Sleep Quality Among Latino Farmworkers in North Carolina: Examination of the Job Control-Demand-Support Model

Sleep problems are associated with physical and mental health disorders and place individuals at an increased risk of workplace injuries. The demand-control-support model posits that job demands and the capacity to control work processes influence workers’ level of distress, thereby affecting their physical and mental health; supervisor support can buffer the negative effect of high demands and low control. Data on the sleep quality and the organization of work of Latino men were collected in agricultural areas in North Carolina in 2012. 147 Mexican-born farmworkers ages 30 and older, most of whom had H-2A visas, provided information about sleep quality and organization of work. Most (83 %) farmworkers reported good sleep quality. The association between working more than 40 h per week and reporting poor sleep quality approached statistical significance. Additional research is needed to understand whether job demands, job control, and social support affect farmworkers’ sleep quality.     

Ethical issues in conducting migrant farmworker studies

Migrant farmworkers should be considered a vulnerable population because they work in a hazardous industry, are often members of an ethnic minority, have known difficulty in accessing health care, and are often of lower socioeconomic status. For these reasons, too, it is extremely important to conduct health-related research with this often-underserved group. However, because migrant farmworkers are vulnerable, investigators must be especially vigilant in protecting them from the potential harms of research and in ensuring that the special ethical issues that arise in research with this population are identified and addressed for every project. In response to the National Cancer Institute's concerns about the feasibility of conducting epidemiologic studies among migrant farmworkers, researchers undertook four feasibility studies near the Texas-Mexico border. Each study raised different, complex ethical questions that challenged the investigators, but whose resolution turned out to be crucial to the success of the studies.     

Obstacles and Opportunities in Designing Cancer Control Communication Research for Farmworkers on the Delmarva Peninsula

Abstract: Little is known about the incidence of cancer among farmworker populations or about effective strategies for communicating with farmworkers about cancer prevention. Some studies suggest that farmworkers may have unusually high incidences of skin and cervical cancers. With these two cancers as the focus, a group of interviewers, researchers, and health communication specialists set out to create, implement, and evaluate a cancer control demonstration project geared toward farmworkers. In 1994, a situation analysis was conducted to identify constraints and opportunities for providing farmworkers with cancer control information and services. The situation analysis provided valuable information to aid in developing intervention and evaluation strategies. This paper outlines how and why the situation analysis was conducted and what was learned with regard to the farmworker population on the Delmarva Peninsula. Living conditions and the local availability of cancer control services are described. Obstacles to conducting research and interventions with farmworkers are high-lighted. Based on what was learned, recommendations are made for designing cancer control research and intervention for farmworkers.     

Mobile and Traditional Modes of Communication Among Male Latino Farmworkers: Implications for Health Communication and Dissemination

This analysis describes (1) cell phone and smartphone ownership, (2) continuity of phone numbers, (3) use of specific technologies while inside and outside the U.S., and (4) perceived adequacy of specific formats to receive health research results among Latino farmworkers. Telecommunications questionnaires were administered to 165 and 102 farmworkers in North Carolina in 2012 and 2013, respectively. Univariate and bivariate analyses were completed. Increasing numbers of Latino farmworkers own cell phones and smartphones. Talk and text functions are used frequently. Relatively few farmworkers maintain consistent phone numbers. They prefer to receive study results through low technology formats. Strategies to use cell phones to improve health or to share research findings will face obstacles in this population. Public health officials who identify and implement effective strategies to overcome these barriers may be able to harness mobile technologies to address the needs of Latino farmworkers.     

Gesundheitliche Ungleichheit im Jugendalter

So far, little is known about the extent of health inequalities during adolescence in Germany. Recent studies point out that, in general, socioeconomic differences in health are rather inconsistent and less pronounced during this part of life. This poses a number of challenges for the planning of strategies and interventions for tackling health inequalities. In order to understand the causes for the inconsistent influence of social inequality on adolescent health, research needs to focus more on the autonomy of the life phase ‘adolescence’. A better understanding of the various roles that secondary socialisation agents, such as school, peer groups and the media, play in the relationship between social inequality and health in adolescence can help to improve the theoretical approaches to social inequality and health as well as to develop interventions which take effect at these central co-ordinating points.     

Perspectives on Safety and Health Among Migrant and Seasonal Farmworkers in the United States and México: A Qualitative Field Study

ABSTRACT:  Context: A large number of hired farmworkers in the United States come from México. Understanding safety and health concerns among the workers is essential to improving prevention programs. Purpose: The purpose of this pilot study was to obtain detailed information about safety and health concerns of hired farmworkers in Colorado and in México. Methods: A total of 10 migrant farmworkers from northern Colorado and 5 seasonal farmworkers from Guanajuato, México, were interviewed using a semi-structured interview process. The social cognitive theory (SCT) served as a framework to gain understanding of safety and health among workers. Findings: Topics of concern identified included causes of farm, home and motor vehicle injuries, and treatment preferences for injuries and illnesses. Four main themes emerged: safety and health concerns, personal control and prevention strategies, factors affecting control and prevention strategies, and the importance of family. Conclusions: Further study of the themes using a revised semi-structured interview will be done in a larger study among hired farmworkers. The results add to the current work to understand specific health and safety concerns among these workers.     

Preventing occupational exposure to pesticides: using participatory research with latino farmworkers to develop an intervention

Pesticide exposure is an occupational health hazard for migrant farmworkers. The US-EPA Worker Protection Standard (WPS) mandates training programs to prevent or reduce exposure. WPS implementation in a local context requires understanding individual, workplace, and community environmental factors that lead to exposure and influence intervention effectiveness. Participatory research within the PRECEDE–PROCEED planning framework was used to design a WPS training program for Mexican farmworkers in North Carolina cucumber and tobacco production. Research with farmworkers, farmers, health care providers, and Cooperative Extension agents identified modifiable behaviors and environmental factors, as well as structural and regulatory barriers requiring intervention. Data were gathered and analyzed through individual and group interviews, community forums, an advisory board, and a partnership between academic researchers and a community-based organization. The intervention's dominant features are (a) focus on key health behaviors, (b) relevance to local conditions, and (c) attention to issues of control in the workplace. Participatory research is effective for designing a health intervention where diverse social, cultural, political, and regulatory issues affect farmworkers' risk of exposure.     

Latino Immigrants: Preventing Occupational Exposure to Pesticides: Using Participatory Research with Latino Farmworkers to Develop an Intervention

Pesticide exposure is an occupational health hazard for migrant farmworkers. The US-EPA Worker Protection Standard (WPS) mandates training programs to prevent or reduce exposure. WPS implementation in a local context requires understanding individual, workplace, and community environmental factors that lead to exposure and influence intervention effectiveness. Participatory research within the PRECEDE–PROCEED planning framework was used to design a WPS training program for Mexican farmworkers in North Carolina cucumber and tobacco production. Research with farmworkers, farmers, health care providers, and Cooperative Extension agents identified modifiable behaviors and environmental factors, as well as structural and regulatory barriers requiring intervention. Data were gathered and analyzed through individual and group interviews, community forums, an advisory board, and a partnership between academic researchers and a community-based organization. The intervention's dominant features are (a) focus on key health behaviors, (b) relevance to local conditions, and (c) attention to issues of control in the workplace. Participatory research is effective for designing a health intervention where diverse social, cultural, political, and regulatory issues affect farmworkers' risk of exposure.     

The US/Mexico border: a binational approach to framing challenges and constructing solutions for improving farmworkers' lives

Mexican migrant and seasonal farmworkers in the US-Mexico border region face health hazards and occupational risks and are becoming commonly known in the public health literature. According to several studies, farmworkers have high levels of chronic diseases such as diabetes and respiratory problems, are at risk for infectious diseases, and experience among the highest incidences of work-related injuries of any profession. The findings from two studies are considered and presented with the objective of contributing to an overall understanding of migrant farmworkers as a workforce moving across national boundaries and affected by the work environments and health stressors both shared and unique to each context. We propose a binational approach to comprehensively address the health problems and socioeconomic challenges faced by migrant and seasonal farmworkers. In this paper we present the results of two distinct but complementary studies of farmworker health on the Arizona-Sonora border.     

Migrant Farmworker Stress: Mental Health Implications

ABSTRACT:  Context: The number of Latinos in rural regions of the United States is increasing. Little is known about factors that undermine the mental health of this segment of the rural population. Purpose: The goal of this study is to determine which stressors inherent in farmwork and the farmworker lifestyle contribute to poor mental health. Methods: An interview containing the Migrant Farmworker Stress Inventory (MFWSI) and 3 mental health scales (the PAI [anxiety], CES-D [depression], and CAGE/4M [alcohol abuse]) was administered to a sample of 125 male migrant farmworkers. Factor analysis differentiated discrete domains of stressors in the MFWSI. Regression models identified associations of the MFWSI stressor domains with mental health outcomes. Findings : Thirty-eight percent of participants had significant levels of stress as determined by the MFWSI. The MFWSI reduced to 5 stressor domains: legality and logistics, social isolation, work conditions, family, and substance abuse by others. Some 18.4% of participants had impairing levels of anxiety, 41.6% met caseness for depression, and 37.6% answered yes to 2 or more questions on the CAGE. Social isolation and working conditions were associated with both anxiety and depressive symptoms. However, social isolation was more strongly associated with anxiety, and working conditions were more strongly linked to depression. Conclusions: Specific categories of stressors (social isolation, working conditions) inherent in farmwork and the farmworker lifestyle are associated with mental health among immigrant farmworkers. Isolating specific categories of stressors helps in designing programs and practice for the prevention and management of mental health disorders in the immigrant, farmworker population.     

Early-life conditions and mechanisms of population health vulnerabilities

The social status of groups is key to determining health vulnerability at the population level. The impact of material and psychological stresses imposed by social inequities and marginalization is felt most intensely during perinatal/early childhood and puberty/adolescent periods, when developmental genes are expressed and interact with social-physical environments. The influence of chronic psychosocial stresses on gene expression via neuroendocrine regulatory dysfunction is crucial to understanding the biological bases of adult health vulnerability. Studying childhood biology vulnerabilities to neighborhood environments will aid the crafting of multifaceted, multilevel public policy interventions providing immediate benefits and compounded long-term population health yields.     

Sun Safety Among Farmers and Farmworkers: A Review

Farmers and farmworkers face increased risks of skin cancer from exposure to solar ultraviolet radiation (UVR) when working outdoors. The objective of this study was to evaluate the evidence from behavioral and intervention studies from the peer-reviewed studies related to sun safety among farmers and farmworkers and identify any gaps in the literature. A comprehensive review was conducted between 1990 and 2013; 22 studies were identified related to behavior and health interventions of sun safety among these targeted groups. The inconsistency of data collection methods makes it difficult to estimate with accuracy any overall meaningful results of behavior. However, from the studies reviewed, farmers and farmworkers most frequently reported wearing some type of hat (23.6%–100%) as a primary method of protection from the sun when working outdoors. Female farmers were more likely than male farmers to use sunscreen and engage in indoor tanning behavior. All sun safety educational interventions studies reviewed reported positive increases in behavioral change. To a large degree, adequate sun protection is lacking and varies geographically among farmers. Although targeted education is key to making improvements on sun protection behavior, aggressive attempts have to be made. Studies related to farmworkers, sun safety behavior, and skin cancer are scarce and more research is needed in this area.     

Work Safety Culture of Youth Farmworkers in North Carolina: A Pilot Study

Objectives. We analyzed aspects of the behavioral, situational, and psychological elements of work safety culture of hired youth farmworkers in North Carolina.Methods. Data were from interviewer-administered questionnaires completed with 87 male and female hired farmworkers aged 10 to 17 years in North Carolina in 2013. We computed means, SDs, and Cronbach α values for the perceived work safety climate and safety perception summary scores.Results. Hired youth farmworkers in North Carolina described a negative work safety culture. Most engaged in unsafe general and unsafe work behaviors, few received training, and many were sexually harassed at work. They had mixed safety attitudes and knew that their employment was precarious. They reported a poor perceived work safety climate characterized by the perception that their supervisors “are only interested in doing the job fast and cheaply.” However, we could not detect statistically significant associations between work safety culture and injuries among these farmworkers.Conclusions. Increased scrutiny of agriculture as a suitable industry for workers as young as 10 years and additional regulations to protect hired youth farmworkers, if not to remove them from this environment, are warranted. Additional research is needed.Youths employed as agricultural workers in the United States experience high rates of injury and mortality.1–4 Many youths are employed in agricultural work on their family’s farm, but many other youths are hired farmworkers working on commercial farms. Current regulations allow youths as young as 14 years to be employed as hired farmworkers without parental permission; youths aged 10 to 13 years can be employed as hired farmworkers with parental permission.5–7 Youths employed in agriculture can work with sharp tools, machinery, and pesticides, as well as do the strenuous tasks of planting, cultivating and harvesting crops, and working with large animals.Most hired youth farmworkers in the United States are Latino, and often they are either immigrants from Mexico and Central American countries or the US-born children of immigrant farmworker parents.8,9 An unknown number of youth farmworkers are unaccompanied minors who migrate for agricultural employment but are not accompanied by a parent.10,11 Hired youth farmworkers share the same vulnerabilities as adult farmworkers, including low wages, few or no benefits, few regulatory protections, hazardous work, discrimination, and limited access to health care.12–14 Youth farmworkers are especially vulnerable to occupational injuries because of their smaller size, lesser strength, and greater surface-to-volume ratio compared with adults; their developing neurological and reproductive systems; and their lack of maturity and experience. Few studies have addressed factors affecting the occupational health and safety of youths working on farms, with fewer studies focused on hired youth farmworkers.Work safety culture is an important aspect of workplace safety.15 On the basis of Bandura’s theory of reciprocal determinism,16,17 Cooper15 argued that safety culture includes behavioral, situational, and psychological elements, thereby encompassing many different aspects of the work environment. Behavioral elements include observable safety and risk behaviors. Situational elements include safety management programs and actions. Psychological elements include subjective assessments of safety. For example, work safety climate, a worker’s perceptions of how an employer values safety over production,18,19 has been related to adverse health outcomes, including musculoskeletal discomfort and working while injured or ill, among adult farmworkers.20Westaby and Lee21 applied the work safety culture model in a longitudinal analysis of injuries among Future Farmers of America members. They found that a behavioral measure, dangerous risk taking, was positively associated with injuries; that a psychological measure, safety consciousness, was inversely related to injuries; but that a situational measure, safety knowledge, had a positive rather than a negative association with injuries. They suggested that this last, counterintuitive result may be explained by workers being placed in more dangerous environments for which they are provided greater safety information.Only a few elements of work safety culture of hired youth farmworkers have been addressed in the literature. For example, among the behavioral elements, general risk behavior (e.g., not wearing a helmet when riding a motorcycle) and work risk behavior (e.g., working with power tools, working with toxic substances) are positively associated with the incidence of injuries among youths working on farms.22–24 Shipp et al.25 reported that few (19%) adolescent farmworkers in Texas received pesticide safety training, a situational element. Parental attitude toward safety is another situational element that has been examined for youths working on farms.26 Having a risky attitude, a psychological element, is associated with the incidence of injuries among youths working on farms.22–24Greater effort is needed to document work safety culture of all youths working on farms; this effort is particularly important for hired youth farmworkers because they are more vulnerable than youths working on family farms. In our analysis, we used data from a pilot study to describe aspects of the behavioral, situational, and psychological elements of work safety culture of hired youth farmworkers in North Carolina.     

Studying health outcomes in farmworker populations exposed to pesticides

A major goal of studying farmworkers is to better understand how their work environment, including exposure to pesticides, affects their health. Although a number of health conditions have been associated with pesticide exposure, clear linkages have yet to be made between exposure and health effects except in cases of acute pesticide exposure. In this article, we review the most common health end points that have been studied and describe the epidemiologic challenges encountered in studying these health effects of pesticides among farmworkers, including the difficulties in accessing the population and challenges associated with obtaining health end point data. The assessment of neurobehavioral health effects serves as one of the most common and best examples of an approach used to study health outcomes in farmworkers and other populations exposed to pesticides. We review the current limitations in neurobehavioral assessment and strategies to improve these analytical methods. Emerging techniques to improve our assessment of health effects associated with pesticide exposure are reviewed. These techniques, which in most cases have not been applied to farmworker populations, hold promise in our ability to study and understand the relationship between pesticide exposure and a variety of health effects in this population. Key words: biomarkers, cancer, epidemiology, health outcomes, immigrants, neurobehavioral, neuropathy, pesticides.     

A Human Rights-Based Approach to Farmworker Health: An Overarching Framework to Address the Social Determinants of Health

Migrant and seasonal workers have a right to the highest attainable standard of health. Unfortunately, these farmworkers face a multitude of challenges. They are employed in one of the most dangerous industries and face serious occupational health risks, while positioned at the bottom of the social hierarchy. They often lack formal education and training, English language proficiency, legal status, access to information, and equitable opportunities to health and healthcare. This article will explore the international human rights conventions that support farmworkers’ right to health and healthcare in the United States. International human rights may provide a valuable legal framework that could be used to advocate on behalf of farmworkers and address the social determinants of health. Therefore, a Human Rights-Based Approach to Farmworker health will be presented along with recommendations for how to advance health and access to healthcare among this population. Fostering the health and well-being of migrant and seasonal farmworkers is critical to advancing equity, social justice, and maintaining the workforce required to meet production needs and safeguard the economic competitiveness of the industry.     

Tuberculosis and other infectious diseases in the adolescent immigrant

Adolescent medicine physicians are frequently the initial contact for adolescents newly arriving in the U.S. and it is important that they recognize the needs of their patients. The adolescent immigrant may be encountered in a school-based health setting, private practice, community health center, or other health care settings. This article begins with a review of the categories of immigrants comprising the adolescent population. It gives an extensive review of tuberculosis among Mexican-American adolescents, detailing history, epidemiology, diagnosis, social factors, and treatment modalities. It further delineates the impact of Mexican tuberculosis control strategies on the practice of medicine in the U.S., and outlines preventive, diagnostic, and therapeutic strategies that should be followed in the adolescent immigrant. This article also reviews viral hepatitis in its multiple forms and its impact on the adolescent immigrant. It concludes by delineating prevention practices required for the adolescent immigrant and summarizes the interventions an initial contact physician should undertake upon encountering such adolescents.     

Social determinants of health: implications for environmental health promotion.

In this article, the authors draw on the disciplines of sociology and environmental and social epidemiology to further understanding of mechanisms through which social factors contribute to disparate environmental exposures and health inequalities. They propose a conceptual framework for environmental health promotion that considers dynamic social processes through which social and environmental inequalities--and associated health disparities--are produced, reproduced, and potentially transformed. Using empirical evidence from the published literature, as well as their own practical experiences in conducting community-based participatory research in Detroit and Harlem, the authors examine health promotion interventions at various levels (community-wide, regional, and national) that aim to improve population health by addressing various aspects of social processes and/or physical environments. Finally, they recommend moving beyond environmental remediation strategies toward environmental health promotion efforts that are sustainable and explicitly designed to reduce social, environmental, and health inequalities.