Thomas A Arcury

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

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Publications (314)630.2 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS. Muscle Nerve, 2013.
    Muscle & Nerve 01/2013; · 2.31 Impact Factor
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    ABSTRACT: Objectives. We sought to (1) describe observed cooking and eating facilities in migrant farmworker camps, (2) compare observed conditions with existing farmworker housing regulations, and (3) examine associations of violations with camp characteristics. Methods. We collected data in 182 farmworker camps in eastern North Carolina during the 2010 agricultural season. We compared our observations with 15 kitchen-related housing regulations specified by federal and state housing standards. Results. We observed violations of 8 regulations in at least 10% of camps: improper refrigerator temperature (65.5%), cockroach infestation (45.9%), contaminated water (34.4%), rodent infestation (28.9%), improper flooring (25.8%), unsanitary conditions (21.2%), improper fire extinguisher (19.9%), and holes or leaks in walls (12.1%). Logistic regression showed that violations were related to the time of the agricultural season, housing type, number of dwellings and residents, and presence of workers with H-2A visas. Conclusions. Cooking and eating facilities for migrant farmworkers fail to comply with regulations in a substantial number of camps. Greater enforcement of regulations, particularly during occupancy during the agricultural season, is needed to protect farmworkers. (Am J Public Health. Published online ahead of print January 17, 2013: e1-e7. doi:10.2105/AJPH.2012.300831).
    American Journal of Public Health 01/2013; · 3.93 Impact Factor
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    ABSTRACT: ABSTRACT Despite widespread use of lay health advisor (LHA) programs, factors related to success of LHAs remain largely unexamined. This study describes experiences and personal transformations of LHAs (promotoras de salud) in a pesticide safety education program targeting farmworker families in North Carolina, using postintervention in-depth interviews conducted with 17 LHAs. LHAs identified assets and barriers that affected their success. LHAs also described increases in self-efficacy and empowerment resulting in perceived improvements in ability to teach and impact their community. Such positive changes are essential benefits to the LHAs. Evaluations that address these topics are needed to better understand continuity and attrition in LHA programs.
    Journal of Agromedicine 01/2013; 18(2):75-86. · 0.72 Impact Factor
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    ABSTRACT: Purpose. This study documents demographic, health, and complementary therapy (CT) correlates of medical skepticism among rural older adults. Methods. Older (≥65 years) African Americans and Whites in rural North Carolina (N=198) were interviewed. Medical skepticism was assessed using the four items from the Medical Expenditure Survey. Bivariate associations between medical skepticism and demographic and health characteristics and CT use were assessed, and independent effects on CT use. Findings. Positive responses to medical skepticism questions ranged from 19.7% (can overcome illness without help) to 59.6% (believes own behavior determines their health). Medical skepticism indicators were associated with few demographic and health characteristics, and one CT category. Conclusions. This study shows a high degree of medical skepticism among rural older adults, but limited associations with demographic and health characteristics and CT use. Further research is needed to understand relationships of attitudes towards conventional care and CT use in this population.
    Journal of Health Care for the Poor and Underserved 01/2013; 24(2):777-787. · 1.10 Impact Factor
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    ABSTRACT: Representative samples are required for ethical, valid, and useful health research. Yet, recruiting participants, especially from historically underserved communities, can be challenging. This paper presents findings from in-depth interviews with 40 mothers about factors that might influence their willingness to participate or allow their children to participate in medical research. Saliency analysis organizes the findings. Frequent and important salient themes about research participation included concerns that it might cause participants harm, hope that participants might gain a health benefit, and recognition that time and transportation resources could limit participation. Ultimately, we propose that a theoretical model, such as the Theory of Planned Behavior (TPB), will facilitate more systematic evaluation of effective methods for recruitment and retention of participants in medical research. Future research should explore the utility of such a model for development of effective recruitment and retention strategies.
    Journal of Health Care for the Poor and Underserved 01/2013; 24(4):1801-15. · 1.10 Impact Factor
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    ABSTRACT: INTRODUCTION: Manual laborers are at increased risk for carpal tunnel syndrome (CTS), and a combination of history, physical examination, and nerve conduction studies is often used to screen for CTS in this population. Neuromuscular ultrasound may be a better screening tool, because it is painless. In this study we compare the accuracy of nerve conduction studies and ultrasound for CTS screening. METHODS: Five hundred thirteen manual laborers were screened prospectively for CTS using nerve conduction studies and neuromuscular ultrasound, and the accuracy of the 2 techniques was compared using the Katz hand diagram as the diagnostic standard. RESULTS: The ROC curves for the 2 techniques were not significantly different (P = 0.542), indicating that the approaches had similar diagnostic accuracy. CONCLUSIONS: Neuromuscular ultrasound is a painless technique that has diagnostic accuracy similar to nerve conduction studies and can be used to screen large populations at risk for CTS. Muscle Nerve, 2013.
    Muscle & Nerve 11/2012; · 2.31 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: BACKGROUND: The goal of this study is to improve understanding of immigrant Latino manual workers' occupational health, focusing on upper body musculoskeletal injury. METHODS: Physical exams were conducted with a representative sample of 516 Latino poultry workers and manual laborers in western North Carolina; outcome measures were prevalence of epicondylitis, rotator cuff syndrome, and low back pain. RESULTS: Low back pain (n = 89; 17.2%) and rotator cuff syndrome (n = 76; 14.7%) indicated by physical exam was common. Epicondylitis was less common, but still frequent (n = 30; 5.8%). Prevalence of each outcome did not differ between poultry processing workers and other manual workers. Workers >40 years old had greater incidence of rotator cuff syndrome and epicondylitis. CONCLUSIONS: Epicondylitis, rotator cuff syndrome, and low back pain are common in immigrant Latino workers, and may negatively impact long-term health and contribute to occupational health disparities. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 10/2012; · 1.97 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;
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    ABSTRACT: The "dual effects" hypothesis argues that social control can be effective in promoting positive health-related behavior change, but it can also jeopardize the targeted individual's well-being. This hypothesis is tested using hemoglobin A1C as an objective indicator of behavioral compliance with diabetes self-management behavior and depressive symptoms. Differences in the effects of social control on A1C and depressive symptoms by sex and ethnicity are tested. Cross-sectional data were obtained from a multi-ethnic sample of older adults with diabetes (N = 593). Greater social control was associated with poorer rather than better odds of achieving glucose control, and with greater depressive symptoms. There was no evidence that social control has differential effects on either glucose control or depressive symptoms by sex or ethnicity. Active use of social control attempts by family members and friends, especially if they are coercive or punitive in nature, are likely counterproductive for maintaining the physical and mental health of older adults with diabetes.
    Behavioral Medicine 10/2012; 38(4):115-20. · 1.03 Impact Factor
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    ABSTRACT: ABSTRACT Latino farmworkers in North Carolina are a hard-to-reach population that faces diverse occupational health risks, including pesticide exposure. Health and safety education efforts often employ lay health advisor or promotor(a) de salud models in which farmworker community members are trained to provide health education. As a frequently tight-knit and isolated group, farmworkers may be well suited to serve as resident lay health advisors. This paper presents data collected from a nonrandom sample of Latino farmworkers living in North Carolina regarding the natural level of occupational safety information exchange among Latino farmworkers, specifically pesticide safety information. The data affirm that farmworkers informally exchange occupational safety information with one another, with the level of exchange increasing during the agricultural season. Consequently, if trained, the data suggest that farmworkers might be situated to provide in situ occupational health and safety education to their peers. This remains to be systematically tested and evaluated.
    Journal of Agromedicine 10/2012; 17(4):415-20. · 0.72 Impact Factor
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    ABSTRACT: Objectives. The purpose of this study was to assess water quality in migrant farmworker camps in North Carolina and determine associations of water quality with migrant farmworker housing characteristics. Methods. We collected data from 181 farmworker camps in eastern North Carolina during the 2010 agricultural season. Water samples were tested using the Total Coliform Rule (TCR) and housing characteristics were assessed using North Carolina Department of Labor standards. Results. A total of 61 (34%) of 181 camps failed the TCR. Total coliform bacteria were found in all 61 camps, with Escherichia coli also being detected in 2. Water quality was not associated with farmworker housing characteristics or with access to registered public water supplies. Multiple official violations of water quality standards had been reported for the registered public water supplies. Conclusions. Water supplied to farmworker camps often does not comply with current standards and poses a great risk to the physical health of farmworkers and surrounding communities. Expansion of water monitoring to more camps and changes to the regulations such as testing during occupancy and stronger enforcement are needed to secure water safety.
    American Journal of Public Health 08/2012; 102(10):e49-e54. · 3.93 Impact Factor
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    ABSTRACT: BACKGROUND: This analysis describes the work safety climate of Latino poultry processing workers and notes differences by worker personal characteristics and employer; describes the use of common personal protective equipment (PPE) among workers; and examines the associations of work safety climate with use of common PPE. METHODS: Data are from a cross-sectional study of 403 Latino poultry processing workers in western North Carolina. RESULTS: Work safety climate differed little by personal characteristics, but it did differ consistently by employer. Provision of PPE varied; for example, 27.2% of participants were provide with eye protection at no cost, 57.0% were provided with hand protection at no cost, and 84.7% were provided with protective clothing at no cost. PPE use varied by type. Provision of PPE at no cost was associated with lower work safety climate; this result was counter-intuitive. Consistent use of PPE was associated with higher work safety climate. CONCLUSIONS: Work safety climate is important for improving workplace safety for immigrant workers. Research among immigrant workers should document work safety climate for different employers and industries, and delineate how work safety climate affects safety behavior and injuries. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 07/2012; · 1.97 Impact Factor
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    ABSTRACT: BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 07/2012; · 1.97 Impact Factor
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    ABSTRACT: To determine the potential role of differential exposure to work organization hazards in musculoskeletal disorders among immigrant Latino workers. Self-reported work organization data were obtained from immigrant Latino workers in poultry processing and nonpoultry, manual occupations (N = 742). Clinical evaluations for epicondylitis, rotator cuff syndrome, and back pain were obtained from a subsample (n = 518). Several work organization hazards (eg, low job control, high psychological demands) were elevated among poultry processing workers. Job control predicted epicondylitis (odds ratio [OR] = 0.77) and rotator cuff syndrome (OR = 0.79); psychological demand predicted rotator cuff syndrome (OR = 1.30) and back pain (OR = 1.24); awkward posture and repeated movements predicted all three outcomes; and management safety commitment predicted rotator cuff syndrome (OR = 1.65) and back pain (OR = 1.81). Immigrant poultry processing workers are exposed to greater work organization hazards that may contribute to occupational health disparities.
    Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 07/2012; 54(8):995-1001. · 1.88 Impact Factor
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    ABSTRACT: To describe diabetes management behaviors and social integration among older adults, and delineate the associations of social integration with diabetes management behaviors. Interview data from 563 African American, American Indian, and White participants (age 60+) from eight south central North Carolina counties selected using a site-based procedure. Statistical analysis comprises descriptive statistics, bivariate analysis, and multivariate analysis. Participants had high levels of social integration and largely adhered to diabetes management behaviors (glucose monitoring, checking feet, maintaining diet, formal exercise program, health provider monitoring A1C and examining feet). Social integration was associated with several behaviors; social network size, particularly other relatives seen and spoken with on the telephone, was associated with provider A1C monitoring and foot examinations. Social integration had small but significant associations with diabetes management behaviors. This analysis suggests specific mechanisms for how social integration influences the effect of disease on disability.
    Journal of Aging and Health 07/2012; 24(6):899-922. · 1.56 Impact Factor
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    ABSTRACT: Latino farmworkers are a vulnerable population who confront multiple threats to their mental health. Informed by the stress-process model of psychiatric disorder, the goal of this paper is to determine primary and context-specific stressors of poor mental health among Latino farmworkers. Structured interview data were obtained from farmworkers (N = 69) in 6 counties in eastern and western North Carolina. Results indicated that a substantial number of farmworkers have poor mental health, as indicated by elevated depressive symptoms (52.2%) and anxiety (16.4%). Results also indicated that each mental health outcome had different predictors. Addressing the mental health issues of farmworkers requires a comprehensive, multifaceted approach.
    The Journal of Rural Health 06/2012; 28(3):277-85. · 1.44 Impact Factor
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    ABSTRACT: INTRODUCTION: The NAFKAM International CAM Questionnaire (I-CAM-Q) was designed to facilitate cross-study comparisons of CAM usage. This research presents the first empirical study of the I-CAM-Q's performance. MATERIALS AND METHODS: Data were collected in two studies in a multi-ethnic (African American, American Indian, and white) population of older adults in the US. In 2010, 564 adults 60+ years were recruited. The I-CAM-Q was interviewer-administered. Data were compared to those collected in 2002 from a random sample of 701 Medicare recipients 65+ years. The 2002 survey included an extensive inventory of specific CAM therapies derived from local ethnographic research. Comparisons of the responses for 14 CAM modalities common to the two studies used logistic regression adjusted for demographics. RESULTS: There were no significant differences between the 2002 and 2010 surveys in the proportions reporting 10 modalities, including use of chiropractors, homeopaths, acupuncturists, herbalists, spiritual healers, vitamins, minerals, homeopathic remedies, Qigong, visualization, and prayer for health. Significantly less use of physicians and more use of relaxation techniques were reported in 2010. Herb use and garlic, as a specific herb, were reported significantly less in 2010. CONCLUSIONS: Overall, the I-CAM-Q obtained results similar to those produced by a population-specific questionnaire. Those differences observed appear to reflect differences in the studies' inclusion criteria or secular trends in CAM. This study supports the intention of the I-CAM-Q to substitute for local and regional surveys in order to allow cross-study comparisons of CAM use. Further tests, preferably through contemporaneous data collection are needed in other populations.
    European journal of integrative medicine. 06/2012; 4(2):e205-e211.
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    ABSTRACT: Objectives: People with diabetes must engage in several self-care activities to manage blood glucose; cognitive function and other affective disorders may affect self-care behaviors. We examined the executive function domain of cognition, depressive symptoms, and symptoms of generalized anxiety disorder (GAD) to determine which common mental conditions can co-occur with diabetes are associated with blood glucose levels. Methods: We conducted a cross-sectional in-person survey of 563 rural older adults (age 60 years or older) with diabetes that included African Americans, American Indians, and Whites from eight counties in south-central North Carolina. Hemoglobin A1C (A1C) was measured from a finger-stick blood sample to assess blood glucose control. Executive function, depressive symptoms, and symptoms of GAD were assessed using established measures and scoring procedures. Separate multivariate linear regression models were used to examine the association of executive function, depressive symptoms, and symptoms of GAD with A1C. Results: Adjusting for potential confounders including age, gender, education, ethnicity, marital status, history of stroke, heart disease, hypertension, diabetes knowledge, and duration of diabetes, executive function was significantly associated with A1C levels: every one-unit increase in executive function was associated with a 0.23 lower A1C value (p = 0.02). Symptoms of depression and GAD were not associated with A1C levels. Conclusions: Low executive function is potentially a barrier to self-care, the cornerstone of managing blood glucose levels. Training aids that compensate for cognitive impairments may be essential for achieving effective glucose control.
    Aging and Mental Health 05/2012; 16(8):950-7. · 1.68 Impact Factor
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    ABSTRACT: OBJECTIVES: This study uses qualitative data to describe the tasks performed by chicken catchers, their organization of work, and possible health and safety hazards encountered. METHODS: Twenty-one Latino immigrant chicken catchers for North Carolina poultry-processing plants were interviewed to obtain their perceptions of the job and its hazards. Interviews were recorded and transcribed (n = 10) or detailed notes recorded (n = 11). Transcripts and notes were subjected to qualitative analysis. RESULTS: Chicken catching takes place in a highly contaminated and hazardous work environment. The fast pace of work, low level of control over work intensity, and piece rate compensation all result in high potential for work-related injury and illness, including trauma, electrical shock, respiratory effects, musculoskeletal injuries, and drug use. Workers receive little safety or job training. CONCLUSIONS: Chicken catching is characterized by a work environment and organization of work that promote injury and illness. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 05/2012; · 1.97 Impact Factor

Publication Stats

4k Citations
630.20 Total Impact Points


  • 1970–2014
    • Wake Forest School of Medicine
      • • Department of Family and Community Medicine
      • • Center for Worker Health
      • • Division of Public Health Sciences
      • • Department of Dermatology
      Winston-Salem, North Carolina, United States
  • 2013
    • Oklahoma State University - Tulsa
      Tulsa, Oklahoma, United States
    • Drexel University
      • Department of Environmental and Occupational Health
      Philadelphia, PA, United States
  • 2009–2012
    • University of North Carolina at Greensboro
      • • Department of Public Health Education
      • • Department of Nutrition
      Greensboro, NC, United States
  • 2011
    • Baylor University
      • Hankamer School of Business
      Waco, Texas, United States
    • Guilford College
      Greensboro, North Carolina, United States
  • 1997–2011
    • Wake Forest University
      • • Department of Sociology
      • • Department of Dermatology
      • • Department of Family and Community Medicine
      • • Department of Public Health Sciences
      Winston-Salem, North Carolina, United States
  • 1996–2010
    • University of North Carolina at Chapel Hill
      • • School of Social Work
      • • Cecil G. Sheps Center for Health Services Research
      • • School of Nursing
      • • Department of Geography
      • • Department of Biostatistics
      • • Center for Urban and Regional Studies
      Chapel Hill, NC, United States