORTANCE

Patient portals can help caregivers better manage care for patients, but how caregivers access the patient portal could threaten patient security and privacy.

OBJECTIVE

To identify the proportions of hospitals that provide proxy accounts to caregivers of adult patients, endorse password sharing with caregivers, and enable patients to restrict the types of information seen by their caregivers.

DESIGN, SETTING, AND PARTICIPANTS

This national cross-sectional study included a telephone survey and was conducted from May 21, 2018, to December 20, 2018. The randomly selected sample comprised 1 independent hospital and 1 health system-affiliated general medical hospital from every US state and the District of Columbia. Specialty hospitals and those that did not have a patient portal in place were excluded. An interviewer posing as the daughter of an older adult patient called each hospital to ask about the hospital's patient portal practices. The interviewer used a structured questionnaire to obtain information on proxy account availability, password sharing, and patient control of their own information.

MAIN OUTCOMES AND MEASURES

The primary outcome was the proportion of hospitals that provided proxy accounts to caregivers of adult patients. Secondary outcomes were the proportion of hospitals with personnel who endorsed password sharing and the proportion that allowed adult patients to limit the types of information available to caregivers.

RESULTS

After exclusions, a total of 102 (51 health system-affiliated and 51 independent) hospitals were included in the study. Of these hospitals, 69 (68%) provided proxy accounts to caregivers of adult patients and 26 (25%) did not. In 7 of 102 hospitals (7%), the surveyed personnel did not know if proxy accounts were available. In the 94 hospitals asked about password sharing between the patient and caregiver, personnel in 42 hospitals (45%) endorsed the practice. Among hospitals that provided proxy accounts, only 13 of the 69 hospitals (19%) offered controls that enabled patients to restrict the types of information their proxies could see.

CONCLUSIONS AND RELEVANCE

This study found that almost half of surveyed hospital personnel recommended password sharing and that few hospitals enabled patients to limit the types of information seen by those with proxy access. These findings suggest that hospitals and electronic health record (HER) vendors need to improve the availability and setup process of proxy accounts in a way that allows caregivers to care for patients without violating their privacy.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

Health and Occupational Injury Experienced by Latinx Child Farmworkers in North Carolina, USA

Children as young as 10 years old are hired to work on farms in the United States (U.S.). These children are largely Latinx. Using interview data collected from 202 North Carolina Latinx child farmworkers in 2017, this analysis documents the heath characteristics and occupational injuries of Latinx child farmworkers and delineates characteristics associated with their health and occupational injuries. Latinx child farmworkers include girls (37.6%) and boys (62.4%), aged 10 to 17 years, with 17.8% being migrant farmworkers. Three-quarters reported receiving medical and dental care in the past year. Respiratory (15.8%) and vision (20.3%) problems were prevalent. Girls more than boys, and younger more than older children had greater health service utilization. Occupational injuries were common, with 26.2% reporting a traumatic injury, 44.1% a dermatological injury, 42.6% a musculoskeletal injury, and 45.5% heat-related illness in the past year. Age increased the odds of reporting work injuries and heat-related illness, and being a non-migrant reduced the odds of reporting work injuries. These results emphasize the need for greater documentation of child farmworker occupational health and safety. They underscore the need to change occupational safety policy to ensure that children working in agriculture have the same protections as those working in all other U.S. industries.

Cancer Knowledge Among Mexican Immigrant Farmworkers in North Carolina

Latino farmworkers are exposed to a number of carcinogens in the workplace. Cancer survival rates for Latinos are below average. This paper describes Mexican immigrant farmworkers' knowledge of colorectal, breast, and testicular cancer, and compares farmworkers' cancer knowledge to that of other Mexican immigrants. Survey interviews for this study were conducted with 100 farmworkers and 100 non-farmworkers in 2015 in North Carolina as part of an ongoing community-based participatory research project. We found low to moderate levels of knowledge about colorectal, breast, and testicular cancer among farmworkers. Compared to non-farmworkers, farmworkers had similar levels of knowledge about breast and testicular cancer, but slightly lower knowledge about colorectal cancer (p = 0.0087). Few studies have used quantitative methods to assess farmworkers' knowledge of specific types of cancer. Our results demonstrate a need for increased dissemination of existing cancer education programs and further research to develop additional educational tools.

"Be careful!" Perceptions of work-safety culture among hired Latinx child farmworkers in North Carolina

BACKGROUND

Children as young as 10 years of age can be hired to work on farms. Many of these hired child farmworkers are Latinx. Although these children experience high rates of injury, little research has addressed work-safety perceptions among hired Latinx child farmworkers.

METHODS

For this qualitative study, we conducted in-depth interviews in North Carolina in 2016 with 30 Latinx child farmworkers, ages 10 to 17. Our analysis used the work-safety culture conceptual framework to delineate their perceptions of the psychological, behavioral, and situational elements of safety culture.

RESULTS

The child farmworkers describe a weak work-safety culture. Psychologically, they understand that their parents want them to be safe, but they observe that safety is important to only a fraction of their supervisors and coworkers. Behaviorally, they recognize many of the hazards they confront while working, but it is not clear how well they use this knowledge to mitigate these hazards or to change their behaviors to avoid these hazards. Situationally, several children note that the only safety training they receive is the imperative to "be careful." Most receive little formal training, much of the training they receive is informally provided by family members and coworkers rather than supervisors, and their training is geared more toward how to complete a task than how to complete the task safely.

CONCLUSIONS

Child farmworkers perceive that work-safety culture is of limited importance in agriculture. Regulations are needed that improve work-safety culture in agriculture, especially for those vulnerable due to minority age.

Hired Latinx child farm labor in North Carolina: The demand-support-control model applied to a vulnerable worker population

BACKGROUND

US government child labor policies allow children as young as age 10 to be hired as workers on farms not operated by family members. Children may face substantial health risks in an industry known for high worker morbidity and mortality rates, due to high demands for productivity, and low control and little support because of the organization of the workplace. This paper examines how child farmworkers in North Carolina experience their work situation.

METHODS

In-depth interviews conducted in 2016 with 30 Latinx child farmworkers, ages 10 to 17, were analyzed using concepts from the demand-control-support model. All had worked as either migrant or seasonal hired farmworkers within the past year.

RESULTS

Children reported planting, cultivating, and harvesting crops including fruits, vegetables, and tobacco. The crew leader supervisory system, piece-rate pay, and coworker pressure produced significant demands to work quickly and take risks including lifting heavy loads, operating mechanical equipment, and working in excessive heat. Children had little control over work to counter demands they experienced; and they labored in a state of fear of firing, wage theft, and other sanctions. Support was variable, with younger children more likely to experience family and coworker support than older children.

CONCLUSIONS

The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation. Future research should systematically document the occupational injury and illness of hired child farmworkers, and consider whether changes in labor policy are warranted.

Migrant Farmworker Nutritional Strategies: Implications for Diabetes Management

OBJECTIVES

Diabetes is a chronic disease prevalent in Hispanic/Latino adults, including migrant farmworkers in the US. Its management requires that individuals follow dietary guidelines, which may be difficult for migrant farmworkers due to work and environmental constraints. This analysis is designed to explore potential barriers to and supports for migrant farmworkers' practice of effective dietary self-management.

METHODS

Interviews were conducted with 200 Latino migrant farmworkers in North Carolina, including workers with and without diabetes, recruited at housing sites throughout the 2017 agricultural season. The survey instrument included questions designed to elucidate how workers obtain food, prepare and consume food, and maintain food security.

RESULTS

Most purchased food is obtained once per week at large grocery stores, with most farmworkers depending on others for transportation. Less than 1 in 5 supplement with garden produce and food from food pantries, farmers markets, and hunting and fishing. About half of lunches and a quarter of dinners are purchased from vendors or other commercial sources. More than 2 in 5 workers report they have to compromise on or lack control of meal content. About 1 in 5 report issues with food security.

CONCLUSIONS

The food-related practices of farmworkers would require change to accommodate effective dietary self-management of diabetes. Greater use of sources of fresh produce and other nutrient-dense foods, coupled with greater control over meal content and cooking techniques would be needed. While some accommodations could be encouraged through education, others would require policy change in housing or access to community resources.

Child Work Safety on the Farms of Local Agricultural Market Producers: Parent and Child Perspectives

Agriculture is a hazardous industry, yet there are few regulations on the ages at which children may engage in farm work. Local agricultural market producers (LAMPs) are a growing subset of farmers within "sustainable agriculture" who engage in direct-to-consumer and direct-to-retailer enterprises. This study explores the occupational health and safety perceptions of parents and children for children who work on their families' LAMP farms. In-depth interviews were conducted with 12 parent-child dyads from LAMP farms in Illinois and North Carolina. Four themes emerged from these 24 interviews; parents and children perceived that: (1) the nature of small farms makes them safer than industrial agricultural operations; (2) child safety on farms is common sense; (3) avoiding hazardous tasks keeps children safe; and (4) parents know best (compared to regulations) about ways to keep their children safe. Some of these themes echo the results of earlier studies conducted with more conventional farms. Further research is needed to develop programs to improve child occupational safety on LAMP farms.

Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics

BACKGROUND

Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study.

METHODS

Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC).

RESULTS

Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC.

CONCLUSIONS

This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.

Engaging Youth Advocates in Community-Based Participatory Research on Child Farmworker Health in North Carolina

BACKGROUND

Wake Forest School of Medicine (WFSM) investigators and Student Action with Farmworkers' (SAF) Levante Leadership Institute, a farmworker youth program, are collaborating on a community-based participatory research (CBPR) study.

OBJECTIVES

1) Describe the collaborative process between WFSM investigators and the Levante advisory board during the strategic planning and implementation phase and 2) highlight practices that support the collaboration and project success.

METHODS

The longitudinal Hired Child Farmworker Study examines the health and safety of hired Latino child farm-workers in North Carolina. Two Levante alumni co- investigators lead research-related activities with the Levante advisory board.

LESSONS LEARNED

Challenges to CBPR with youth are overcome by the longstanding partnership between WFSM and SAF, attention to logistical details, power sharing, building on shared values, and assessment of youth preferences.

CONCLUSIONS

The partnership between WFSM and Levante demonstrates the mutual benefit of CBPR and will continue during the upcoming study phases.

Conventional and complementary cancer treatments: where do conventional and complementary providers seek information about these modalities?

Background

Both conventional health care providers and complementary therapists treat cancer patients. To provide effective treatment, both types of providers should to be familiar with their own as well as alternative types of treatment. Our aim was to compare how conventional health care providers (oncology doctors, oncology nurses, family physicians) and complementary therapists (acupuncturists, reflexologists, massage therapists) seek information about conventional and complementary cancer treatments.

Method

This analysis was conducted on the basis of feedback from 466 participants. We used self-administered questionnaires in a cross-sectional study.

Results

The majority of the medical doctors (96%) searched for evidence-based information regarding conventional cancer treatments. They gathered this information mostly from guidelines, which is considered best practice and is expected from Norwegian health personnel. Eighty-one percent of the nurses gather this information from evidence based resources such as UpToDate. Colleagues were asked for information by 58% of the medical doctors and 64% of the nurses. Moreover, 50% of the medical doctors and 57% of the nurses searched for evidence-based information about complementary cancer modalities. The acupuncturists gathered evidence-based information for both conventional (79%) and complementary (77%) modalities, followed by the reflexologists (54 and 54%, respectively) and massage therapists (54 and 52%, respectively). Nearly half of the acupuncturist (49%) asked a colleague for information.

Conclusion

To provide safe cancer care, it is important that advice about complementary modalities is based on current and evidence-based evaluations. The majority of the medical doctors and nurses in this study sought information according to evidence-based medicine regarding conventional cancer treatments, and about half of them gathered evidence-based information about complementary cancer modalities. This was also true for the complementary therapists as they gathered information about complementary and conventional treatments from evidence-based evaluations. This demonstrates that since the term evidence-based medicine was first introduced in 1991, the approach has grown extensively and both conventional and complementary providers use this approach to seek information.

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Background

Electronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access.

Objective

The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers.

Methods

We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data.

Results

All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information.

Conclusions

Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

Older Adult Internet Use and eHealth Literacy

We examine Internet use and eHealth literacy among older adults (aged 55+ years) who were patients at clinics serving low-income populations. Participants included 200 minority and White adults who completed interviews based on a technology acceptance conceptual model. A total of 106 participants (53.0%) used the Internet; utilization was associated with personal characteristics (age, ethnicity, education, poverty), computer characteristics (number of e-devices, computer stress), social support (marital status), and health knowledge and attitudes (health literacy, medical decision making, health information sources), but not health status. Of the 106 participants who used the Internet, 52 (49.1%) had high eHealth literacy; eHealth literacy was associated with computer characteristics (number of e-devices, computer stress), and health knowledge and attitudes (medical decision making, health information sources). In multivariate analysis, computer stress maintained a significant inverse association with eHealth literacy. Educational interventions to help older adults successfully use technology and improve eHealth literacy must be identified.

Mexican Sobadores in North Carolina: Manual Therapy in a New Settlement Context

Latino immigrants to the New Settlement area of the southeastern United States face structural and cultural obstacles to accessing the conventional health care system, and come from areas with long traditions of medical treatments from healers without professional training or licensure. Little is known about the use of such healers in New Settlement areas. This study focuses on sobadores, healers who use manipulative therapy. Goals were to describe sobadores practicing in North Carolina, including their background, conditions treated, and their understanding of the pathophysiology of their patients' conditions and how their treatments work. The paper also describes who sobadores treat and sobadores' understanding of where their treatment fits into patients' pursuit of relief from symptoms. This focused ethnography draws from in-depth, semi-structured interviews conducted with six sobadores from Mexico practicing in North Carolina. These sobadores appear to meet both structural and cultural needs for healthcare in the immigrant Latino population.

Farmworker and nonfarmworker Latino immigrant men in North Carolina have high levels of specific pesticide urinary metabolites

This article compares detections and concentrations of specific organophosphate (OP), bis-dithiocarbamate, and pyrethroid pesticide urinary metabolites among Latino male farmworkers and nonfarmworkers in North Carolina. Data are from interviews and urine samples collected in 2012 and 2013. Farmworkers and nonfarmworkers frequently had detections for OP and pyrethroid pesticide urinary metabolites. Detection of bis-dithiocarbamate urinary metabolites was less frequent, but substantial among the nonfarmworkers. The concentrations of organophosphate, bis-dithiocarbamate, and pyrethroid pesticide urinary metabolites were high for farmworkers and nonfarmworkers compared to National Health and Nutrition Examination Survey results. Pesticide urinary metabolite detection was not associated with occupation in nonfarmworkers. Research for reducing pesticide exposure among farmworkers remains important; research is also needed to determine pesticide exposure pathways among Latino nonfarmworkers.

Relationship between maternal depression symptoms and child weight outcomes in Latino farmworker families

This study sought to characterize depressive symptoms among mothers in Latino farmworker families, determine if maternal depression increases children's risk of obesity, and ascertain whether relevant risk factors such as physical activity, diet, and feeding style mediate this relationship. Mothers from 248 families completed the 10-item Center for Epidemiologic Studies Depression Scale 9 times over a 2-year period. Four distinct patterns were used to describe mothers: few symptoms, moderate episodic symptoms, severe episodic symptoms, and chronic symptoms. Approximately two-thirds of women experienced moderate symptoms of depression at least once. Children of mothers fitting each pattern were compared. At the end of the study, children of mothers with severe episodic and chronic symptoms were significantly more likely to be overweight and obese than children of mothers with few symptoms (p < .05). After controlling for covariates, differences in weight status for children of mothers with severe episodic symptoms remained significant. Children of mothers with either moderate episodic or chronic symptoms were fed in a less responsive fashion (p < .05), and children of chronically symptomatic mothers had lower diet quality (p < .01). Although nonresponsive feeding has been linked to childhood obesity, in this analysis, feeding style did not mediate the relationship between maternal depression and diet quality. Elevated levels of depressive symptoms are common in this population, and those symptoms, especially when severe or chronic in nature, may increase children's risk of obesity. Additional research is needed to characterize the pathways through which maternal depression influences children's weight.

Mental Health Among Latina Farmworkers and Other Employed Latinas in North Carolina

The mental health of Latinas with manual occupations, particularly those employed in agriculture, is a public health concern. The goals of this analysis were to describe the mental health of Latina farmworkers, and to compare their mental health with that of other Latina manual workers. Participants included 35 employed Latina farmworkers, 35 employed non-farmworkers, and 25 unemployed non-farmworkers who completed interviews in 2012. Measures included stress, anxiety, depressive symptoms, elevated depressive symptoms, and risk for alcohol dependence. Farmworkers had greater stress and anxiety than did employed and unemployed non-farmworkers. Employed Latinas, whether farmworkers or in other occupations, had greater stress and anxiety than unemployed Latinas. Depressive symptoms, although high, did not differ significantly by occupation and employment. Few were at risk for alcohol dependence. Concrete steps are needed to address the mental health of Latina farmworkers, and to continue documentation of mental health concerns and their causes in this population.