Thomas A Arcury

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

Are you Thomas A Arcury?

Claim your profile

Publications (370)659.01 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Preschool age children of Latino farmworkers are at risk for early childhood caries and subsequent oral health (OH) problems; many face significant barriers in accessing dental care. We compare OH and hygiene between migrant and seasonal farmworker children and note disparities between maternal knowledge and practices. The Nios Sanos Study is a cohort (N=248) of mothers and preschool age children from migrant and seasonal farmworker families recruited in North Carolina. Mothers reported the child's OH condition, hygiene behaviors, and professional care, as well as their beliefs about child OH in response to the Behavioral Risk Factor Questionnaire of the NIDCR Centers for Research to Reduce Disparities in Oral Health. At interview, children averaged 44.3 7.4 months. Migrant mothers rated their child's OH condition and OH-related quality-of-life significantly worse than did seasonal mothers. 87% of children had ever had teeth examined by a healthcare provider, and 83% had had fluoride varnish applied in the previous year; rates did not differ between migrant and seasonal families. Children enrolled in Head Start were more likely to have had examinations and varnish applied than those not in Head Start. Mothers exhibited high levels of knowledge of proper child oral hygiene, but rates of recommended practices were substantially lower. Farmworker families, particularly migrants, frequently live in crowded, substandard housing and share facilities with other families. Steps to help families achieve appropriate OH practices should prioritize behaviors and problem-solve with mothers ways to best meet child OH needs in the context of farmworker living conditions.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
  • [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    ABSTRACT: Community-based participatory research (CBPR) has become essential in health disparities and environmental justice research; however, the scientific integrity of CBPR projects has become a concern. Some concerns, such as appropriate research training, lack of access to resources and finances, have been discussed as possibly limiting the scientific integrity of a project. Prior to understanding what threatens scientific integrity in CBPR, it is vital to understand what scientific integrity means for the professional and community investigators who are involved in CBPR. This analysis explores the interpretation of scientific integrity in CBPR among 74 professional and community research team members from of 25 CBPR projects in nine states in the southeastern United States in 2012. It describes the basic definition for scientific integrity and then explores variations in the interpretation of scientific integrity in CBPR. Variations in the interpretations were associated with team member identity as professional or community investigators. Professional investigators understood scientific integrity in CBPR as either conceptually or logistically flexible, as challenging to balance with community needs, or no different than traditional scientific integrity. Community investigators interpret other factors as important in scientific integrity, such as trust, accountability, and overall benefit to the community. This research demonstrates that the variations in the interpretation of scientific integrity in CBPR call for a new definition of scientific integrity in CBPR that takes into account the understanding and needs of all investigators.
    Social Science [?] Medicine 11/2013; 97:134-42. · 2.56 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The reliability of an item designed to measure health belief is often confounded with response consistency at the person level. The study applied contemporary measurement methods to an inventory of common sense beliefs about diabetes and used a sample of N = 563 adults with diabetes to test the hypothesis that individuals whose beliefs are congruent with a biomedical model are more consistent in their responses. Item-level analysis revealed that the domains of Causes and Medical Management were the least reliable. Person-level analysis showed that respondents who held views congruent with the biomedical model were more consistent than people who did not.
    Journal of Health Psychology 10/2013; · 1.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PurposeThe purpose of the study was to assess the performance of a Short Diabetes Knowledge Instrument (SDKI) in a large multi-ethnic sample of older adults with diabetes and to identify possible modifications to improve its ability to document diabetes knowledge.Research Design and MethodsA sample of 593 African American, American Indian, and white female and male adults 60 years and older, with diabetes diagnosed at least 2 years prior, was recruited from 8 North Carolina counties. All completed an interview that included a 16-item questionnaire to assess diabetes knowledge. A subsample of 46 completed the questionnaire a second time at a subsequent interview. Item-response analysis was used to refine the instrument to well-performing items. The instrument consisting of the remaining items was subjected to analyses to assess validity and test-retest reliability.ResultsThree items were removed after item-response analysis. Scores for the resulting instrument were lower among minority and older participants, as well as those with lower educational attainment and income. Scores for test-retest were highly correlated.Conclusions The SDKI (13-item questionnaire) appears to be a valid and reliable instrument to evaluate knowledge about diabetes. Assessment in a multi-ethnic sample of older adults suggests that this instrument can be used to measure diabetes knowledge in diverse populations. Further evaluation is needed to determine whether or not this instrument can detect changes in knowledge resulting from diabetes education or other interventions.
    The Diabetes Educator 10/2013; · 1.92 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study examines older adults’ fears of diabetes complications and their effects on self-management practices. Existing models of diabetes self-management posit that patients’ actions are grounded in disease beliefs and experience, but there is little supporting evidence. In-depth qualitative interviews were conducted with a community-based sample of 74 African American, American Indian, and White older adults with diabetes. Analysis uses Leventhal’s Common Sense Model of Diabetes to link fears to early experience and current self-management. Sixty-three participants identify fears focused on complications that could limit carrying out normal activities: amputation, blindness, low blood glucose and coma, and disease progression to insulin use and dialysis. Most focus self-management on actions to prevent specific complications, rather than on managing the disease as a whole. Early experiences focus attention on the inevitability of complications and the limited ability of patients to prevent them. Addressing older adults’ fears about diabetes may improve their diabetes self-management practices.
    Journal of Applied Gerontology 10/2013; 32(7):783-803. · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This analysis describes beliefs about work safety and personal protective equipment (PPE) among Latino roofing workers, it delineates their perceptions of work environment characteristics that affect work safety and PPE use, and it describes how they experience work injuries and the consequences of these injuries. In-depth interviews were completed with 10 current and former Latino residential roofers. Interview transcripts were subjected to systematic qualitative analysis. Participants' valued productivity over safety, and this had a negative influence on their safety behavior and reduced their PPE use. They understood that roofing was hazardous. They limited use of PPE when they felt it reduced productivity and when it was uncomfortable. Work environment characteristics that affected safety included company size, the physical demands of the job, lack of training, the need for work, general life stress, and distractions at work. An injury had to result in lost work time to be considered significant. Access to health care is limited by employers not providing Workers' compensation. Future research is needed to substantiate these descriptive results and to delineate factors that are associated with safety behavior and use of PPE. Interventions, based on a lay health educator model, are needed to improve safety in this population. Safety regulations need to be evaluated and their enforcement needs to be improved. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 09/2013; · 1.59 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To examine the demographic, health and diabetes management correlates of physician trust in a rural, multiethnic population with diabetes. 563 older (≥ 60 years) African American, American Indian and White adults completed in-home surveys, including the 11-item General Trust in Physicians Scale. Higher trust scores were seen among: older (>75) participants (p < .01), those with fewer (<3) chronic health conditions (p < .01), and those who adhered to physical activity (p < .05) and dilated eye exam (p < .01) guidelines; the latter remained significant (eye exam, p = .019) or approached significance (physical activity, p = .051) after adjustment for potential confounders. Physician trust may influence patient adherence to diabetes management recommendations. Efforts should be made to build trust in the patient-provider relationship to enhance patient outcomes.
    American journal of health behavior 09/2013; 37(5):660-6. · 1.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Migrant farmworkers are exposed to pesticides at work. Housing provided to migrant farmworkers may also expose them to pesticides, increasing their health risks. This analysis (1) describes the presence of organophosphorous (OP) and pyrethroid pesticides in North Carolina migrant farmworker houses, and (2) delineates associations of farmworker camp characteristics with pesticide detection and concentration. In 2010, 186 migrant farmworkers camps in NC were recruited (participation rate of 82.3%); pesticide wipe samples for 176 houses were analyzed. Tobacco is the predominant hand-harvested crop in this region. Two farmworkers per camp completed interviews; a third assisted with a housing inspection. Gas chromatography-mass spectrometry was used to detect OP and pyrethroid pesticides. Covariates of pesticide detection and concentration were determined with ANOVA and Tobit regression. OPs were found in 166 of 176 houses (average of 2.4/house); pyrethroids were found in 171 houses (average of 4.3/house). The number of different OPs detected in each camp and concentrations of these OPs were not associated with camp and housing characteristics. The number of different pyrethroids detected in each camp and concentrations of these pyrethroids were associated with camps having residents with H2-A visas, a posted North Carolina Department of Labor Certificate of Inspection, no barracks, fewer residents, no bedroom weather protection or floor violations, and no roaches. Farmworkers are exposed to pesticides where they live. Policy on removing pesticides from farmworker houses is needed. Reducing pesticides in farmworker houses will reduce one health risk confronted by this vulnerable population. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 08/2013; · 1.59 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many older adults use complementary therapies in health self-management but do not disclose this use to their physicians. This article examines factors affecting disclosure of complementary therapy use and considers ethnic and gender differences in disclosure. It is based on a systematic qualitative analysis of in-depth interviews conducted with 62 African American and White adults aged 65 and older. Twenty-three of the 39 older adults who acknowledge using complementary therapies disclose this to their physicians. Themes leading to disclosure are believing that physicians are supportive and the importance of sharing information. Themes for not disclosing complementary therapy use include physicians’ negative views, complementary therapy use affecting physicians’ incomes, and the need to protect cultural knowledge. African American women were least likely to disclose use. Disclosure by older adults to their physicians is a complex decision process. Medical encounters, including decisions regarding information to disclose, are embedded in broader social structures.
    Journal of Applied Gerontology 08/2013; 32(5):627-645. · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article describes the types of complementary therapies used by older adults for health promotion, and delineates the predisposing, enabling, and need factors associated with their use. One-hundred ninety-five African American and White participants (age 65+) completed a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. Complementary therapies for health promotion included home remedies, specific foods or beverages, herbs, supplements, vitamins, over-the-counter (OTC) medicine, prayer, exercise, and being active. Although gender, ethnicity, education, and trust in doctors were associated with the use of complementary therapies for health promotion, health information seeking was the predisposing factor most often associated. The enabling factors were also associated with their use. Health information seeking, which reflects a wellness lifestyle, had the most consistent associations with complementary therapy use for health promotion. This health self-management for health promotion may have positive effects on future medical expenditures.
    Journal of applied gerontology : the official journal of the Southern Gerontological Society. 07/2013;
  • [Show abstract] [Hide abstract]
    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
  • Article: Case Study.
    Journal of Occupational and Environmental Hygiene 07/2013; 10(7):D79-D85. · 1.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy. The sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA. Cognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively. These results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.
    Diabetes research and clinical practice 06/2013; · 2.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although the health risk to farmworkers of working in hot conditions is recognized, potential for excessive heat exposure in housing affecting rest and recovery has been ignored. We assessed heat index in common and sleeping rooms in 170 North Carolina farmworker camps across a summer and examined associations with time of summer and air conditioning use. We recorded dangerous heat indexes in most rooms, regardless of time or air conditioning. Policies to reduce heat indexes in farmworker housing should be developed. (Am J Public Health. Published online ahead of print June 13, 2013: e1-e3. doi:10.2105/AJPH.2012.301135).
    American Journal of Public Health 06/2013; · 3.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study analyzes the role of traditional and commercial herbs in older adults’ health self-management based on Leventhal’s Self-Regulatory Model conceptual framework. Sixty-two African American and White adults age 65 and older completed qualitative interviews describing the forms of herbs currently being used, sources of information about them, interpretations of health (acute symptoms or chronic conditions) that led to their use, and the initiation and suspension of use. Traditional herbs are native to the region or have been traditionally cultivated, usually taken raw or boiled to produce tea, and used for treating mild symptoms. Commercial herbs are prepared as pills, extracts, or teas; they are purchased at local stores or ordered by catalog or Internet and used for health promotion, illness prevention, or treatment of chronic conditions. Herbs are widely used among older adults; this analysis differentiates the types of herbs they use and their reasons for herbs use.
    Journal of Applied Gerontology 06/2013; 32(4):387-407. · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT This analysis was conducted to evaluate the prevalence of airway obstruction among Latino poultry processing workers. Data were collected from 279 poultry processing workers and 222 other manual laborers via spirometry and interviewer-administered questionnaires. Participants employed in poultry processing reported the activities they perform at work. Participants with forced expiratory volume in one second (FEV--1) or FEV1/forced expiratory volume (FVC) below the lower limits of normal were categorized as having airway obstruction. Airway obstruction was identified in 13% of poultry processing workers and 12% of the comparison population. Among poultry processing workers, the highest prevalence of airway obstruction (21%) occurred among workers deboning chickens (prevalence ratio: 1.75; 95% confidence interval: 0.97, 3.15). These findings identify variations in the prevalence of airway obstruction across categories of work activities.
    Archives of Environmental and Occupational Health 05/2013; · 0.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Skin conditions are common among Latino migrant farm workers. Although many skin conditions are related to occupational exposures, poor housing conditions may also contribute to skin ailments in migrant farm workers. OBJECTIVES: To evaluate the association between housing conditions and skin conditions among Latino migrant farm workers. MATERIALS AND METHODS: A cross-sectional study design using interview questionnaires, home inspections, and environmental sampling was implemented to document housing quality of farm worker camps/homes and the prevalence of self-reported skin conditions in Latino migrant farm workers. Interviews were completed with 371 farm workers residing in 186 of the 226 camps (camp response rate 82.3%). RESULTS: Self-reported pruritus (31%), rash (25%), scaling (12%), blisters (11%), and ingrown nails (10%) were common among the participants. Pruritus was more likely to be reported by farm workers living in dwellings without air-conditioning (P < 0.05). Rash was associated with dwellings reported to have a low humidity (P < 0.05). Scaling was more likely to be reported by farm workers living in dwellings with indoor temperatures in the thermal discomfort range (P < 0.05). No statistically significant associations were detected for indoor allergens and self-reported skin ailments among migrant farm workers. CONCLUSIONS: Skin conditions are common among migrant farm workers in North Carolina. The quality of housing conditions, particularly hot, dry indoor thermal environment, demonstrated significant associations with pruritus, rash, and scaling. The impact of housing characteristics on pruritus and blisters was greatest in new migrant farm workers. Further research is needed to delineate additional housing factors that could cause or exacerbate skin diseases in farm workers.
    International journal of dermatology 05/2013; · 1.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: Immigrant workers make up an important portion of the hired workforce in the Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industry sectors in the US. Despite the inherent dangers associated with this sector, worker protection is limited. METHODS: This article describes the current occupational health and safety policies and regulatory standards in the AgFF sector and underscores the regulatory exceptions and limitations in worker protections. Immigration policies and their effects on worker health and safety are also discussed. Emphasis is placed on policies and practices in the Southeastern US. RESULTS: Worker protection in the AgFF sector is limited. Regulatory protections are generally weaker than other industrial sectors and enforcement of existing regulations is woefully inadequate. The vulnerability of the AgFF workforce is magnified by worker immigration status. Agricultural workers in particular are affected by a long history of "exceptionalism" under the law as many regulatory protections specifically exclude this workforce. CONCLUSIONS: A vulnerable workforce and high-hazard industries require regulatory protections that, at a minimum, are provided to workers in other industries. A systematic policy approach to strengthen occupational safety and health in the AgFF sector must address both immigration policy and worker protection regulations. Am. J. Ind. Med. XX:XXX-XXX, 2013. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 04/2013; · 1.59 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This analysis examines the associations of oral health with social integration among ethnically diverse (African American, American Indian, white) rural older adults. Data are from a cross-sectional survey of 635 randomly selected community-dwelling adults aged 60+. Measures include self-rated oral health, number of teeth, number of oral health problems, social engagement, and social network size. Minority elders have poorer oral health than do white older adults. Most rural elders have substantial social engagement and social networks. Better oral health (greater number of teeth) is directly associated with social engagement, while the relationship of oral health to social network size is complex. The association of oral health with social engagement does not differ by ethnicity. Poorer oral health is associated with less social integration among African American, American Indian and white elders. More research on the ways oral health affects the lives of older adults is warranted.
    Journal of Applied Gerontology 04/2013; 32(3):302-323. · 0.97 Impact Factor

Publication Stats

4k Citations
659.01 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
    • East Carolina University
      • Department of Public Health
      Greenville, NC, United States
    • Drexel University
      • Department of Environmental and Occupational Health
      Philadelphia, PA, United States
    • Oklahoma State University - Tulsa
      Tulsa, Oklahoma, United States
  • 2008–2012
    • University of North Carolina at Greensboro
      • • Department of Public Health Education
      • • Department of Nutrition
      Greensboro, NC, United States
  • 2011
    • Guilford College
      Greensboro, North Carolina, United States
    • Baylor University
      • Hankamer School of Business
      Waco, Texas, 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
  • 2005
    • University of Kentucky
      Lexington, Kentucky, United States