Participation levels in 25 Community-based participatory research projects

This analysis describes the nature of community participation in National Institutes of Health and Centers for Disease Control and Prevention funded community-based participatory research (CBPR) projects, and explores the scientific and social implications of variation in community participation. We conducted in-depth interviews in 2012 with professional and community researchers from 25 CBPR projects in the Southeast US. Interview topics focused on participants' experiences with the nature and conduct of their CBPR project. Projects were rated on community participation in 13 components of research. Projects varied substantially in community participation. Some projects had community participation in only two to three components; others had participation in every component. Some professional researchers were deliberate in their inclusion of community participation in all aspects of research, others had community participation in some aspects, and others were mainly concerned that community members had the opportunity to participate in the study. Findings suggest a need for a standardized rubric for community-based research that facilitates delineation of approaches and procedures that are effective and efficient. Little actual community participation may also result in negative social impacts for communities.

Pesticide exposures to migrant farmworkers in Eastern NC: detection of metabolites in farmworker urine associated with housing violations and camp characteristics

BACKGROUND

The purpose of this paper is to present and evaluate descriptively bivariate associations between urinary metabolites of pesticides and herbicides and migrant camp conditions, violations, and personal worker behaviors at home for farmworkers who do not apply pesticides.

METHODS

We studied 183 migrant farmworker camps in eastern North Carolina in 2010. Data and urine samples were collected from 371 men. Predictor measures included violations in six domains of housing regulations and nonviolation characteristics and personal behaviors that might impact urinary metabolites.

RESULTS

Cockroaches and bathroom violations were predictive of increased exposure to pyrethroids and cyfluthrin/chlorpyrifos, respectively. Changing and storing clothing and shoes in sleeping rooms increased the number of detects for the diazinon metabolite.

CONCLUSIONS

Farmworkers had exposures to multiple chemicals. No single housing domain was identified as critical to mitigating housing-related exposure; specific attention should be paid to changing and storing soiled clothing in sleeping rooms, and insect infestations.

Insight into the sharing of medical images: physician, other health care providers, and staff experience in a variety of medical settings

BACKGROUND

Scant knowledge exists describing health care providers' and staffs' experiences sharing imaging studies. Additional research is needed to determine the extent to which imaging studies are shared in diverse health care settings, and the extent to which provider or practice characteristics are associated with barriers to viewing external imaging studies on portable media.

OBJECTIVE

This analysis uses qualitative data to 1) examine how providers and their staff accessed outside medical imaging studies, 2) examine whether use or the desire to use imaging studies conducted at outside facilities varied by provider specialty or location (urban, suburban, and small town) and 3) delineate difficulties experienced by providers or staff as they attempted to view and use imaging studies available on portable media.

METHODS

Semi-structured interviews were conducted with 85 health care providers and medical facility staff from urban, suburban, and small town medical practices in North Carolina and Virginia. The interviews were audio recorded, transcribed, then systematically analyzed using ATLAS.ti.

RESULTS

Physicians at family and pediatric medicine practices rely primarily on written reports for medical studies other than X-rays; and thus do not report difficulties accessing outside imaging studies. Subspecialists in urban, suburban, and small towns view imaging studies through internal communication systems, internet portals, or portable media. Many subspecialists and their staff report experiencing difficulty and time delays in accessing and using imaging studies on portable media.

CONCLUSION

Subspecialists have distinct needs for viewing imaging studies that are not shared by typical primary care providers. As development and implementation of technical strategies to share medical records continue, this variation in need and use should be noted. The sharing and viewing of medical imaging studies on portable media is often inefficient and fails to meet the needs of many subspeciality physicians, and can lead to repeated imaging studies.

Immigrant farmworkers' health-related quality of life: an application of the job demands-control model

This study tests basic predictions from the demands-control model of occupational stress in Latino immigrant farmworkers. Cross-sectional data were obtained from 151 farmworkers in eastern North Carolina via face-to-face interviews conducted in Spanish during the summer of 2005. Results suggest that farmwork is characterized by low psychological demand and low control, or that it is a "passive job." Multivariate analyses provided little support for predictions. Isometric load, an indicator of physical job demands reflecting how frequently workers maintain awkward postures for long periods, was associated with poorer physical health, and high worker control was associated with better mental health. However, pace of work, an indicator of psychological job demand, was unassociated with physical and mental health, and physical exertion, another indicator of physical job demand, was not robustly associated with health outcomes. The results suggest that core predictions from the demands-control model do not hold for immigrant farmworkers, and they foreshadow possible ways of refining the model.

Housing quality among North Carolina farmworker families

Substandard housing poses risks for health and safety. Few studies have documented the housing conditions experienced by Latino farmworker families in the U.S. The purpose of this analysis is to assess the quality of housing occupied by farmworker families in eastern North Carolina and determine how individual and family characteristics are associated with housing quality. Interviews were completed in six North Carolina counties with 186 Latino farmworker households that included a child under the age of 18 to document respondent, household, and dwelling characteristics. Most households were crowded, with 69.4% having more than one person per room (excluding bathrooms and kitchens). Dwellings were often located adjacent to fields (46.0%), suffered from structural problems (e.g., 18.3% had roof leaks), and lacked facilities and appliances (e.g., 26.9% did not have a working oven). Most farmworker family dwellings did not meet the U.S. Department of Housing and Urban Development's minimum criteria for health and safety. Respondents in their thirties, who lived in North Carolina for less than five years, moved two or more times in the past year to follow crops, and lived in grower-provided housing had the poorest housing quality. These results demonstrate that North Carolina Latino farmworker families lack adequate housing. Further research is needed to evaluate farmworker housing conditions in all areas of the U.S., and to document the relationship of these housing conditions to health outcomes. The collaboration of researchers, advocates, policy makers, housing developers, health care providers, and educators is needed to improve the housing conditions of farmworker families.

Oral Health and Quality of Life of Migrant and Seasonal Farmworkers in North Carolina

Oral health deficits can have a significant effect on workers' general health and their ability to carry out normal activities. Although farmworkers have been found to lack access to dental care, few studies have documented their oral health status or its impact on quality of life (QOL). This research (1) describes the oral health problems experienced and oral health care received by Latino farmworkers in North Carolina, and (2) explores the association between oral health and QOL. Data were collected using face-to-face interviews from a representative sample of 151 farmworkers; data included oral health-related QOL (OHIP-14) and general health-related QOL (SF-12 Health Survey). Workers reported a high number of unmet needs: 52% reported caries, and 33% reported missing teeth. Only 21% had received dental services in the past year, almost all in Mexico rather than the U.S. The dimensions of oral health-related QOL most impaired were psychological discomfort and physical pain caused by dental problems. Number of functional oral health problems was the strongest predictor of oral health-related QOL (p < 0.001) and physical health-related QOL (p < 0.05), but was unrelated to mental health-related QOL. These findings indicate that the high rate of unmet oral health needs is associated with poorer farmworker QOL. The consequences of suffering on-going dental pain for work performance, sleep, and nutritional status are unknown. Because national data indicate that fewer farmworkers are returning to their countries of origin, communities with large farmworker populations need to address their unmet needs for dental care.

Skin disease among Latino farmworkers in North Carolina

An estimated 4.2 million seasonal and migrant farmworkers and their dependents live in the U.S. Most of these farmworkers are Latino. These workers are exposed to numerous occupational and environmental risk factors that can result in skin disease. Few data exist on the prevalence of skin disease in this population. The purpose of this study was to estimate the prevalence and predictors of skin disease in a sample of Latino farmworkers in North Carolina. A sample of 59 farmworkers was recruited and interviewed at two camps during the 2004 agricultural season. A dermatologist completed a skin exam of each worker and recorded any skin disease present. Forty-two (77.7%) of the 54 men, and all five of the women examined had a diagnosed skin disease. For the men, onychomycosis (nail fungus, 31.5%), tinea pedis (foot fungus, 27.8%), and acne (24.1 %) were the most commonly diagnosed skin diseases, with contact dermatitis diagnosed in 5.6% of the sample. Other diagnoses included scars, sunburn, and atopic dermatitis. Among the women, diagnoses included melasma (dark patches on the face, 2 cases), xerosis (excessively dry skin, 1 case), tinea pedis (2 cases), onychomycosis (1 case), acne (1 case), and insect bites (1 case). There were no statistically significant differences between workers in the two camps despite different growing seasons and different crops harvested. Skin disease is prevalent among the North Carolina Latino farmworkers who participated in this study, with fungal disease being the most prevalent.

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.

An introduction to three studies of rural elderly people: effects of religion and culture on health

The paper introduces three empirical studies which relate the religious beliefs and practices or rural older adults from different ethnic groups to their health behaviors. It briefly describes the rationale for the studies and their main components, including their aims, study sites, study populations, methods used, and their principal findings. Then it discusses two primary themes which run through all the papers, namely rurality and cross-cultural comparisons. Finally, several secondary themes are discussed, including the importance of place, types of analysis, variable definition, causal relationships among variables, types of healing, locus of control, discourses about religion and health, and the religion and health connection.

Faith and health self-management of rural older adults

This analysis uses in-depth interview data collected from 145 African American, European American and Native American men and women aged 70 and older who reside in two rural North Carolina counties to understand the role of religious faith and prayer in the health self-management of these older adults. The analysis addresses three specific questions: how do these older adults use religion to help them manage their health; are there ethnic and gender differences in the use of religion; and are differences in health status related to differences in the use of religion? The integral role of religion in the lives of these older rural adults is an overarching theme present in the interview texts. Six major themes link religion and health self-management: (1) prayer and faith in health self-management, (2) reading the Bible, (3) church services, (4) mental and spiritual health, (5) stories of physical healing, and (6) ambivalence. Faith and religious activities provide an anchor in the lives of these older adults. There is little variation in the use of religion for health self-management by gender, ethnicity or health status. These results suggest that the strength of religion in rural culture may limit the effectiveness of general religiosity scales to discern the relationship of religion to health and health behavior in rural populations.

An exploratory analysis of occupational skin disease among Latino migrant and seasonal farmworkers in North Carolina

Occupational skin disease is highly prevalent among all agricultural workers. However, few data exist on risk factors for occupational skin disease among migrant and seasonal farmworkers. The goal of this analysis was to further document the prevalence of occupational skin disease among Latino farmworkers and delineate risk factors. This exploratory analysis used data collected in repeated survey interviews with Latino farmworkers in North Carolina in June and July (early season) and in August and September (late season), 1999. Respondents were largely male (95%) and from Mexico (95%), with about one-third each age 18-24, 25-34, and 35 and older. About half were in the U.S. on work contracts. Independent variables included the physical environment (crops worked), the social environment (having received pesticide safety training, having a work contract), and behavior and individual characteristics (re-wearing work clothes, showering after work, age). The dependent measures were reporting having had itching or burning skin or a skin rash in the two months prior to each interview; 24% of the respondents in the early season, and 37% in the late season reported skin disease signs and symptoms during the previous two months. Those reporting signs and symptoms in the early season were more likely to report them in late season. Significant independent risk factors for skin signs and symptoms in early season were re-wearing work clothes, showering after work, and being age 35 or older. In late season, those who had not received pesticide safety training had lower odds of reporting skin disease signs and symptoms, after adjusting for other potential risk factors. This exploratory study indicates that Latino migrant and seasonal farmworkers experience a high incidence of occupational skin disease. Further research is required with improved measurement of skin disease signs and symptoms, diagnosis of specific skin disease, and improved measurement of risk factors.

Farmer health beliefs about an occupational illness that affects farmworkers: the case of green tobacco sickness

Latino migrant and seasonal farmworkers, like all agricultural workers, experience high rates of occupational illness and injury. Interventions to reduce occupational injury among farmworkers must attend to the health beliefs of agricultural employers as well as employees, as employers control many aspects of the work environment. Occupational safety programs for Latino migrant and seasonal farmworkers must also be conceptually based in health behavior change and health disparities theories. We examine health beliefs of tobacco farmers about green tobacco sickness (GTS) to show the importance of delineating employer beliefs in agricultural safety. GTS is a highly prevalent occupational illness among tobacco workers that results from nicotine poisoning through dermal absorption of nicotine during cultivation and harvesting. We use qualitative methods structured by the Explanatory Models of Illness approach to identify farmer beliefs about the etiology, onset, pathophysiology, course, and treatment of GTS. Data were collected through semi-structured in-depth interviews with 15 North Carolina tobacco farmers. A computer-assisted, systematic qualitative analysis framework was applied to the interview transcripts. While tobacco farmers were generally knowledgeable about GTS, their explanatory models for this occupational illness often mis-identified its causes (heat and bending rather than nicotine) and minimized its seriousness. These models included methods of prevention that are not proven (e.g., use of anti-nausea drugs) or are more harmful than GTS (smoking cigarettes). The need for medical treatment was also discounted. Addressing each of these beliefs is important in any program to prevent GTS among farmworkers. Documenting and understanding the beliefs and knowledge of agricultural employers is an important undertaking in our efforts to reduce occupational injury and illness among farmworkers.

Staying healthy: the salience and meaning of health maintenance behaviors among rural older adults in North Carolina

Beliefs about what constitutes health promoting behaviors vary by culture and class, and knowing how an older adult interprets a specific health behavior can improve health education and medical compliance. Ethnomedical approaches have investigated how people define disease and the therapies used to return to a state of health. However, little research has addressed how individuals define health, or the behaviors they use to maintain health. We analyze the behaviors elders state are needed to stay healthy, and their meanings for these behaviors. Narratives collected through in-depth interviews with 145 male and female rural North Carolina residents aged 70 and older, including African Americans, Native Americans and European Americans are analyzed using systematic text analysis. The participants' narratives include seven salient health maintenance domains: (1) Eating Right, (2) Drinking Water, (3) "Taking" Exercise, (4) Staying Busy, (5) Being with People, (6) Trusting in God and Participating in Church, and (7) Taking Care of Yourself. Several of these domains are multi-dimensional in the meanings the elders ascribe to them. There is also overlap in the content of some of the domains; they are not discrete in the minds of the elders and a specific health behavior can reflect more than one domain. Four themes cross-cut the domains: "balance and moderation", "the holistic view of health", "social integration", and "personal responsibility". Elders in these rural communities hold a definition of health that overlaps with, but is not synonymous with a biomedical model. These elders' concept of health seamlessly integrates physical, mental, spiritual, and social aspects of health, reflecting how health is embedded in the everyday experience of these elders. Staying healthy is maintaining the ability to function in a community. These results indicate that providers cannot assume that older patients will share their interpretation of general health promotion advice.

Predictors of incidence and prevalence of green tobacco sickness among Latino farmworkers in North Carolina, USA

STUDY OBJECTIVE

The characteristics of some populations make epidemiological measurement extremely difficult. The objective of this study is to identify risk factors that explain variation among incidence densities and proportions of one occupational illness, green tobacco sickness, within one such special population, Latino migrant and seasonal farmworkers in the United States.

DESIGN

Prospective cohort study.

SETTING

37 farmworker residential sites located in Granville and Wake Counties, North Carolina, USA.

PARTICIPANTS

182 migrant and seasonal farmworkers that included 178 Latino men, three Latino women, and one non-Hispanic white man.

MAIN RESULTS

Green tobacco sickness had a prevalence of 0.082, and an incidence density of events per 100 days of 1.88 among the farmworkers. Prevalence and incidence density increased from early to late agricultural season. Major risk factors included lack of work experience, work activities, and working in wet clothes. Tobacco use was protective.

CONCLUSION

Green tobacco sickness has a high incidence among migrant and seasonal farmworkers. Because workers have little control over most risk factors, further research is needed to identify ways to prevent this occupational illness.

Environmental and behavioral predictors of salivary cotinine in Latino tobacco workers

We report the results of a cohort study of 182 seasonal and migrant farmworkers engaged in tobacco production in two North Carolina counties. Data were collected on tobacco work tasks and risk factors for exposure to nicotine, including smoking, every 2 weeks over a 10-week period during the summer of 1999. Saliva samples were collected for cotinine analysis at every contact. Salivary cotinine levels increased across the season, independent of smoking status. Multivariate analyses identified a model (R2 = 0.68) in which predictors of cotinine included greater age, later-season work, wet working conditions, smoking, and work task. Harvesting ("priming") tobacco was associated with higher cotinine levels than other tasks. This study demonstrates that tobacco workers experience substantial work-related exposure to nicotine. The long-term effects of such exposure should be investigated.

Developing socio-spatial knowledge networks: a qualitative methodology for chronic disease prevention

Chronic disease is a significant and costly social problem. The burden is even more pronounced in communities with high rates of a particular chronic disease. Assessment of health belief systems and the local geographies of health beliefs can assist community health planners to create cost-effective strategic intervention programs where populations are at high risk for chronic diseases. In this paper, we elaborate the concept of socio-spatial knowledge networks (SSKNs) and demonstrate that SSKNs can be useful in informing the design of health care prevention strategies. In our project, we demonstrate how to identify key socio-spatial information for intervention strategies which will prevent or delay the onset of a particular chronic disease, Type 2 diabetes. Our qualitative framework allows us to determine which sites might be best characterized as socio-spatial knowledge network nodes for sharing diabetes information and which sites might be less suited to such exchange. Our strategy explores cross-cultural similarities, differences, and overlap in a multi-ethnic rural North Carolina context through simple techniques such as mapping social networks and sites in which people share their knowledge and beliefs about diabetes. This geographical analysis allows us to examine exactly where health knowledge coincides with other social support, and where such resources may be improved in a particular community. Knowing precisely what people in a community understand about a chronic disease and its treatment or prevention and knowing where people go to share that information helps to (1) identify strategic locations within a community for future interventions and, (2) evaluate the effectiveness of existing interventions. The geographical approach presented here is one that can serve other communities and health practitioners who hope to improve chronic disease management in diverse local environments.

Pesticide exposure beliefs among Latino farmworkers in North Carolina's Christmas tree industry

BACKGROUND

Pesticide exposure is a major preventable occupational hazard for farmworkers. This study examined the beliefs of Latino farmworkers in North Carolina's Christmas tree industry regarding pesticide exposure.

METHODS

In-depth interviews were conducted with 20 Mexican male seasonal farmworkers. Participants discussed beliefs about agricultural chemicals, routes of exposure, and health effects of these chemicals. They also discussed their knowledge and use of pesticide safety practices and safety training received.

RESULTS

Most farmworkers knew that pesticides could be harmful, though workers varied in their levels of knowledge regarding routes of exposure, specific health effects of pesticides, and ways to avoid and reduce exposure. Workers varied considerably in the amount of safety training received and use of safety practices. Perceived lack of control and health beliefs were salient factors that decreased workers' use of safety practices.

CONCLUSIONS

This study adds to the growing body of research which documents the health beliefs of Latino farmworkers in the U.S. relative to pesticides and pesticide safety. This literature is beginning to show convergence on several points (e.g., farmworker knowledge of acute vs. long-term illness resulting from pesticide exposure), as well as regional variation in pesticide safety beliefs. This study substantiates the need for pesticide safety education to address issues of control as well as beliefs.

The incidence of green tobacco sickness among Latino farmworkers

We estimated the prevalence and incidence density (ID) and the risk factors of green tobacco sickness among minority farmworkers in North Carolina. Using a prospective surveillance design, 182 farmworkers were interviewed up to 5 times at biweekly intervals in 1999. The green tobacco sickness prevalence was 24.2%, whereas the ID was 1.88 days per 100 days worked. Greater work experience (5+ years, ID = 0.87; first year ID = 2.41) and tobacco use (ID of 1.18 vs 2.39) were negatively associated with green tobacco sickness. Task (e.g., priming ID, 4.04; topping ID, 1.86; barning ID, 0.62) and working in wet clothing (25% of workdays ID, 2.97; fewer than 25% of workdays ID, 1.29) had the largest effect. More effort must be directed toward preventing this occupational illness that affects workers who have little control over workplace safety.

Training farmworkers about pesticide safety: issues of control

Farmworkers experience a lack of control over the conditions of their work environment. In trying to reduce the effects of exposure to pesticides, most health care providers give instructions to farmworkers about how to protect themselves. Outreach programs that target farmworkers focus on health education and recommend washing hands, wearing appropriate clothing, and avoiding direct contact. The research reported in this paper shows that farmworkers in North Carolina perceive many of these preventive measures to be outside their control. The ability of farmworkers to engage in safe practices depends on their capability to communicate with their employer, have positive work relationships, and the availability of protective equipment. The perceptions of control identified in this paper are issues that service providers and policy makers should consider to provide programs that will effectively promote pesticide safety and healthier farmworkers.

Eye symptoms and use of eye protection among seasonal and migrant farmworkers

BACKGROUND

Farmworkers face an array of environmental and workplace hazards that pose risks of eye damage from accidents involving agricultural chemicals and equipment and from exposure to wind, dust, and ultraviolet rays. Eye safety risks are known among industrial and agricultural occupations, yet little is known about the prevalence of eye symptoms and use of eye protection among farmworkers.

METHODS

A survey of 197 Latino farmworkers in North Carolina used self-report data to measure workers' prevalence of eye symptoms and eye protection use.

RESULTS

Eye pain and redness after working all day in the field were reported by more than 40% of workers. Most (98.4%) reported not wearing sunglasses when working in the fields; reasons included lack of sunglasses and interference with field tasks.

CONCLUSIONS

Eye symptoms are prevalent in this population. Failure to use eye protection indicates the need for further education and training of Latino farmworkers and their employers about occupational risks to eyesight.

Something for everyone? A community and academic partnership to address farmworker pesticide exposure in North Carolina

Partnerships between academic researchers and community organizations are frequently formed to address environmental health concerns in underserved communities. Although such participatory approaches to research combine valuable assets of both partners, they are often difficult to maintain. We describe a partnership formed to investigate migrant and seasonal farmworker exposure to pesticides in North Carolina and to develop effective interventions to reduce exposure. North Carolina ranks fifth in the United States in the number of farmworkers; most are from Mexico, and a significant minority come to the United States on work contracts. Several barriers to establishing effective collaboration were recognized in this partnership, including stereotypes, cultural differences, competing demands for time and attention, and differences in orientation to power structures. To overcome these barriers, members of the partnership took actions in three domains: clarifying the different goals of each partner, operationalizing a model of participation that could involve many different community segments developing cultural sensitivity. By taking these actions, the work of the partnership was accomplished in ways that met the criteria for success of both academic researchers and community members. This approach can be used by others to develop collaborative relationships to investigate environmental health issues within a community-based participatory framework.

Farmworker pesticide exposure and community-based participatory research: rationale and practical applications

The consequences of agricultural pesticide exposure continue to be major environmental health problems in rural communities. Community-based participatory research (CBPR) is an important approach to redressing health disparities resulting from environmental causes. In this article we introduce a collection of articles that describe projects using CBPR to address the health disparities resulting from pesticide exposure in agricultural communities, particularly the communities of migrant and seasonal farmworkers. The articles in this collection are based on a workshop convened at the 1999 American Public Health Association meeting. The goals in presenting this collection are to provide those endeavoring to initiate CBPR projects needed information, guidelines, and procedures to improve the quality of the CBPR experience; to increase the scientific validity of CBPR projects; and to reduce the potential difficulties and stress of these collaborations. In this introduction we discuss the context in which these projects operate, summarizing background information about farmworkers in the United States, what is known about farmworker pesticide exposure, and the concept of community-based participatory research. Finally, the articles in this collection are summarized, and major themes common to successful CBPR projects are identified. These common features are taking the time to interact with the community, using multiple approaches to engage the different parts of the community, understanding different participants often have different goals, appreciating each group's strengths, valuing community knowledge, and being flexible and creative in conducting research. The final article in this collection describes the translational research program at the National Institute of Environmental Health Sciences (NIEHS) highlighting activities pertinent to the health of rural communities, giving an overview of NIEHS-supported projects addressing health concerns of Native Americans and rural African-American communities in addition to farmworkers, and discussing future plans for CBPR at NIEHS.

Farmworker reports of pesticide safety and sanitation in the work environment

BACKGROUND

Migrant and seasonal farmworkers are at risk for occupational illnesses from pesticide exposure, and the effectiveness of pesticide safety regulations has not been evaluated. It is important to learn from farmworker safety experiences to develop effective measures to improve agricultural workplace safety.

METHODS

Formative research included in-depth interviews with farmworkers, farmers, extension agents, and health care providers. Survey research included interviews with 270 minority farmworkers during 1998, and 293 during 1999.

RESULTS

Farmworkers and farmers hold different beliefs concerning pesticide safety which affect sanitation practices. Farmworkers report in survey data that farmers do not adhere to regulations mandating training and basic sanitation facilities.

CONCLUSIONS

Several points of intervention are available to improve pesticide safety and sanitation. Additional regulation by itself is not an advantageous starting point. The emphasis for intervention must include educating farmers as well as farmworkers.

Vitamin and mineral supplement use by older rural adults

BACKGROUND

Vitamin and mineral supplement products are widely consumed by older adults. This study describes supplement product use in a multiethnic rural population, relates supplement usage to dietary nutrient intake, and determines predictors of supplement usage.

METHODS

Data are from a population-based sample of 130 community-dwelling adults aged 70 years and older in two rural North Carolina counties. The sample was 34% African American, 36% European American, and 30% Native American. Interviewer-administered semiquantitative food frequency questionnaires were used to obtain data on usual diet and supplement use. In-home interviews allowed verification of supplement composition. Intakes from diet and supplement products were examined for vitamins A, E, B6, C, folate, iron, zinc, and calcium.

RESULTS

Of those who participated in the study, 47% reported using one or more supplement products. African Americans were significantly less likely to take supplements than Native Americans or European Americans. Based on dietary intakes, 65% of the participants were deficient (<2/3 recommended dietary allowance [RDA]) for at least one nutrient. The use of supplement products for the eight nutrients investigated was not related to dietary nutrient deficiency. For all nutrients investigated, except iron and calcium, a greater proportion of those without dietary deficiency took a supplement product than those with deficiency. Using logistic regression, ethnicity (European American and Native American), and gender (women) were significant predictors of supplement use.

CONCLUSIONS

These findings suggest that although both dietary deficiencies of vitamins and minerals and supplement use are relatively high in this population, there is no association between supplement use and deficient dietary intakes for the eight nutrients examined. Health care providers should be aware that nutritional counseling and guidance on appropriate supplement usage is needed in this population.

On their own: nutritional self-management strategies of rural widowers

In-depth interviews conducted with 12 rural widowers participating in a population-based study of nutritional strategies of rural adults 70 years and older were analyzed to (a) identify factors that place widowers at risk for nutritional problems and (b) understand how rural residence is related to this risk. The nutritional strategies that successfully accomplished three groups of food-related tasks (food acquisition, food use, and maintaining food security) focused on one of three resource domains: self-care, informal support, and formal support. Resources that facilitated these nutritional strategies are identified, as are those conditions that led to nutritional strategies inadequate to ensure food acquisition, food use, and food security. These findings can be used to help identify rural elderly widowers who are at nutritional risk.

Farmworkers and pesticides: community-based research

In this paper we summarize the results of a workshop conducted to disseminate information about community-based research on the environmental health risks of exposure of farmworkers to pesticides. Community-based research is an approach that is advocated for addressing issues of environmental justice such as exposure of farmworkers to pesticides. This workshop brought together scientists, community organization members, and agency representatives to review and discuss the research methods and organizational relationships that have been successful in conducting past community research so these principles can be applied to new situations. The objectives of this workshop were to a) be a forum in which those conducting community-based research with farmworkers could share what they had learned; b) delineate the successes and barriers across different projects to further develop models and methods for conducting community-based research; and c) determine future directions and needs of farmworker community-based research for environmental justice.

Migrant farmworkers and green tobacco sickness: new issues for an understudied disease

BACKGROUND

The transition from family tobacco production to dependence on hired labor has placed migrant and seasonal farmworkers (MSF) at risk for green tobacco sickness (GTS). No previous studies of GTS have focused on MSF.

METHODS

One hundred and forty-four Hispanic MSF working in tobacco production in North Carolina were surveyed to obtain self-reports of GTS, preventive behaviors, and treatments.

RESULTS

Forty-one percent reported having GTS at least once during the summer. Most had taken no precautions to prevent GTS. Ninety-six percent of those with GTS had tried to treat it. Antinausea medications were the most common treatments. Only 9% sought medical treatment; 7% lost work time.

CONCLUSIONS

The incidence of GTS obtained by interviewing MSF is much higher than that in other studies, which have relied on rates of medical treatment or farmers' reports for their workers. MSF constitute a population at risk for GTS who have little control over work conditions to prevent GTS or seek treatment.

Nutritional self-management of elderly widows in rural communities

Studies of the nutritional status of older adults (by marital status) and of older women recently widowed suggest that widows are nutritionally vulnerable. Yet few studies have examined nutrition-related behaviors among widows to see why this is true. We conceptualize these behaviors as nutritional self-management strategies, encompassing behaviors related to obtaining food, consuming it, and maintaining food security. Data come from in-depth interviews conducted with 64 widowed women age 70+ in rural North Carolina (23 African American, 24 European American, 17 Native American). Transcripts were coded and analyzed using a systematic text-analysis procedure. Length of widowhood ranged from less than 1 year to 39 years. Themes identified in recent widows' interviews and corroborated in those widowed longer indicate that there are varied responses to widowhood. Some may have a positive impact on nutritional strategies (e.g., following own dietary needs), but most are likely to be negative (e.g., meal skipping, reduced home food production, less dietary variety). Rural communities need to develop ways to identify such widows and assist them in finding acceptable ways to meet nutritional needs.

Meaning in the use of unconventional arthritis therapies

PURPOSE

To determine the meanings that rural adults have for 11 different unconventional arthritis remedies.

METHODS

Interviews were conducted with 219 adults from a nonmetropolitan North Carolina county. Open-ended responses to questions surrounding the use of 11 unconventional arthritis therapies were tape recorded and transcribed verbatim. A variable-based approach was used to analyze and interpret these qualitative data.

RESULTS

Several themes were present for the different unconventional therapies. The most extensive set of themes was present for religion, which included faith, transformation, communion, self-help, and spiritual healing. The mechanical aspect of rubbing used in the application of several therapies (ointments as well as turpentine) was also an important theme. Skepticism about the effectiveness of the unconventional therapies was another pervasive theme.

CONCLUSIONS

The respondents had a consistent set of meanings about the unconventional therapies that transcended gender and ethnic groups. Understanding the meanings or belief systems of rural adults is essential to the development of culturally appropriate health education and intervention.

Enhancing community participation in intervention research: farmworkers and agricultural chemicals in North Carolina

The participation of affected communities in the development of public health intervention research improves project sustainability and effectiveness by making projects more relevant and acceptable to the communities. This article presents a multimode, multidomain model approach for community participation in different project components, which ensures the benefits of participation without requiring the same level of participation in every activity or by every community sector. A case study is used to illustrate the model, describing procedures for establishing and maintaining farmworker participation in developing an intervention to reduce exposure to chemicals. Farmworkers are a poor and underserved population for which the empowering and culturally appropriate benefits of community participation are especially needed. However, this population presents challenges for participatory health projects: geographic dispersion, ethnic diversity, lack of organization, sense of powerlessness, and communication and transportation difficulties. The lessons learned in this case extend the method and theory of community participation.

Implementation of EPA's Worker Protection Standard training for agricultural laborers: an evaluation using North Carolina data

The US Environmental Protection Agency has promulgated a Worker Protection Standard which requires that farmworkers receive pesticide safety training. The implementation of these regulations has not been evaluated. Using data collected through personal interviews with 270 Hispanic farmworkers recruited from 35 labor sites in an eight-county area, the authors analyzed the extent to which farmworkers received pesticide safety training, characteristics of the training, and variations in knowledge and safety behavior. Approximately a third of the farmworkers reported having ever received information or training on pesticide safety, and 25.6% reported having received training in the year in which they were interviewed. Workers with H2A visas were significantly more likely to have received training than workers without these visas. The training received varied in location, duration, and language. Most included the use of a video, as well as verbal presentation, and most included printed materials. However, few workers knew the ways in which they could be exposed to pesticides or reported using any method to protect themselves from pesticide exposure.

Barriers to nutritional well-being for rural elders: community experts' perceptions

Older adults use public and private services, as well as personal resources, to meet nutritional needs. In-depth interviews conducted with 73 service providers and community experts in two rural North Carolina counties were analyzed for these experts' perceptions of barriers to adequate nutrition for older adults. Perceived barriers included characteristics of the county and programs, transportation, and kin, as well as older adult medical and economic conditions, food habits, knowledge, and attitudes. The importance given each of these domains varied by respondents' area of expertise. Community experts and providers may not see the connection between their services and nutritional well-being of older adults.

Qualitative methods in arthritis research: sampling and data analysis

Qualitative research presents unique opportunities for understanding arthritis from the perspective of those affected by the condition, as well as for critically evaluating many of the associations of traditional psychosocial variables that have emerged from decades of quantitative research. Its growing acceptance and popularity in the health sciences is reflected in the number of program announcements and other research requests that stress the need to understand health and disease in the context of human diversity. At the same time, it is important that qualitative research be done well and be critically evaluated in the same manner as quantitative research. Many of the same cautions (e.g., garbage in, garbage out) and principles (e.g., standardization of data collection and analysis steps, documentation of research activities) apply in all types of scientific inquiry. By maintaining high standards for qualitative research, those conducting and evaluating qualitative research can ensure its continued acceptance as a valid and powerful mode of research.

Qualitative methods in arthritis research: overview and data collection

The intent of this paper has been to introduce qualitative methods to arthritis researchers and provide them with basic skills to critically evaluate results of qualitative research. Qualitative research provides the arthritis researcher with the opportunity to look at the meaning that the subject places on his or her behavior, their knowledge of their condition and of its treatment, and the meaning they infer from the actions of those around them, including their care providers and social supports. If carefully conducted, qualitative research methods can produce rich and insightful findings. We have limited our discussion to an overview of qualitative research and data collection methods. We will discuss issues related to how participants are selected and methods of data analysis in a subsequent paper.

Predicting mortality from community surveys of older adults: the importance of self-rated functional ability

Using data from the 1990 baseline of the National Survey of Self-Care and Aging (NSSCA), and nearly three years of follow-up mortality data, we examined the association between self-rated functional ability, a global measure of perceived ability of function independently, and mortality among a national sample of older adults. The study included 3,485 subjects selected from the Medicare Beneficiary Files according to a stratified random sampling design, with approximately equal numbers of adults by gender in each of three age categories, 65-74, 75-84, and 85 and over. Self-rated functional ability was found to have an independent contribution to the subsequent risk of death among older adults. Using multivariate models that accounted for self-rated health, age, gender, medical conditions, functional status, and assistance from others, poor self-ratings on this single item nearly doubled the risk of death during the follow-up period. These findings suggest the importance, for both researchers and clinicians, of measuring the potential prognostic importance of self-ratings of health and self-ratings of functional ability among older adults.

The perceived availability, quality, and cost of long-term care services in America

This study gathered primary data on the patterns and predictors of home-based, community-based, and institutional long-term care services for older adults residing in the United States. A stratified random sample of policymakers and agency representatives (n = 153; response rate 67.1%) completed a comprehensive mail survey to provide detailed information on the perceived availability, quality, and costs of long-term care services in their community settings. Descriptive analyses revealed that there are significant differences in perceived access, use, quality, and costs of care by service type and agency affiliation. The results present an interesting dilemma for policymakers as many of the services found to be most widely available and of the highest quality were considered too costly. Implications for public policy and suggestions for further research are highlighted.

Gender and ethnic differences in alternative and conventional arthritis remedy use among community-dwelling rural adults with arthritis

OBJECTIVE

To examine the frequency of, and the ethnic and gender differences in, the use of arthritis remedies among rural adults.

METHODS

Interviews were conducted with 219 adults from a nonmetropolitan North Carolina county. Participants reported whether they ever used and still used 19 remedies. Participants were evaluated for the actual presence of arthritis and functional capacity. Analysis included descriptive statistics and multivariate logistic regression.

RESULTS

Participants used a variety of alternative and conventional remedies, with prayer (92%) being most widely used. Prescription medicine was used by 60%. Differences in remedy use included European-Americans making greater use of conventional remedies and African-Americans making greater use of some alternative remedies. Those with greater functional disability have used alternative remedies, but they still used prescription medicine.

CONCLUSIONS

Rural individuals use a variety of remedies, with differences by gender, ethnicity, and functional capacity. Future research must examine the role of gender, culture, residence, and disease severity in arthritis remedy use decisions.

The journey to birth: medical and geographical patterns of births to women of a rural Kentucky county, 1911-1980

A relative lack of medical services is common in rural areas, and it has been suggested that the number of births in the mother's county of residence reflects both the availability of obstetric services as well as attitudes toward local and nonlocal medical care. In order to better understand these relationships, we analyzed the evolution of medical and geographical patterns of births to women of a rural Kentucky county in the context of both a changing philosophy and a changing availability of medical care. Specifically, using archival data, we assessed the locus (i.e., home versus hospital) and location (i.e., county) of births to Robertson County women from 1911 to 1980. Without a hospital for the entire period and with the number of physicians declining, the percentage of in-county home births increased steadily, reaching virtually 100 percent by 1950. During this same period, the number of physicians practicing there decreased from 22 to 2. Subsequent delivery patterns reflect the acceptance by the physicians and women of the "principle" of hospital delivery formally enounced in 1945. By 1965, home births had been eliminated, and Robertson County women were, of necessity, traveling the 25-30 miles to the several hospitals in contiguous counties. In the past 15 years, a substantial proportion (almost 20 percent) have elected to travel to hospitals even farther (55-60 miles) from Robertson County. Generally, the Robertson County experience reflects the "lag" observed in the rural-urban, home versus hospital birth experience. Nevertheless, since 1966, all recorded births to Robertson County women have occurred in hospitals.(ABSTRACT TRUNCATED AT 250 WORDS)