Jennifer W Talton

Wake Forest School of Medicine, Winston-Salem, North Carolina, United States

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Publications (29)105.12 Total impact

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    ABSTRACT: Increased availability of telecommunication devices may provide a means to distribute occupational health and safety (OSH) information. This analysis examined device ownership and actual and potential use of multiple modalities to present OSH information. Male Latino immigrant farmworkers and non-farmworkers in NC (n=177) completed a survey about actual and potential use of telecommunication devices in 2013. Almost all (171/177; 97%) reported they owned cell phones; 48% of cell phone owners had smartphones. The telephone numbers of 54% of cell phone owners had changed within the past year. Among all respondents, regardless of cell phone ownership, during the past two months 89%, 67%, 38%, and 28% of participants had spoken to someone on a cell phone, read a text message, accessed the internet, or used a social networking site, respectively, at least once a week. Among cell phone owners, 96% and 80% stated they would want to receive text messages about health information and severe weather within their area, respectively. Among smartphone owners, 86% and 74% stated they would want to have videos sent to their smartphones about health information and severe weather, respectively. Penetrance of cell phone ownership is high among Latino men in NC. Widespread ownership and use of cell phones and moderate ownership of smartphones may enable health workers and advocates to distribute general and occupational health information to Latino farmworkers and non-farmworkers. However, challenges imposed by impermanent phone numbers will need to be addressed before the OSH education potential of cell phones can be achieved.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Food security is a managed process, negotiated in local places. Economic, or job, stability is key to food security. This analysis describes food security and food strategies of 101 male Hispanic rural farmworkers (guestworkers on H2-A visas) and 71 urban non-farmworkers of mixed employment in North Carolina. In 2013, participants responded to the USDA Household Food Security Survey module, with reference to the previous three months, and questions about obtaining food. Farmworkers were not accompanied by family; food security questions refer only to household adults. High food security was reported by more farmworker (82.2%) than non-farmworker households (64.8%). Non-farmworker, compared to farmworker, households reported excess marginal (22.5% vs. 11.9%) and combined low/very low food security (12.7% vs. 5.9%). Over half in both groups obtained most of their food at superstores. Most farmworkers reported shopping weekly, using employer-provided transportation. Non-farmworkers had more variability in grocery shopping frequency and transportation; 5.6% obtained most of their food from restaurants and food pantries. Farmworkers accessed flea markets (23% vs. 10%) and farmers markets (18% vs. 3%) more than non-farmworkers. Non-farmworkers reported more gardening and fishing than farmworkers (32%/15% vs. 10%/9%). Overall, farmworkers reported food security considerably better than the US in 2012, and non-farmworkers were at levels approximately the same as US households. These findings suggest that the H2A visa program provides farmworkers job stability, reflected in food security, that other Hispanics who may be undocumented are not afforded. Additional research into the why non-farmworker households are food insecure is warranted. Grant R01 ES008739.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The SEARCH for Diabetes in Youth Study prospectively identified youth less than 20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence rate and 95 percent CI, overall, by age group and by sex, were calculated per 100,000 person-years at risk for 2002 through 2009 for non-Hispanic white (NHW) youth. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9-24.8) in 2002 to 27.4/100,000 (95% CI 26.9-27.9) in 2009 (p for trend=0.0008). The relative annual increase in T1D incidence was 2.72% (1.18-4.28%) per year; 2.84% (1.12-4.58%) for males and 2.57% (0.68-4.51%) for females. After adjustment for sex, there were significant increases for those 5-9 years (p=0.0023), 10-14 years (p= 0.0008), and 15-19 years (p=0.004), but not among 0-4 year olds (p=0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age group. Continued surveillance of T1D in youth in the United States to identify future trends in T1D incidence and to plan for health care delivery is warranted.
    Diabetes 06/2014; · 7.90 Impact Factor
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    ABSTRACT: IMPORTANCE Despite concern about an "epidemic," there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups. OBJECTIVE To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009. DESIGN, SETTING, AND PARTICIPANTS Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan. MAIN OUTCOMES AND MEASURES Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years. RESULTS In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes. CONCLUSIONS AND RELEVANCE Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases.
    JAMA The Journal of the American Medical Association 05/2014; 311(17):1778-86. · 29.98 Impact Factor
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    ABSTRACT: Background Pesticide exposure poses a health risk for farmworkers. This analysis documents lifetime and current pesticide exposure of North Carolina Latino migrant farmworkers, with comparison to non-farmworker Latino immigrants.Methods During May to October 2012, 235 Latino farmworkers and 212 Latino non-farmworkers completed interviews with items to construct measures of lifetime, current residential and occupational pesticide exposure.ResultsFarmworkers experience levels of lifetime and residential pesticide exposure that are consistently greater than among non-farmworkers. Farmworkers report a large number of occupational pesticide exposures. Lifetime exposure and current residential pesticide exposure are related to social determinants. Education is inversely related to lifetime pesticide exposure for farmworkers and non-farmworkers; farmworkers with H-2A visas report greater residential pesticide exposure than those without H-2A visas.Conclusions Occupational safety policy needs to consider these patterns of lifetime exposure when setting standards. Health care providers should be aware of the lifetime and current exposure of this vulnerable population. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 04/2014; · 1.97 Impact Factor
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    ABSTRACT: To evaluate the effects of smoking on early markers of cardiovascular disease (arterial stiffness) in adolescents with and without type 1 diabetes (T1D) in the SEARCH Cardiovascular Disease Study. Participants included 606 youth (18.9 ± 3.3 years, 83% non-Hispanic white; 50% male). Six groups were defined: (1) smokers with T1D (n = 80); (2) former smokers with T1D (n = 88); (3) nonsmokers with T1D (n = 232); (4) smokers without T1D (n = 40); (5) former smokers without T1D former (n = 51); and (6) nonsmokers without T1D (n = 115). Arterial stiffness measurements included pulse wave velocity (PWV), augmentation index, and brachial distensibility. Multivariate linear regression was used to assess the independent and joint effects of T1D and smoking on arterial stiffness. Nearly 20% of both youth with and without T1D and T1D were smokers. In youth without T1D, smokers had higher trunk and arm PWV. After adjustment for potential confounders, T1D, but not smoking, was an independent predictor of PWV (P < .05). Moreover, smoking status did not modify the association between T1D and increased arterial stiffness. We found a high prevalence of smoking among youth with and without T1D; however, smoking status was not independently associated with increased arterial stiffness in youth with T1D.
    The Journal of pediatrics 03/2014; · 4.02 Impact Factor
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    ABSTRACT: In their Strategic Impact Goal Statement, the American Heart Association focused on primordial prevention of cardiovascular risk factors by defining metrics for ideal cardiovascular health (ICH). The prevalence of ICH among youth with type 1 diabetes is unknown. Youth with type 1 diabetes face an increased risk of cardiovascular disease (CVD) as they age. The purpose of this report was to examine the prevalence of ICH in a population of youth with type 1 diabetes and to examine the association of ICH with measures of cardiovascular structure and function. This report is based on SEARCH CVD an ancillary study to the SEARCH for Diabetes in Youth. A total of 190 adolescents with type 1 diabetes had complete data on all of the ICH metrics at baseline and had measures of arterial stiffness [pulse wave velocity (PWV), brachial distensibility (BrachD), and augmentation index (AIx)] and carotid intima-media thickness completed at a follow-up visit [on average 5 yr after baseline (interquartile range 4-5)]. No subjects met the ICH criteria for all 7 metrics. Meeting an increasing number of ICH metrics was significantly associated with lower arterial stiffness [lower PWV of the trunk (β = -0.02 ±0.01; p = 0.004) and AIx (β = -2.2 ±0.66; p = 0.001), and increased BrachD (β = 0.14 ±0.07; p = 0.04)]. Increasing number of ICH metrics was significantly associated with decreased arterial stiffness, but prevalence of ICH in this population was low. Youth with type 1 diabetes could benefit from improvements in their cardiovascular health.
    Pediatric Diabetes 01/2014; · 2.08 Impact Factor
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    ABSTRACT: ABSTRACT Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N = 352) living in employer-provided housing. A cross-sectional sample of adult Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and FEV1 /FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%), and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%), and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between mold and coughing up phlegm when not having a cold (P = .0262); presence of mold and asthma (P = .0084); pesticides used in the home and tightness of chest (P = .0001); and use of tobacco and coughing up phlegm (P = .0131). Although causal inference can be difficult to establish from a cross-sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable workgroup population.
    Journal of Agromedicine 01/2014; 19(4):395-405. · 0.72 Impact Factor
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    ABSTRACT: 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. 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. 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. 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. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 11/2013; · 1.97 Impact Factor
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    ABSTRACT: Farmworkers are at risk for health consequences of pesticide exposure. While acute exposure causes immediate symptoms, most exposure is likely low level and chronic, with possible health effects manifest years later as neurodegenerative diseases. We hypothesized that subclinical effects might be detected in current farmworkers to provide evidence of early stage neurodegeneration. From animal studies, olfactory function, an early sign of Parkinson's disease, is known to be sensitive to pesticide exposure. The study objective was to compare olfactory function in comparable samples of exposed and non-exposed workers. Migrant farmworkers (n=304) and a comparison sample of non-farmworkers (n=247) 18+ years and self-identified Latino/Hispanic were recruited in North Carolina with the help of community partners. Non-farmworkers were restricted to those with no occupational pesticide exposure in the previous 3 years. Odor identification and odor threshold tests were administered in a clinic setting and analyzed using logistic and linear regressions, adjusting for age, gender, and smoking. Lifetime pesticide exposure was obtained using the NINDS common data elements questionnaire to confirm group pesticide exposure differences. The total sample was 84% male, 23% current smokers, and 97% born in Latin America. Farmworkers and non-farmworkers did not differ in odor identification performance (p=0.6726). However, non-farmworkers detected a standard odor at significantly lower concentrations than did farmworkers (p<.0001). Farmworkers display significant non-selective impairment in olfactory function, compared to non-farmworkers. These results suggest that subclinical markers signal neurological effects before neurodegenerative diseases can be detected. Such data could be important in demonstrating health consequences of occupational pesticide exposure.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: Community-based participatory research (CBPR) joins communities and researchers to facilitate encouraging community members to participate in research relevant to their health. In prospective epidemiological studies, CBPR designs should aid in participant retention. 371 Latino males (210 exposed migrant farmworkers and 161 non-exposed non-farmworkers) were enrolled in a prospective CBPR study of the neurological effects of occupational pesticide exposure. The sample was constructed via face to face recruitment employing community partners who visited potential participants in their homes. Participants were enrolled at a clinic visit where biological sample collection and neurological testing were conducted. Those who returned for a second clinic three months later were compared to those who did not on age, education, marital status, social integration and participation, CES-D, and exposure status (farmworker vs. non-farmworker). Overall, 68.7% of the 371 participants were retained. The retention rate for farmworkers was 65.7%; the rate for the non-farmworkers was 72.7%. Retained participants differed only on exposure status. The community partners reported that community members discontinued participation due to lack of trust in the study, fear of contributing blood samples, peer influence, seasonal demands of farm work, and loss to follow up due to the transient nature of the population being studied. While stable non-migrant populations will always be easier to retain in prospective studies, retention strategies focused on potentially modifiable barriers such as fear and lack of trust are needed to enhance retention. Community partnerships provide the appropriate context for exploring such barriers and developing effective solutions.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: OBJECTIVE To evaluate if presence of cardiovascular (CV) risk factors and their clustering as metabolic syndrome (MetS) is associated with increased arterial stiffness and accelerated progression over time among youth with type 1 diabetes.RESEARCH DESIGN AND METHODS Longitudinal study of 298 youth with type 1 diabetes (age 14.5 years; 46.3% female; duration 4.8 years), with two research visits conducted 5 years apart. CV factors included: waist circumference, blood pressure (BP), fasting lipids (HDL cholesterol, LDL cholesterol [LDL-c], triglycerides), albumin/creatinine ratio, and HbA1c. MetS was based on Adult Treatment Panel III criteria modified for youth. Pulse wave velocity (PWV) in the carotid-femoral segment was measured by tonometry. Mixed models were used to assess the rate of progression in PWV and the association between CV factors and PWV over time.RESULTSPWV increased significantly over time (0.145 m/s/year; P < 0.0001). MetS (P = 0.0035), large waist (P < 0.0001), and elevated BP (P = 0.0003) at baseline were each associated with worse PWV over time. These baseline factors, however, did not significantly influence the rate of progression. Increases in waist circumference (P < 0.0001), LDL-c levels (P = 0.0156), and declining glucose control (HbA1c; P = 0.0419) were independently associated with higher PWV over time.CONCLUSIONS Presence, clustering, and worsening of CV risk factors are associated with increased arterial stiffness over time in youth with type 1 diabetes. Whether improvement in CV risk factors early in life will slow the progression of arterial stiffness and reduce the burden of CV disease in this population requires further study.
    Diabetes care 10/2013; · 7.74 Impact Factor
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    ABSTRACT: Objective To estimate the prevalence of diabetes in U.S. youth aged < 20 years in 2009 and to estimate the total number of youth with diabetes in U.S. by age, race/ethnicity, and diabetes type.Research Design and Methods To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged < 20 years on 12/31/2009 with physician diagnosed diabetes in selected areas of Colorado, Ohio, South Carolina and Washington, among health plan members of Kaiser Permanente Southern California and among American Indians living on reservations in Arizona and New Mexico. Diabetes was classified as type 1, type 2 or other. Race/ethnicity was by self- report.ResultsFrom a population of 3,458,974 youth aged < 20 years, 7,695 with diabetes were identified (2.22/1000) - 6,668 with type 1 (1.93/1000), 837 with type 2 (0.24/1000) and 190 (0.05/1000) with other diabetes types. Prevalence increased with age, was slightly higher in females than males, and was most prevalent in non-Hispanic White (NHW) and least prevalent in Asian/Pacific Islanders, with Native American and Black youth having the highest prevalence of type 2 diabetes. An estimated 191,986 U.S. youth aged < 20 years have diabetes; 166,984 type 1, 20,262 type 2 diabetes, and 4,740 other types.Conclusion Diabetes mellitus, one of the leading chronic diseases in childhood, affects over 190,000 (1 out of 433) youth less than age 20 years in the US, with racial and ethnic disparities seen in diabetes prevalence, overall and by diabetes type.
    Diabetes care 09/2013; · 7.74 Impact Factor
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    ABSTRACT: Abstract Aim: This study explored the role of glycemic control on cardiac autonomic function, measured by heart rate variability (HRV), in youth with type 1 diabetes. Patients and Methods: A retrospective cohort of 345 youth with type 1 diabetes (mean age, 18.5 years; duration, 10 years) participating in the SEARCH for Diabetes in Youth study were enrolled in the ancillary SEARCH Cardiovascular Disease (CVD) study. Anthropometric, metabolic, and HRV parameters were collected at the current research visit. Glycemic control over time was assessed by the mean glycated hemoglobin (A1c) levels collected over the past 6 years. Multiple linear regression analysis assessed the association between A1c over time and HRV parameters, independent of demographic and CVD risk factors. Participants were categorized into four glycemic control categories based on their mean A1c over time: Group 1, optimal (mean A1c, ≤7.4%); Group 2 (mean A1c, 7.5-8.4%); Group 3 (mean A1c, 8.5-9.4%), and Group 4, poor (mean A1c, ≥9.5%), and a linear trend was explored across these categories. Results: For every 1% increase in the average A1c over 6 years there was a 5% decrease in the SD of the normal RR interval (SDNN) (P=0.02) and 7% decrease in the root mean square successive difference of the RR interval (RMSSD) (P=0.02), independent of demographic and traditional CVD risk factors. A dose-response relationship between worsening glucose control categories and measures of overall reduced HRV was found. Conclusions: Chronic hyperglycemia is the main determinant of early cardiac autonomic dysfunction, manifested as reduced overall HRV and parasympathetic loss, among youth with type 1 diabetes.
    Diabetes Technology &amp Therapeutics 09/2013; · 2.21 Impact Factor
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    ABSTRACT: To identify the source of behavior change resulting from a health education intervention focused on pesticide safety. Data were from the La Familia Sana demonstration project, a promotora-delivered pesticide safety education intervention conducted with immigrant Latinos (N = 610). The La Familia Sana program produced changes in 3 sets of pesticide safety behaviors. Changes in the conceptual targets of the intervention and promotora attributes explained 0.45-6% and 0.5-3% of the changes in pesticide-related behavior, respectively. The conceptual targets of the La Familia Sana program explained the greatest amount of change in pesticide-related behavior. Promotora attributes also contributed to intervention success.
    American journal of health behavior 07/2013; 37(4):449-57. · 1.31 Impact Factor
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    ABSTRACT: OBJECTIVE Reduced heart rate variability (HRV) and increased arterial stiffness (AS) are both present in youth with type 1 diabetes. However, it is unclear whether they are associated and whether their association is independent of cardiovascular disease (CVD) risk factors.RESEARCH DESIGN AND METHODS The SEARCH Cardiovascular Disease Study explored the cross-sectional relationships between HRV and several measures of AS in youth with (n = 344) and without (n = 171) type 1 diabetes. The SphygmoCor device (AtCor Medical, Sydney, Australia) was used to measure HRV using SD of normal R-R interval (SDNN), as well as AS, using pulse wave velocity in the carotid to femoral segment (PWV-trunk) and augmentation index adjusted to a heart rate of 75 bpm (AIx75). Brachial distensibility (BrachD), another index of AS, was measured with a DynaPulse instrument (Pulse Metric, San Diego, CA). Multiple linear regression analyses explored the associations between HRV and each of the three AS measures, after adjusting for demographic characteristics and traditional CVD risk factors (blood pressure, lipids, obesity, microalbuminuria, and smoking) separately, for youth with and without type 1 diabetes.RESULTSAmong youth with type 1 diabetes, lower SDNN was associated with peripheral AS (lower BrachD, P = 0.01; r(2) = 0.30) and central AS (higher PVW-trunk, P < 0.0001; r(2) = 0.37; and higher AIx75, P = 0.007; r(2) = 0.08). These associations were attenuated with adjustment for CVD risk factors, but remained statistically significant for BrachD and PWV-trunk. While a similar association between HRV and BrachD was present in control youth, lower HRV was not associated with increased central AS or with AIx75.CONCLUSIONS Longitudinal studies are needed to understand the pathways responsible for these associations.
    Diabetes care 02/2013; · 7.74 Impact Factor
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    ABSTRACT: Although poor sleep quality and associated sleep disorders are associated with increased risk of job injury and multiple mental and physical health problems, scant research has examined sleep quality among Latino farmworkers. Interviews were conducted with 371 male Latino farmworkers working in North Carolina during the 2010 agricultural season. Data on housing quality and sleep quality were collected. Access to air conditioning was significantly and positively associated with good sleep quality. This association remained when other housing characteristics and individual health indicators were controlled. Good sleep quality was associated with low levels of pain, depression, and anxiety. Poor sleep quality among Latino farmworkers was associated with poorer indicators of health. One important indicator of housing quality, air conditioning, was associated with better sleep quality. Further research is required to delineate how to improve the adequacy of farmworker housing to improve sleep quality and other health indicators.
    Journal of Immigrant and Minority Health 11/2012; · 1.16 Impact Factor
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    ABSTRACT: Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families' knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.
    Health Promotion Practice 10/2012; · 0.55 Impact Factor
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    ABSTRACT: OBJECTIVE This study compared heart rate variability (HRV) parameters in youth with and without type 1 diabetes and explored potential contributors of altered HRV.RESEARCH DESIGN AND METHODSHRV parameters were measured among 354 youth with type 1 diabetes (mean age 18.8 years, diabetes duration 9.8 years, and mean A1C 8.9%) and 176 youth without diabetes (mean age 19.2 years) participating in the SEARCH CVD study. Multiple linear regression was used to assess the relationship between diabetes status and HRV parameters, adjusting for covariates.RESULTSCompared with control subjects, youth with type 1 diabetes had reduced overall HRV (10.09 ms lower SD of NN intervals [SDNN]) and markers of parasympathetic loss (13.5 ms reduced root mean square successive difference of NN intervals [RMSSD] and 5.2 normalized units (n.u.) reduced high frequency [HF] power) with sympathetic override (5.2 n.u. increased low frequency [LF] power), independent of demographic, anthropometric, and traditional cardiovascular risk factors. Older age, female sex, higher LDL cholesterol and triglyceride levels, and presence of microalbuminuria were independently associated with lower HRV but did not account for the observed differences between youth with and without diabetes. Youth with type 1 diabetes and A1C levels ≥7.5% had significantly worse HRV parameters than control subjects; however, in youth with optimal glycemic control (A1C <7.5%), HRV parameters did not differ significantly from control subjects.CONCLUSIONS Youth with type 1 diabetes have signs of early cardiac autonomic neuropathy: reduced overall HRV and parasympathetic loss with sympathetic override. The main driver of these subclinical abnormalities appears to be hyperglycemia.
    Diabetes care 09/2012; · 7.74 Impact Factor
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    ABSTRACT: Migrant farmworkers in North Carolina (n = 300) reported eye injuries, circumstances of injuries, and outcomes during lifetime U.S. agriculture work. Seventeen injuries were reported by 15 farmworkers; five resulted in lost work time. Most reported injuries were penetrating or open wounds, often caused by branches or other foreign objects. Injuries were seldom reported to employers; and treatment at clinics, when received, was often delayed. The incidence rate of lost work-time injuries of 23.8/10,000 worker years (95% confidence interval 7.5, 55.9), exceeds the 2009 national incidence rate (6.9/10,000). Migrant farmworkers constitute a vulnerable population; better occupational safety protections should be considered.
    Journal of Agromedicine 01/2012; 17(1):63-9. · 0.72 Impact Factor

Publication Stats

104 Citations
105.12 Total Impact Points

Institutions

  • 2010–2014
    • Wake Forest School of Medicine
      • • Department of Biostatistical Sciences
      • • Division of Public Health Sciences
      • • Department of Family and Community Medicine
      Winston-Salem, North Carolina, United States
  • 2013
    • Oklahoma State University - Tulsa
      Tulsa, Oklahoma, United States
    • Sansum Diabetes Research Institute
      Santa Barbara, California, United States
  • 2012–2013
    • Colorado Department of Public Health and Environment
      Denver, Colorado, United States