Thomas A Arcury

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

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Publications (366)641.23 Total impact

  • [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; · 1.94 Impact Factor
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    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
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    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; · 1.97 Impact Factor
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    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
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    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; · 1.97 Impact Factor
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    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
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    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;
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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
  • Article: Case Study.
    Journal of Occupational and Environmental Hygiene 07/2013; 10(7):D79-D85. · 1.28 Impact Factor
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    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
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    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
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    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
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    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 & occupational health. 05/2013;
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    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; · 1.18 Impact Factor
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    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; · 1.97 Impact Factor
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    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
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    ABSTRACT: Studies on complementary therapy use among adults with diabetes are limited by crude use measures and lack of specificity of use for treating diabetes. Data are from a study including baseline and repeated 3-day assessments of complementary therapy use among rural African American and White older (age ≥64) adults (n=71). Most commonly used complementary therapies for diabetes at baseline included prayer (88.7%), food/beverages (50.7%), herbs (11.3%) and home remedies (9.9%). In repeated measures (1131 interviews), prayer was used on 57.2% of days, followed by food/beverages (12.7%), herbs (3.4%) and home remedies (2.7%). 56.3% who reported praying did so on ≥5 reporting periods; other complementary therapy use was sporadic. These data show, with the exception of prayer and food/beverages, limited complementary therapy use for diabetes treatment among rural older adults, and less inconsistent use patterns of most complementary therapies. Further research is needed to understand the motivations and patterns of complementary therapy use for diabetes patients.
    Journal of evidence-based complementary & alternative medicine. 04/2013; 18(2).
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    ABSTRACT: BACKGROUND: The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the US is comprised primarily of Latino immigrants. Health care access for these workers is limited and increases health disparities. METHODS: This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers. CONTENTS: Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers. C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    American Journal of Industrial Medicine 03/2013; · 1.97 Impact Factor
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    ABSTRACT: This study examined the use of complementary and medical treatments, both individually and in combination, to address common general and upper respiratory symptoms. Data for the analysis were collected from a series of 18 daily diary questionnaires administered to community-living older African American and white adults living in rural counties in North Carolina. Participants reported symptoms experienced on each diary day and the treatment strategies they used each day in response to the particular symptom(s). Older adults used diverse categories of strategies to treat symptoms; treatment strategies were used inconsistently across symptoms. Use of only complementary strategies, only medical conventional strategies, or both complementary and medical strategies to treat any one symptom rarely corresponded to the use of the same strategy to address other symptoms. Future research would benefit from analyzing how older adults use health care strategies across symptom categories.
    Journal of applied gerontology : the official journal of the Southern Gerontological Society. 03/2013;
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    ABSTRACT: Background Immigrant Latino workers represent an expanding workforce in rural areas of the USA, where their employment is concentrated in occupations such as poultry processing that entail chemical, infectious, and mechanical skin exposures. Occupation-related skin illnesses in this vulnerable population are not well characterized. Objectives This study was designed to describe the prevalences of skin diseases among immigrant Latino poultry processors and other manual workers in North Carolina. Methods Community-based sampling was used to recruit 742 immigrant Latino workers, 518 of whom underwent a physical examination supervised by a board-certified dermatologist. The presence or absence of skin disease on the face, neck, arms, hands, and feet was recorded. Results Workers ranged in age from 18 years to 68 years. Slightly over half of the sample were male (52.6%). Poultry workers represented 55.8% of the study sample. Infectious skin diseases were the most common diagnosis, present in 52.3% of workers. Inflammatory skin diseases were present in 28.2% and pigmentary disorders in 21.8% of workers. The most common skin conditions were tinea pedis (37.6%), onychomycosis (31.9%), scars (13.7%), acne (11.8%), and melasma (9.3%). Age, sex, first language, and work as a poultry processor accounted in part for the prevalence of these diseases. Conclusions Several skin diseases are highly prevalent in immigrant Latino workers and may relate to work environment. These may impair the quality of life of these workers and predispose them to further illness.
    International journal of dermatology 03/2013; · 1.18 Impact Factor

Publication Stats

4k Citations
641.23 Total Impact Points

Institutions

  • 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
    • 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