[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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.
[show abstract][hide abstract] 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
[show abstract][hide abstract] 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
[show abstract][hide abstract] ABSTRACT: Latino residential construction workers experience high rates of occupational fatality and injury. Work safety climate is an especially important consideration for improving the safety of these immigrant workers. This analysis describes work safety climate among Latino residential construction workers, delineates differences in work safety climate by personal and employment characteristics, and determines associations of work safety climate with specific work safety behaviors.
Data are from a cross-sectional survey of 119 Latino residential framers, roofers, and general construction workers in western North Carolina; 90 of these participants also provided longitudinal daily diary data for up to 21 days using an Interactive Voice Response (IVR) system. Measures included the Perceived Safety Climate Scale, and daily reports of five individual and five collective safety practices.
Work safety climate was mixed among workers, with roofers (19.9) having lower levels than framers (24.3) or general construction workers (24.3). Days reported for several individual (glove-related risks, not doing something known to be unsafe) and collective safety practices (attended daily safety meeting, not needing to use damaged equipment, not seeing coworker create an unsafe situation) were positively associated with work safety climate.
Work safety climate predicts subsequent safety behaviors among Latino residential construction workers, with differences by trade being particularly important. Interventions are needed to improve safety training for employers as well as workers. Further research should expand the number of workers and trades involved in analyses of work safety climate.
American Journal of Industrial Medicine 04/2012; 55(8):736-45. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This analysis delineates the predisposing, need, and enabling factors that are associated with regular and recent dental care in a multiethnic sample of rural older adults.
A cross-sectional, comprehensive, oral-health survey conducted with a random, multiethnic (African American, American Indian, white) sample of 635 community-dwelling adults aged 60 years and older was completed in two rural southern counties. Logistic regression models assessed the simultaneous associations of dental care with predisposing, enabling, and need factors.
Almost no edentulous rural older adults received dental care; 27.1 percent of dentate rural older adults had received regular dental care, and 36.7 percent had received recent dental care. Predisposing (less than high-school education, dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of regular dental, while predisposing (dental anxiety), enabling (no regular place for dental care), and need factors (no filled teeth) reduced the odds of recent dental care. Having excellent, very good, or good self-rated oral health increased the odds of receiving regular and recent dental care.
Regular and recent dental care are infrequent among rural older adults. Contrary to expectations, those not receiving dental care are those who most need care; this has been referred to as the Paradox of Dental Need. Community access to dental care and the ability of older adults to pay for dental care must be addressed by public-health policy to improve the health and quality of life of older adults in rural communities.
Journal of Public Health Dentistry 04/2012; 72(3):190-7. · 1.21 Impact Factor
[show abstract][hide abstract] ABSTRACT: Job stress has been associated with cognitive function, but the relationship is often overlooked when considering occupational health and safety issues of farmworkers. This study examined the relationship between stress and change in stress with change in cognitive function in a representative sample of 123 Latino farmworkers.
A prospective study design was used in which stress and cognitive function data were collected at baseline and at 3-month follow-up. Linear regression models were used for analyses. Potential confounders included baseline gender, age, education, number of years worked in U.S. agriculture, ever smoking status, self-rated health, and depressive symptoms.
Baseline stress was significantly correlated with baseline cognitive function (r = -0.27; P < 0.001). Adjusting for confounders, increased baseline stress was associated with greater decline in cognitive function (P = 0.024). Short-term changes in stress were not associated with cognitive change in this cohort.
Stress at work is an important risk factor for poor cognitive function. This analysis suggests several implications for the provision of health care and for the organization of work for farmworkers.
American Journal of Industrial Medicine 03/2012; 55(8):707-13. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This analysis described Latino migrant farmworkers' work safety climate and its association with musculoskeletal discomfort, working while injured or ill, and depressive symptoms.
Data were from a cross-sectional survey of 300 farmworkers conducted in North Carolina in 2009. Generalized estimating equations models were used to investigate the association of work safety climate with health and safety outcomes.
Farmworkers perceived their work safety climate to be poor. About 40% had elevated musculoskeletal discomfort, 5.0% had worked at least 1 day while injured or ill, and 27.9% had elevated depressive symptoms. The odds of elevated musculoskeletal discomfort were 12% lower and the odds of working while injured or ill were 15% lower with each 1-unit increase in the work safety climate. Work safety climate was not associated with depressive symptoms.
Work safety climate was important for agricultural workers. Poor work safety climate was associated with health outcomes (musculoskeletal discomfort) and safety (working while injured or ill). Interventions to improve work safety climate in agriculture are needed, with these interventions being directed to employers and workers.
American Journal of Public Health 03/2012; 102 Suppl 2:S272-8. · 3.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: The quality of housing provided to migrant farmworkers is often criticized, but few studies have investigated these housing conditions. This analysis examines housing regulation violations experienced by migrant farmworkers in North Carolina, and the associations of camp characteristics with the presence of housing violations.
Data were collected in183 eastern North Carolina migrant farmworker camps in 2010. Housing regulation violations for the domains of camp, sleeping room, bathroom, kitchen, laundry room, and general housing, as well as total violations were assessed using North Carolina Department of Labor standards.
Violations of housing regulations were common, ranging from 4 to 22 per camp. Housing regulation violations were common in all domains; the mean number of camp violations was 1.6, of sleeping room violations was 3.8, of bathroom violations was 4.5, of kitchen violations was 2.3, of laundry room violations was 1.2, and of general housing violations was 3.1. The mean number of total housing violations was 11.4. Several camp characteristics were consistently associated with the number of violations; camps with workers having H-2A visas, with North Carolina Department of Labor Certificates of Inspection posted, and assessed early in the season had fewer violations.
These results argue for regulatory changes to improve the quality of housing provided to migrant farmworkers, including stronger regulations and the more vigorous enforcement of existing regulations.
American Journal of Industrial Medicine 03/2012; 55(3):191-204. · 1.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the association of cognitive function with use of non-prescribed therapies for managing acute and chronic conditions, and to determine whether use of non-prescribed therapies changes over time in relation to baseline cognitive function.
200 community-dwelling adults aged 65 and older were recruited from three counties in south central North Carolina. Repeated measures of daily symptoms and treatment were collected on three consecutive days at intervals of at least one month. The Mini-Mental State Examination, the primary cognitive measure, was collected as part of the baseline survey. Data were collected on the daily use of common non-prescribed therapies (use of prayer, ignore symptoms, over-the-counter remedies, food and beverage therapies, home remedies, and vitamin, herb, or supplements) on each of the three days of the follow-up interviews for up to six consecutive months.
Older adults with poorer cognitive function were more likely to pray and ignore symptoms on days that they experienced acute symptoms. Poorer cognitive function was associated with increased use of home remedies for treating symptoms related to existing chronic conditions.
Cognitive function may play a role in why older patients use some non-prescribed therapies in response to acute and chronic conditions.
Aging and Mental Health 02/2012; 16(5):648-58. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: To determine the prevalence of carpal tunnel syndrome (CTS) in Latino poultry-processing workers.
Symptoms and nerve conduction studies were used to prospectively assess 287 Latino poultry-processing workers and 226 Latinos in other manual-labor occupations.
The prevalence of CTS was higher in poultry-processing (8.7%) compared with nonpoultry manual workers (4.0%; P < 0.0001). The adjusted odds ratio for the prevalence of CTS in poultry workers was 2.51 (95% confidence interval, 1.80-3.50) compared with nonpoultry workers. Within the poultry workers, those who performed packing, sanitation, and chilling had a trend toward less CTS than those who performed tasks requiring more repetitive and strenuous hand movements.
Latino poultry-processing workers have a high prevalence of CTS, which likely results from the repetitive and strenuous nature of the work.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2012; 54(2):198-201. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: To evaluate associations between poultry processing work and respiratory health among working Latino men and women in North Carolina.
Between May 2009 and November 2010, 402 poultry processing workers and 339 workers in a comparison population completed interviewer-administered questionnaires. Of these participants, 279 poultry processing workers and 222 workers in the comparison population also completed spirometry testing to provide measurements of forced expiratory volume in 1 second and forced vital capacity.
Nine percent of poultry processing workers and 10% of workers in the comparison population reported current asthma. Relative to the comparison population, adjusted mean forced expiratory volume in 1 second and forced vital capacity were lower in the poultry processing population, particularly among men who reported sanitation job activities.
Despite the low prevalence of respiratory symptoms reported, poultry processing work may affect lung function.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 02/2012; 54(2):177-83. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Complementary and Alternative Medicine Beliefs Inventory (CAMBI) was developed to provide a comprehensive measure of beliefs believed to differentiate complementary therapy (CT) users from nonusers. The initial evaluation of the CAMBI was based on a relatively homogeneous sample of CT users, which raises questions about its applicability in more generalized samples. This study uses data from a community-based sample of older adults (N=200) to evaluate the utility of the CAMBI in more diverse samples. Results indicated substantial variation in responses to items with each of a priori belief domains (i.e., perceived value of natural treatments, preference for participation in treatments, and orientation toward holistic health) and modest inter-correlation among items within each belief domain. Confirmatory factor analysis results indicated the a priori measurement structure provided a poor fit to obtained data. Post hoc analyses indicated that African Americans and those with less education had less consistent responses to items within each belief domain. Revision and additional development of the CAMBI is needed to enable its use in more diverse research samples.
Complementary therapies in medicine 02/2012; 20(1-2):54-60. · 1.95 Impact Factor