Article

Occupational Exposures and Migration Factors Associated With Respiratory Health in California Latino Farm Workers The MICASA Study

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Abstract

To evaluate associations of agricultural work and migration on self-reported respiratory symptoms in a Latino farm worker sample. Work history and respiratory symptoms were assessed in 702 workers through interviews in a community-based cohort. Prevalence was 6% for asthma, 5% for chronic cough, 3% for chronic bronchitis, and 7% for persistent wheeze. The total number of years in agriculture was associated with asthma; however, time-weighted average dust exposure, use of protective equipment, and pesticide use in the past 12 months were not associated with respiratory outcomes. Living 15 years or more in the United States (adjusted odds ratio = 3.60; 95% confidence interval = 1.16 to 11.16) and medium/high acculturation (adjusted odds ratio = 6.06; 95% confidence interval = 1.40 to 26.29) were associated with increased odds of asthma in women. Analysis of this community-based Latino farm worker cohort identified associations with asthma, particularly with migration factors in women.

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... A study by Stoecklin-Marois et al. [28] demonstrates that many other complexities may contribute to asthma risk. In the MICASA study, 843 male and female Californian farmworkers aged 18-55 years were interviewed in person. ...
... Asthma prevalence was determined based on the ATS and NHLI Division of Lung Diseases (DLD) questionnaire (ATS-DLD-78 questionnaire) and acculturation (i.e. adoption of culture traits of another group) was measured based on the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II) [28]. Results showed an overall low asthma prevalence of 6%; however, the total number of years worked in agriculture was associated with asthma (OR: 1.04; CI: 1.00-1.09) ...
... Results showed an overall low asthma prevalence of 6%; however, the total number of years worked in agriculture was associated with asthma (OR: 1.04; CI: 1.00-1.09) [28]. In subset analysis, medium/high acculturated male farmers had no increased risk of asthma, but medium/ high acculturated female farmers had a higher prevalence of asthma (OR: 6.06; CI: 1.40-26.29) ...
Article
Objective: Recent studies have made advances into understanding the complex agriculture work exposure environment in influencing asthma in adults. The objective of this study is to review studies of occupational agricultural exposures including dust, animal, and pesticide exposures with asthma in adult populations. Data sources: PubMed databases were searched for articles pertaining to farming, agriculture, asthma, occupational asthma, airway inflammation, respiratory disease, lung disease, pesticides, and organic dust. Study selections: Studies chosen were published in or after 1999 that included adults and asthma and farming/agricultural work or agricultural exposures and airway inflammatory disease measurements. Results: The data remain inconclusive. Several retrospective studies demonstrate agricultural work to be protective against asthma in adults, especially with increased farming exposure over time. In contrast, other studies find increased risk of asthma with farming exposures, especially for the non-atopic adult. Mechanistic and genetic studies have focused on defining the wide variety and abundance of microorganisms within these complex organic dusts that trigger several pattern recognition receptor pathways to modulate the hosts' response. Conclusion: Asthma risk depends on the interplay of genetic factors, gender, atopic predisposition, type of livestock, pesticide exposure, and magnitude and duration of exposure in the adult subject. Longer exposure to occupational farming is associated with decreased asthma risk. However, studies also suggest that agricultural work and multiple types of livestock are independent risk factors for developing asthma. Prospective and longitudinal studies focusing on genetic polymorphisms, objective assessments, and environmental sampling are needed to further delineate the influence of agriculture exposure in the adult worker.
... specific pesticides). A study by Stoecklin-Marois et al. [28] demonstrates that many other complexities may contribute to asthma risk. In the MICASA study, 843 male and female Californian farmworkers aged 18–55 years were interviewed in person. ...
... Asthma prevalence was determined based on the ATS and NHLI Division of Lung Diseases (DLD) questionnaire (ATS- DLD-78 questionnaire) and acculturation (i.e. adoption of culture traits of another group) was measured based on the Acculturation Rating Scale for Mexican-Americans II (ARSMA-II) [28]. Results showed an overall low asthma prevalence of 6%; however, the total number of years worked in agriculture was associated with asthma (OR: 1.04; CI: 1.00–1.09) ...
... Results showed an overall low asthma prevalence of 6%; however, the total number of years worked in agriculture was associated with asthma (OR: 1.04; CI: 1.00–1.09) [28]. In subset analysis, medium/high acculturated male farmers had no increased risk of asthma, but medium/ high acculturated female farmers had a higher prevalence of asthma (OR: 6.06; CI: 1.40–26.29) ...
Chapter
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Objective: Recent studies have made advances into understanding the complex agriculture work exposure environment in influencing asthma in adults. The objective of this study is to review studies of occupational agricultural exposures including dust, animal, and pesticide exposures with asthma in adult populations. Data sources: PubMed databases were searched for articles pertaining to farming, agriculture, asthma, occupational asthma, airway inflammation , respiratory disease, lung disease, pesticides, and organic dust. Study selections: Studies chosen were published in or after 1999 that included adults and asthma and farming/ agricultural work or agricultural exposures and airway inflammatory disease measurements. Results: The data remain inconclusive. Several retrospective studies demonstrate agricultural work to be protective against asthma in adults, especially with increased farming exposure over time. In contrast, other studies find increased risk of asthma with farming exposures, especially for the non-atopic adult. Mechanistic and genetic studies have focused on defining the wide variety and abundance of microorganisms within these complex organic dusts that trigger several pattern recognition receptor pathways to modulate the hosts' response. Conclusion: Asthma risk depends on the interplay of genetic factors, gender, atopic predisposition, type of livestock, pesticide exposure, and magnitude and duration of exposure in the adult subject. Longer exposure to occupational farming is associated with decreased asthma risk. However, studies also suggest that agricultural work and multiple types of livestock are independent risk factors for developing asthma. Prospective and longitudinal studies focusing on genetic polymorphisms, objective assessments, and environmental sampling are needed to further delineate the influence of agriculture exposure in the adult worker.
... Negatu et al. [15] showed that patients with a history of alcohol consumption display higher levels of respiratory disorders than those who abstain from alcohol use. Work-related factors, such as lack of protective clothing, knowledge [23], direction while spraying pesticides, and safety measures against potential risks of pesticide exposure [24], can lead to higher risk of pesticide exposure [25] and alterations in AChE levels [26]. Typically, farmers either do not or incorrectly wear personal protective equipment, due to probable economic crisis, according to previous studies, which indicate a relationship between economic growth and poverty reduction in Indonesia before and after the Asian Financial Crisis [27]. ...
... Moreover, our results were inconsistent with those obtained from a cohort of Latin farm workers [26] and a matched case-control study in farm workers in India using OP-and CM-containing pesticides, both of which demonstrated a reduction in red blood cell AChE in association with respiratory disorder symptoms, including runny or stuffy nose, sore throat, dry cough, wheeze, breathlessness, chest tightness, dyspnea, and chronic bronchitis. It is important to note that the assessment patterns of pesticide exposure were different between the studies. ...
... For instance, the farm workers used hats for protection against sunlight instead of a mask to prevent pesticide inhalation. Personal preventive equipment use was not associated with RSDS, according to a report by Stoecklin-Marois [26], but inconsistent with a study by Thetkathuek et al. [53], which focused on pesticide use by Cambodian farm workers on a vegetable farm. The latter showed a link between the use of personal preventive equipment and respiratory, neuronal, and digestive disorder symptoms. ...
Article
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Migrant farm workers are exposed to occupational hazards in terms of exposure to pesticides containing organophosphate (OP) and carbamate (CM). In cases of mishandling of a pesticide, workers may be exposed to higher amounts of such toxic particles. Our study involved assessing factors related to respiratory disorders, including evidence of impaired lung function and respiratory system disorder symptoms (RSDS), in 274 migrant farm workers in Eastern Thailand. The experimental procedure involved interviews, as well as serum cholinesterase (SChE) and lung function assessments using a reactive paper blood test and spirometry, respectively. A multiple logistic regression analysis of independent variables and RSDS revealed an odds ratio (OR, 95% CI) of 2.787 (1.210, 6.470) in female subjects. Consumption of >4 glasses of alcohol/week and exposure to dust for >4 h/day were associated with an OR (95% CI) of 4.675 (1.395, 15.671) and 2.743 (1.238, 6.093), respectively. The multiple linear regression analysis of independent variables indicated that the SChE level, gender, age, and carrying of a sprayer were associated with as determined from the forced vital capacity (R = 0.579, R2 = 0.34; p < 0.05) and additionally associated with the forced expired volume in one second (R = 0.562, R2 = 0.315; p < 0.05). The assessment of respiratory system disorders is necessary for female farm workers who consume >3 glasses of alcohol/week, are older in age, and perform tasks that involve carrying a sprayer. Moreover, the SChE level should be routinely screened to monitor the health of migrant workers. Index Terms-Migrant farm workers, cholinesterase level, respiratory impairment, lung function test, fruit farm, Thailand.
... The reported prevalence are higher than the US baseline prevalence of asthma in Whites [13]. While the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) population-based study that interviewed Mexican-American adults in their homes in Spanish found an overall prevalence of asthma of 6.0%, 12.9% of participants reported having a respiratory symptom seen in asthma [14]. Agricultural work was associated with asthma (OR 1.04; 95% CI 1.00 to 1.09) and medium to highly acculturated women were six times more likely to have asthma (95% CI = 1.40 to 26.29) [14] and seven times more likely to have chronic bronchitis (OR 3.60; 95% CI 1.16 to 11.16) [14]. ...
... While the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) population-based study that interviewed Mexican-American adults in their homes in Spanish found an overall prevalence of asthma of 6.0%, 12.9% of participants reported having a respiratory symptom seen in asthma [14]. Agricultural work was associated with asthma (OR 1.04; 95% CI 1.00 to 1.09) and medium to highly acculturated women were six times more likely to have asthma (95% CI = 1.40 to 26.29) [14] and seven times more likely to have chronic bronchitis (OR 3.60; 95% CI 1.16 to 11.16) [14]. Men did not demonstrate the same association [14]. ...
... While the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) population-based study that interviewed Mexican-American adults in their homes in Spanish found an overall prevalence of asthma of 6.0%, 12.9% of participants reported having a respiratory symptom seen in asthma [14]. Agricultural work was associated with asthma (OR 1.04; 95% CI 1.00 to 1.09) and medium to highly acculturated women were six times more likely to have asthma (95% CI = 1.40 to 26.29) [14] and seven times more likely to have chronic bronchitis (OR 3.60; 95% CI 1.16 to 11.16) [14]. Men did not demonstrate the same association [14]. ...
Article
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Purpose of review: The aim of this review is to examine the prevalence of and impact of environmental exposures in the workplace and home on immigrant respiratory health in the USA. Recent findings: Few studies report levels of workplace and home environmental exposures for immigrant children and adults, and documenting these findings is an important first step to addressing their respiratory health concerns. Rates of respiratory disease are lowest upon first arrival and increase with duration of residency in the USA. Community Health Workers may be an efficacious intervention to reducing exposures and improving lung health among immigrant populations. Immigrant children and adults have a high risk of occupational and home environmental exposures that can negatively affect their respiratory health. While limited studies exist, more documentation of these exposures and their impact on immigrant person's respiratory health are needed to begin to tackle these disparities.
... Little is known about the physiological burden of crop production work performed in hot weather conditions, and even less is known about HRI in the Midwest as most studies are based in the southern states such as Arizona (Harlan et al., 2014), North Carolina (Beck, Balanay, & Johnson, 2018;Moyce et al., 2017), Texas (Zhang, Chen, & Begley, 2015), California, and Alabama (Singleton et al., 2016;Stoecklin, Bigham, Bennett, Tancredi, & Schenker, 2015). Also, there are few safety inspections for heat-related prevention/management strategies on U.S. farms except for the states of California (Arcury et al., 2015) and Washington (Reid & Schenker, 2016). ...
Article
Heat-related illness (HRI) is a largely undocumented phenomenon in Midwestern Hispanic migrant and seasonal farmworkers in the United States. Frequently, the physiological burden of crop production is overlooked while workers are in the fields. We completed a mixed-methods study using a cross-sectional survey among migrant and seasonal farmworkers about their experience with HRI symptoms (N = 148) and conducted an intensive surveillance on a smaller group of workers (N = 20) in field trials (N = 57 trials) using a chest-strapped multi-parameter monitoring wearable sensor (MPMWS) that measured skin/body temperature, heart and breathing rate, kilocalories burned per hour, and provided a physiological intensity (PI) score. The field trials were conducted across three classes of climate conditions and three PI score categories. We found that those in the uncomfortable category (PI score > 4.0) had a statistically significant (F ratio = 16.41, p <.001) higher body temperatures (M = 100.05°F) than those with a mild PI (range = 0-5) score ⩽ 2.5 (M = 99.56°F) or moderate PI score > 2.5-4 (99.84°F). We also found that those in the uncomfortable climate condition category had a higher mean heart rate and breathing rate than those working under mild and moderate field trials.
... Other research has shown that undocumented farmworkers in California were less likely to have health insurance or receive workers compensation or to have knowledge of worker's compensation than were documented workers [Villarejo et al., 2010]. Yet, other work has shown that this workforce has a large burden of ill health Stoecklin-Marois et al., 2015]. ...
Article
Objective: Farm work is labor-intensive, physically demanding, and incurs a high risk of injury. The aim of this study was to identify characteristics of farmworkers at increased risk of adverse health outcomes to focus targeted interventions. Methods: The National Agricultural Workers Survey for 2008-2012 was used to compare characteristics associated with adverse health and safety conditions among US-born and Mexican and Central American-born Latino and Indigenous, documented and undocumented farmworkers, separately for males and females. Results: US-born farmworkers had more secure work, worked less onerous tasks, and earned more per hour than other categories of farmworkers. Undocumented Indigenous workers had more precarious work, worked more onerous tasks, and were more likely to do piece work, than undocumented Latino workers. Discussion: We highlight disparities in modifiable occupational health risk factors across groups of farmworkers that are associated with increased risks of work-related injury and poor health. Am. J. Ind. Med. 59:644-655, 2016. © 2016 Wiley Periodicals, Inc.
... Other research has shown that undocumented farmworkers in California were less likely to have health insurance or receive workers compensation or to have knowledge of worker's compensation than were documented workers [Villarejo et al., 2010]. Yet, other work has shown that this workforce has a large burden of ill health Stoecklin-Marois et al., 2015]. ...
Article
Introduction Farm work is labour intensive, physically demanding and incurs a high risk of injury. Indigenous farmworkers from southern Mexico and Central America increasingly work on US farms. Few studies have examined the working conditions of farm workers in relation to both indigenous and documentation status because of the lack of available data. The aim of this study was to identify characteristics of farm workers at increased risk of adverse health outcomes. Methods The National Agricultural Workers Survey has collected data thrice annually from agricultural crop workers in the U.S. since 1989. Data for the most recent period, 2008–12 (n = 8898), was used to compare characteristics associated with adverse health and safety conditions. Specifically we examined demographic and job characteristics, working conditions, wages and access to health care and insurance among US-born and Mexican and Central American-born farmworkers. Descriptive analysis and regression models included indigenous and documentation status, and was done separately for males and females. Results 63% of US-born male farm workers were employed year round compared with 37% of undocumented indigenous males. US-born males (41%) and documented Latino males (48%) worked semi-skilled tasks compared with 23% of undocumented indigenous males who worked pre-harvest (33%) and harvest tasks (31%). Earnings were higher per hour for US-born males and females compared with all other groups $9 and $8, respectively. >80% of undocumented workers did not have health insurance compared with 34% of US-born females. In general documented farm workers and non-Indigenous fared better than undocumented and Indigenous, and on most measures undocumented Indigenous workers fared worst. Discussion We highlight disparities in modifiable occupational health risk factors across groups of farm workers that are associated with increased risks of work-related injury and poor health. Efforts to increase documentation of foreign-born farmworkers will likely result in beneficial health and safety outcomes.
... In this study behavioral characteristics such smoked cigarette, current smoker, sharing room with a smoker, use of cleaning detergent at home, vegetable garden at home and the use of pesticides at home were considered as factors which may also exacerbate respiratory symptoms among farmworkers. Self-behaviors such as smoking among farmworkers, have been reported with previous studies to be the source of respiratory health problems [13]. ...
... The study by Stoecklin-Marois et al. (2015) also reported an association between asthma and number of years in agriculture (OR=1.04, 95%CI=1.00-1.09)(39). These results were consistent with the study reporting that farm workers who were exposed to pesticide equal or more than 31 years had the highest odds of asthma (OR=2.32, ...
Article
This review paper aimed to analyze scientific evidence and provide an overview of the relationship of pesticide exposure with respiratory outcomes among farmers and farmworkers. It also synthesized the association of exposure to specific pesticides and other factors with respiratory outcomes. Articles published in PubMed, Scopus, and ScienceDirect databases from 1991 to 2018 were reviewed and the scientific evidence was evaluated. Forty-five articles were selected for synthesis. Twenty-nine pesticides revealed an association with respiratory diseases and 49 pesticides with respiratory symptoms. In addition, 14 pesticides had an association with both respiratory diseases and symptoms (seven for herbicides, six for insecticides, and one for fungicide). Although the evidence from these reviewed studies suggested an association between pesticide exposure and respiratory outcomes among farmers and farmworkers, several limitations from the studies were found. Toward a better quality for further research, prospective study, standardized tools for exposure and outcome assessment, appropriate sample size and sampling method, and controlled confounding factors, should be thoroughly considered.
... [138][139][140] As such, immigrant workers face a combination of risk factors for heat-related illnesses, including lack of OSH knowledge and quality training, poverty, seasonality of jobs, and extreme work conditions. [141][142][143][144][145] As new technologies are developed and evaluated, changing demographics must be taken into consideration to guarantee these technologies are inclusive of the workforce's diversity and equitably benefit and provide protections for all. For example, protecting the workforce requires that workers have properly fitting tools, machines, workspaces, and PPE. ...
Article
The future of work embodies changes to the workplace, work, and workforce, which require additional occupational safety and health (OSH) stakeholder attention. Examples include workplace developments in organizational design, technological job displacement, and work arrangements; work advances in artificial intelligence, robotics, and technologies; and workforce changes in demographics, economic security, and skills. This paper presents the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health's Future of Work Initiative; suggests an integrated approach to address worker safety, health, and well-being; introduces priority topics and subtopics that confer a framework for upcoming future of work research directions and resultant practical applications; and discusses preliminary next steps. All future of work issues impact one another. Future of work transformations are contingent upon each of the standalone factors discussed in this paper and their combined effects. Occupational safety and health stakeholders are becoming more aware of the significance and necessity of these factors for the workplace, work, and workforce to flourish, merely survive, or disappear altogether as the future evolves. The future of work offers numerous opportunities, while also presenting critical but not clearly understood difficulties, exposures, and hazards. It is the responsibility of OSH researchers and other partners to understand the implications of future of work scenarios to translate effective interventions into practice for employers safeguarding the safety, health, and well-being of their workers.
Article
Objective: This meta-analysis study was performed to examine the relationship between occupational exposure to pesticides and the risk of obstructive pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Study design: This is a systematic review and meta-analysis study. Methods: PubMed and Scopus databases were searched for English-language publications. Eight cohort studies and one case-control study were included in the pooled analysis. Results: These studies had a total of 101,353 participants from eleven different countries and were published between 2006 and 2018. The heterogeneity among the studies was high (P < 0.001, I2 = 68.7%). In a random-effects model meta-analysis, a pooled odds ratio (OR) analysis showed that there was a direct relationship between occupational exposure to the pesticides and obstructive pulmonary diseases (OR = 1.33, 95% confidence interval [CI]: 1.21-1.47). A positive significant relationship was also observed between exposure to the pesticides and risk of chronic bronchitis (OR = 1.27, 95% CI: 1.23-1.31). Also, there was a significant relationship between occupational exposure to the pesticides and an increased risk of COPD (OR = 1.44, 95% CI: 1.14-1.81). No evidence of publication bias was found among the studies according to the results of the Egger's test (P of bias = 0.157). Conclusions: Findings of this study show that occupational exposure to pesticides can be associated with an increased risk of obstructive lung diseases including chronic bronchitis and COPD.
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Background: The incidence of respiratory disease is increasing. In relation to this, in addition to infection, factors associated with working with chemical insecticides are a cause for concern. Some of the chemicals involved have been shown to affect the respiratory system, and consequentially workers are at increased risk of conditions such as asthma. However, medical opinion around this area is still controversial; therefore, the objective of this study is to investigate the association between exposure to insecticides and asthma by means of a systematic review of the relevant literature. Methods: Relevant literature was identified, and a systematic review was conducted to investigate the association between exposure to insecticides and asthma. Results: A total of five studies (three cross sectional and two cohort) including 45,435 subjects were identified as relevant. The summary odds ratios related to the impact of exposure to specific insecticides on asthma were organophosphates 1.31 (95% CI = 1.17–1.48, I2 = 27%, p = 0.172), carbamates 1.44 (95% CI 1.08–1.92, I2 = 56.7%, p = 0.031) and organochlorines 1.31 (95% CI 1.19–1.64, I2 = 37.3%, p = 0.131). Conclusion: Farmers exposed to certain insecticides may have an increased risk of asthma and asthmatic symptoms, but further research on that issue is urgently needed.
Article
Objective This meta-analysis study was performed to examine the relationship between occupational exposure to pesticides and the risk of obstructive pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and chronic bronchitis. Study design This is a systematic review and meta-analysis study. Methods PubMed and Scopus databases were searched for English-language publications. Eight cohort studies and one case–control study were included in the pooled analysis. Results These studies had a total of 101,353 participants from eleven different countries and were published between 2006 and 2018. The heterogeneity among the studies was high (P < 0.001, I2 = 68.7%). In a random-effects model meta-analysis, a pooled odds ratio (OR) analysis showed that there was a direct relationship between occupational exposure to the pesticides and obstructive pulmonary diseases (OR = 1.33, 95% confidence interval [CI]: 1.21–1.47). A positive significant relationship was also observed between exposure to the pesticides and risk of chronic bronchitis (OR = 1.27, 95% CI: 1.23–1.31). Also, there was a significant relationship between occupational exposure to the pesticides and an increased risk of COPD (OR = 1.44, 95% CI: 1.14–1.81). No evidence of publication bias was found among the studies according to the results of the Egger's test (P of bias = 0.157). Conclusions Findings of this study show that occupational exposure to pesticides can be associated with an increased risk of obstructive lung diseases including chronic bronchitis and COPD.
Chapter
Migrating populations are at greater risk from developing respiratory diseases. Although not usually considered a vulnerable group, migrants are more susceptible to experiencing higher rates of chronic lung diseases. Moving to a new country often involves a change in occupational and environmental exposures, such as ubiquitous allergens that lead to the development of allergic sensitization, air pollution mixtures and urban contextual environments, changes in diet and behaviors, and workplace exposures. Paradoxically, although migrants often move to better their social and economic status, they also adopt many of the risks factors that lead to chronic lung diseases. Further, occupational exposures due to farming increase the risk for developing different types of occupational lung parenchymal and airway disease. The development of lung diseases in migrating populations, especially in those that come from different social and living standards, is a process likely defined by a complex interplay of losing protective factors while gaining additional risks. This chapter will review the epidemiology of how US migration relates to relevant occupational and nonoccupational lung diseases, and propose future directions for research and health policy in migrant populations.
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To examine the effects of gender and acculturation on illicit drug use among the Mexican-origin population in California. The 3012 subjects between 18 and 59 years of age were selected under a stratified, multi-stage cluster sampling method. Fresno County in California is primarily agricultural, with only one metropolitan area. Over 30% of the total population of 764,800, are Hispanics, of Mexican origin. A modified version of the World Health Organization's Composite International Diagnostic Instrument (WHO-CIDI) was used to ascertain drug use. Respondents were considered drug users if they had ever used marijuana, cocaine, hallucinogens, heroin or inhalants. Acculturation was measured with a Likert scale, assessing English vs. Spanish language preference. Other covariates of interest were nativity and place of residence. Men had higher rates of use than women for every drug (men = 46.3%, women = 23.2%). Urban rates were higher than rural rates, for both women (urban = 32.8% vs. rural = 16.6%) and men (urban = 57.0% vs. rural = 36.8%). In logistic regression models, men were more likely than women to have ever used illicit drugs or inhalants (adjusted OR = 4.8), cocaine (adjusted OR = 5.3) or marijuana (OR = 4.3). However, the combined effect of United States nativity and acculturation, on drug use, was greater among women (adjusted OR = 29.3) than among men (adjusted OR = 7.4). The effect of acculturation was stronger among urban, than among town or rural residents. Acculturation and United States nativity are risk factors for illicit drug use among Mexican origin men and women. However, women have increased vulnerability compared with men. Findings reinforce the need for culturally based public health interventions.
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Hired farm workers provide the majority of the workforce for California's labor-intensive agricultural sector Agriculture is one of the most hazardous occupations, but there has been little research into the etiology of poor health outcomes that occur disproportionately in hired farm worker populations. MICASA is a cohort investigation of occupational and environmental health risks in hired farm worker households in Mendota, California, that employed a two-stage sampling process, including random selection of census blocks and door-to-door enumeration. The aim of this analysis was to evaluate the success of the sampling process and compare demographics of the enumerated population to other regional samples of Latino populations. In the enumeration, 1257 addresses were mapped and 729 hired farm worker households were enumerated. Findings showed no significant differences between the enumerated population and the resulting MICASA study sample; however, the MICASA population was more likely to be male, from Central America, work in agriculture, and have fewer years residency in the U.S. than California Health Interview Survey (CHIS) respondents. Additionally, 9.4% of the enumerated dwellings were back houses or unofficial dwellings and may have been missed by the U.S. Census 2000. Demographic comparisons between the enumerated population, census data, and CHIS data highlight the differences in these sampling methods and suggest possible demographic changes in hired farm workers in California. While difficulties in accessing hired farm workers often account for the lack of population-based research, the MICASA cohort provides an opportunity to examine occupational health patterns relevant to other farm worker populations.
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Respiratory health is an important component of the ability to perform physically demanding work. The authors assessed respiratory symptom prevalence among Latino farmworkers engaged in crop production, and investigated work activities as risk factors for respiratory symptoms. During June to September 2008, 122 farmworkers completed up to 3 questionnaires. The authors estimated associations between work activities and wheezing symptoms using alternating logistic regression, controlling for age and smoking. At the first data collection, 29 (24%) farmworkers reported ever wheezing and 10 (8%) reported wheezing within the past month. Though not statistically significant, the odds of wheezing were elevated for individuals who reported performing tobacco-related work in the last 3 days. The odds were decreased among individuals who reported harvesting activities (odds ratio: 0.3, 95% confidence interval: 0.1, 1.0). Among Latino farmworkers, respiratory symptoms may be associated with work activities.
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We conducted a cross-sectional study in the agricultural Central Valley to evaluate the prevalence of respiratory symptoms, smoking status, and pulmonary function in Hispanic California farmworkers. Of 759 farmworkers completing questionnaires and spirometry, 747 were Hispanic. The prevalences of current, former, and never smokers (29, 17, and 54 percent, respectively) were comparable to rates in other studies of Hispanics, but daily cigarette consumption (median-five for men and three for women) was lower than in comparison populations. Prevalences of chronic cough, chronic phlegm, and persistent wheeze were low (1.6, 5.1, and 2.8 percent, respectively). Current smoking, increased age, female sex, and working greater than or equal to 8 months per year in agriculture were associated with increased prevalence of respiratory symptoms. Adjusted lung function was higher than for reference populations. Hispanic California farmworkers have a similar smoking prevalence to other Hispanic populations, but lower respiratory symptom prevalences and higher pulmonary function are consistent with lower daily cigarette consumption and the "healthy worker effect."
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Data from the Hispanic Health and Nutrition Examination Survey were used to examine the influence of acculturation on alcohol consumption among Puerto Rican, Cuban-American, and Mexican-American women in the United States. Acculturation was found to be positively related to frequency of consumption and probability of being a drinker among all three groups. A positive relationship was also evident for total drinks consumed among Cuban-American women, and volume (drinks per occasion) and total drinks consumed among Mexican-American women.
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Personal exposure to dust and endotoxin was measured among 198 Dutch pig farmers. For each participant 8-h measurements were made on 2 days, one in summer 1991 and one in winter 1992. Mean time-weighted average (TWA) exposure to dust was 3.0 mg m−3 (arithmetic mean, range 0.3–27 mg m−3) and mean TWA exposure to endotoxin was 130 ng m−3 (arithmetic mean, range 6–1503 mg m−3). Empirical statistical modelling was applied to identify activities and farm characteristics associated with exposure. In a multiple least-squares regression analysis, aspects of hygiene and feeding were major characteristics associated with dust exposure. Flooring and feeding were predominant characteristics explaining variation in endotoxin exposure. Activities performed frequently, like feeding and controlling, cleaning activities and activities in which very active animals were involved, such as teeth cutting and ear tagging, were associated with exposure to dust and endotoxin. The models were used to set priorities for the development of control measures to eliminate the dust and endotoxin hazard of pig farmers.
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Data from the Southwestern sample of the Hispanic HANES are employed to evaluate the relationship of acculturation into the larger society with alcohol consumption. As in previous work, acculturation was not found to be related to alcohol consumption of Mexican American men, but was positively related to the consumption of younger Mexican American women. Among middle-aged women, acculturation was not important. However, we found evidence that middle-aged women might be turning to alcohol in response to marital disruption and poverty. In addition, middle-aged women who are not employed are less frequent drinkers but those who drink are heavier drinkers than employed women.
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Chronic bronchitis was studied in relation to work time and years of exposure in farming, as well as to production type, dusty occupation outside farming, and the combination of work exposure and smoking, in a population of farmers. In 1989 a representative cohort of 10,792 farmers and spouses was selected from a government register and invited to participate in a cross-sectional study in 1991. The total response rate was 80%. There were 33% part-time farmers, and among the men 32% of the full-time and 42% of the part-time farmers had worked in dusty occupations outside farming. Bronchitis symptoms were recorded on a self-administered questionnaire, spirometric data were obtained, and internal reference equations were calculated for forced expiratory volume in 1 s (FEV1.0). The exposure factors of importance for chronic bronchitis were full-time farming versus part-time farming, livestock production types (poultry, dairy, swine, horse and combinations), and occupational dust exposure outside agriculture. The combinations of the work exposure factors were significant and showed a 2- to 3-fold increase in risk for chronic bronchitis. Combinations with smoking showed up to a 6-fold increase in risk. Over the age of 50 years, chronic bronchitis was a risk factor for airway obstruction defined as the standardized residuals for FEV1.0 less than -2 for both nonsmokers (OR 2.8, 95% CI 1.1-6.8) and smokers (OR 8.5, 95% CI 5.1-14.3). Work exposure factors in farming and other dusty occupations enhance the risk for chronic bronchitis from 2- to 3-fold for farmers. In combination with smoking the risk increases to up to 6-fold.
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The aim of this study was to measure personal dust exposure levels and the dust particle size distribution during various agricultural operations in California. Personal dust exposure levels were measured with four-stage cascade impactors and respirable dust cyclones during field crop, fruit and nut farming, and dairy operations at three farms. Altogether, 103 cascade impactor measurements and 108 cyclone measurements were taken. High personal dust exposure levels were measured during various operations in particular during ground preparation operations such as land planing (geometric mean [GM] = 57.3 mg/m3, geometric standard deviation [GSD] = 2.4) and discing (GM = 98.6 mg/m3, GSD = 2.9). Dust particles were relatively large and the great majority belonged to the extrathoracic fraction. Dust levels were considerably lower when an enclosed cabin was present on the tractor; for example, during discing, dust exposure levels were reduced more than sixtyfold for the larger dust particle fraction and more than fourfold for the respirable dust fraction.
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The aim of this study was to identify determinants, if any, of personal dust exposure levels during agricultural field crop operations in California. Personal dust concentrations were measured with four-stage cascade impactors and respirable dust cyclones. Altogether, 57 cascade impactor measurements and 63 cyclone measurements were used for analyses. High personal dust concentrations were measured during most operations, in particular during ground preparation operations such as land planing and discing. For the larger dust particles, which is dust collected on all stages of the cascade impactor and dust with a 50% cutoff < 9.8 microns, the most important determinants of personal dust exposure were the presence of an enclosed cabin, relative humidity, type of operation, and tractor speed. The presence of an enclosed cabin on the tractor, higher relative humidity, and lower tractor speed were all associated with a decrease in personal dust levels. For smaller dust particles, which is dust with a 50% cutoff < 3.5-4 microns, the presence of an enclosed cabin, relative humidity, and soil temperature appear to be related to dust levels. The results of this study could be used to reduce the high levels of personal dust exposure currently experienced by those who work in field crop farming in California.
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The aim of this study was to measure personal exposure to dust, endotoxin and crystalline silica during various agricultural operations in California over a period of one year. Ten farms were randomly selected in Yolo and Solano counties and workers were invited to wear personal sampling equipment to measure inhalable and respirable dust levels during various operations. The samples were analysed for endotoxin using the Limulus Amebocyte Lysate assay and crystalline silica content using X-ray diffraction. In total 142 inhalable samples and 144 respirable samples were collected. The measurements showed considerable difference in exposure levels between various operations, in particular for the inhalable fraction of the dust and the endotoxin. Machine harvesting of tree crops (Geometric mean (GM) = 45.1 mg/m3) and vegetables (GM = 7.9 mg/m3), and cleaning of poultry houses (GM = 6.7 mg/m3) showed the highest inhalable dust levels. Cleaning of poultry houses also showed the highest inhalable endotoxin levels (GM = 1861 EU/m3). Respirable dust levels were generally low, except for machine harvesting of tree crops (GM = 2.8 mg/m3) and vegetables (GM = 0.9 mg/m3). Respirable endotoxin levels were also low. For the inhalable dust fraction, levels were reduced considerably when an enclosed cabin was present. The percentage of crystalline silica was overall higher in the respirable dust samples than the inhalable dust samples. Considerable differences exist in personal exposure levels to dust, endotoxin and crystalline silica during various agricultural operations in California agriculture with some operations showing very high levels.
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Relative to non-Latino Whites, Latinos have a worse socioeconomic profile but a lower mortality rate, a finding that presents an epidemiologic paradox. This study tested the salmon bias hypothesis that Latinos engage in return migration to their country of origin and are thereby rendered "statistically immortal" and the alternative hypothesis that selection of healthier migrants to the United States accounts for the paradox. National Longitudinal Mortality Study data were used to examine mortality rates of the following groups for whom the salmon hypothesis is not feasible: Cubans, who face barriers against return migration; Puerto Ricans, whose deaths in Puerto Rico are recorded in US national statistics; and US-born individuals, who are not subject to either salmon or healthy migrant effects. The sample included 301,718 non-Latino Whites and 17,375 Latino Whites 25 years or older. Cubans and Puerto Ricans had lower mortality than non-Latino Whites. Moreover, US-born Latinos had lower mortality than US-born non-Latino Whites. Neither the salmon nor the healthy migrant hypothesis explains the pattern of findings. Other factors must be operating to produce the lower mortality.
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Most studies of respiratory disease from dust exposure in the agricultural workplace have focused on allergic diseases caused by inorganic dusts, specifically occupational asthma and hypersensitivity pneumonitis. Exposures to inorganic (mineral) dusts among farmers and farm workers may be substantial. Such exposures are most frequent in dry-climate farming regions. In such locations farming activities that perturb the soil (e.g., plowing, tilling) commonly result in exposures to farm operators of 1-5 mg/m(3) respirable dust and >= 20 mg/m(3) total dust. The composition of inorganic dust in agriculture generally reflects the soil composition. Crystalline silica may represent up to 20% of particles, and silicates represent up to 80%. These very high concentrations of inorganic dust are likely to explain some of the increase in chronic bronchitis reported in many studies of farmers. Pulmonary fibrosis (mixed dust pneumoconiosis) has been reported in agricultural workers, and dust samples from the lungs in these cases reflect the composition of agricultural soils, strongly suggesting an etiologic role for inorganic agricultural dusts. However, the prevalence and clinical severity of these cases are unknown, and many exposures are to mixed organic and inorganic dusts. Epidemiologic studies of farmers in diverse geographic settings also have observed an increase in chronic obstructive pulmonary disease morbidity and mortality. It is plausible that agricultural exposure to inorganic dusts is causally associated with chronic bronchitis, interstitial fibrosis, and chronic obstructive pulmonary disease, but the independent contribution of mineral dusts beyond the effects of organic dusts remains to be determined. Images Figure 1 Figure 2 Figure 3
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We studied the relationship between occupational exposures, chronic bronchitis, and lung function in a general population survey in 14 industrialized countries, including 13,253 men and women aged 20 to 44 yr. We studied associations between occupational group, occupational exposures, bronchitis symptoms (cough and phlegm production for at least 3 mo each year), FEV(1), and nonspecific bronchial responsiveness (NSBR) separately in lifetime nonsmokers, cigarette smokers, and ex-smokers. Occupational exposure to vapors, gas, dust, or fumes, estimated with a job exposure matrix (JEM), was associated with chronic bronchitis among current smokers only (prevalence ratio (PR): 1.2 to 1.7). The interaction of occupational exposure with smoking, however, was not statistically significant (p > 0.1). Self-reported exposure was related to chronic bronchitis in all smoking groups. An increased risk for chronic bronchitis was found in agricultural, textile, paper, wood, chemical, and food processing workers, being more pronounced in smokers. Lung function and NSBR were not clearly related to occupational exposures. Findings were similar for asthmatic and nonasthmatic subjects. In conclusion, occupational exposures contributed to the occurrence of chronic (industrial) bronchitis in young adults. Fixed airflow limitation was not evident, probably due to the relatively young age of this population.
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This paper reviews the literature on the nature of the Hispanic paradox and the major explanations provided for it. We conclude by suggesting directions for future research. DATA IDENTIFICATION AND STUDY SELECTION: Articles were selected by a systematic review procedure using Medline (1966 through 1999) and Sociological Abstracts (1963 through 1999), as well as focused searches on specific diseases or factors believed to influence Hispanic health. For the past twenty years there has been widespread evidence of an Hispanic paradox in the United States, in which most Hispanic groups are characterized by low socioeconomic status, but better than expected health and mortality outcomes. A closer look reveals variations by age, gender, Hispanic subgroup, acculturation, country of birth, and cause of death. Possible under-reporting of Hispanic deaths, "salmon bias" and healthy migrant effects, and risk profile may contribute to, but do not explain, the paradox. The reasons for this paradox are likely to be multifactorial and social in origin. Empirical studies should be conducted on the protective effects of immigrant status, identification with a subculture, interaction between acculturation and socioeconomic status, and supportive aspects of Hispanic culture.
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Respiratory diseases have long been recognized in association with work in farming. Overall, only a small proportion of the population is employed in agriculture, so respiratory disease in farmers is not a major public health issue. However, farmers are known to have high morbidity and mortality from certain respiratory diseases, as shown by routinely collected statistics. Despite this, knowledge of the frequency, nature and risk factors for some respiratory disorders in agricultural workers is incomplete. Multiple exposures are common and some exposures can give rise to more than one specific disease. Moreover, the most common respiratory symptoms reported by farm workers (wheeze, dyspnoea and cough) are relatively non-specific and can be associated with several occupational respiratory disorders. This review describes the main occupational respiratory illnesses in farming and summarizes the current literature about epidemiology and prevention. The most important diseases are rhinitis and asthma, which, although common, are not usually fatal. Some non-allergic conditions, e.g. asthma-like syndrome and organic toxic dust syndrome, are not yet fully understood, but appear to be common among farm workers. The most serious respiratory diseases are hypersensitivity pneumonitis and respiratory infections, but these are rare. Most importantly, respiratory diseases are preventable by controlling harmful exposures to organic dust, toxic gases and chemicals on farms through improvements in animal rearing techniques, ventilation of animal accommodation, careful drying and storage of animal feed-stuffs, crops and other products, and use of personal protective equipment.
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In the United States, among Hispanics, Mexican Americans have the lowest rate of asthma. However, this population includes Mexican Americans born in the United States and in Mexico, and risk factors that might impact the prevalence of asthma differ between these groups. To determine the prevalence of and risk factors for asthma among U.S.- and Mexican-born Mexican Americans, we analyzed data from two U.S. surveys that included 4,574 persons who self-reported their ethnicity as Mexican American from the Third National Health and Nutrition Examination Survey (NHANES III) 1998-1994 and 12,980 persons who self-reported their ethnicity as Mexican American from National Health Interview Survey (NHIS) 1997-2001. U.S.-born Mexican Americans were more likely than Mexican-born Mexican Americans to report ever having asthma in both the NHANES III (7% [SE 0.5] vs. 3% [SE 0.3], p < 0.001) and NHIS surveys (8.1% [0.4] vs. 2.5% [0.2], p < 0.001). In a multivariate regression model controlling for multiple demographic variables and health care, the risk for asthma was higher among U.S.-born Mexicans in NHANES III (odds ratio 2.1, 95% confidence interval 1.4-3.3) and NHIS (odds ratio 2.7, 95% confidence interval 1.6-5.5). In conclusion, the prevalence of asthma was higher in U.S.-born than in Mexican-born Mexican Americans. This finding highlights the importance of environmental exposures in developing asthma in a migratory population.
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This chapter provides an overview of the concept of acculturation and reviews existing evidence about the possible relationships between acculturation and selected health and behavioral outcomes among Latinos. The effect of acculturation on Latino health is complex and not well understood. In certain areas-substance abuse, dietary practices, and birth outcomes-there is evidence that acculturation has a negative effect and that it is associated with worse health outcomes, behaviors, or perceptions. In others-health care use and self-perceptions of health-the effect is mostly in the positive direction. Although the literature, to date, on acculturation lacks some breadth and methodological rigor, the public health significance of findings in areas in which there is enough evidence justifies public health action. We conclude with a set of general recommendations in two areas-public health practice and research-targeted to public health personnel in academia, community-based settings, and government agencies.
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The U.S. population is aging and is expected to double by the year 2030. The current study evaluated the prevalence of asthma and its correlates in the elderly Hispanic and non-Hispanic white population. Data from a sample of 3021 Hispanics and non-Hispanic White subjects, 65 years and older, interviewed as part of an ongoing cross-sectional study of the elderly in west Texas, were analyzed. The outcome variable was categorized into: no asthma (reference category), current asthma, and probable asthma. Polytomous logistic regression analysis was used to assess the relationship between the outcome variable and various socio-demographic measures, self-rated health, asthma symptoms, quality of life measures (SF-12), and various occupations. The estimated prevalence of current asthma and probable asthma were 6.3% (95%CI: 5.3-7.2) and 9.0% (95%CI: 7.8-10.1) respectively. The majority of subjects with current asthma (Mean SF-12 score 35.8, 95%CI: 34.2-37.4) or probable asthma (35.3, 34.0-36.6) had significantly worse physical health-related quality of life as compared to subjects without asthma (42.6, 42.1-43.1). In multiple logistic regression analyses, women had a 1.64 times greater odds of current asthma (95%CI: 1.12-2.38) as compared to men. Hay fever was a strong predictor of both current and probable asthma. The odds of current asthma were 1.78 times (95%CI: 1.24-2.55) greater among past smokers; whereas the odds of probable asthma were 2.73 times (95%CI: 1.77-4.21) greater among current smokers as compared to non-smokers. Similarly fair/poor self rated health and complaints of severe pain were independently associated with current and probable asthma. The odds of current and probable asthma were almost two fold greater for obesity. When stratified by gender, the odds were significantly greater among females (p-value for interaction term = 0.038). The odds of current asthma were significantly greater for farm-related occupations (adjusted OR = 2.09, 95%CI: 1.00-4.39); whereas the odds were significantly lower among those who reported teaching as their longest held occupation (adjusted OR = 0.36, 95%CI = 0.18-0.74). This study found that asthma is a common medical condition in the elderly and it significantly impacts quality of life and general health status. Results support adopting an integrated approach in identifying and controlling asthma in this population.
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Hispanic individuals trace their ancestry to countries that were previously under Spanish rule, including Mexico, large parts of Central and South America, and some Caribbean islands. Most--but not all--Hispanics have variable proportions of European, Amerindian, and African ancestry. Hispanics are diverse with regard to many factors, including racial ancestry, country of origin, area of residence, socioeconomic status, education, and access to health care. Recent findings suggest that there is marked variation in the prevalence, morbidity, and mortality of asthma in Hispanics in the United States and in Hispanic America. The reasons for differences in asthma and asthma morbidity among and within Hispanic subgroups are poorly understood but are likely due to the interaction between yet-unidentified genetic variants and other factors, including environmental tobacco smoke exposure, obesity, allergen exposure, and availability of health care. Barriers to optimal management of asthma in Hispanics in the United States and in Hispanic America include inadequate access to health care, suboptimal use of antiinflammatory medications, and lack of reference values for spirometric measures of lung function in many subgroups (e.g., Puerto Ricans). Future studies of asthma in Hispanics should include large samples of subgroups that are well characterized with regard to self-reported ethnicity, country of origin, place of birth, area of residence, and indicators of socioeconomic status. Because Hispanics are disproportionately represented among the poor in the United States, implementation of adequate access to health care and social reforms (e.g., improving housing conditions) would likely have a major impact on reducing asthma morbidity in this population.
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Standardized procedures have been developed for use in epidemiological studies of relatively large population groups. Investigations of this type often require field studies carried on at a distance from traditional research laboratories. To obtain adequate data with a minimum of bias in such studies, which involve large numbers of subjects, time limitations, unavailability of sophisticated equipment, and a multiplicity of observers, simple and reliable standardized procedures are needed. In some respects, epidemiological studies serve as screening procedures. Performed initially or cross-sectionally, they determine the prevalence of symptoms, status of pulmonary function, and similar situations at one point in time. Repeated, using the same population at a later point in time, they serve as prospective or longitudinal studies and can then determine incidence of disease or give information regarding the progression of illness. Data required for epidemiological studies may differ from those required for clinical studies, which are diagnostic and directed toward individuals rather than groups. In clinical studies, much more detailed information about an individual may be required to assure correct diagnosis. This report does not deal with population selection or numbers of subjects. These topics were the subjects of an earlier report from a Committee on Standards for Epidemiological Survey in Chronic Respiratory Disease of the American Thoracic Society (ATS), published in 1969. Reference should be made to that document, which complements this presentation. Here we are concerned with how and when to use standard questionnaires on respiratory symptoms, tests of pulmonary function, and chest radiographs.
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Objective: To study whether dust exposure in California agriculture is a risk factor for respiratory symptoms. Methods: A population-based survey of 194 7 California farmers collected respiratory symptoms, occupational and personal exposures. Associations between dust and respiratory symptoms were assessed by logistic regression models. Results: The prevalence of Persistent wheeze was 8.6%, chronic bronchitis 3.8%, chronic cough 4.2%, and asthma 7.8%. Persistent wheeze was independently associated with dust in a dose-response fashion odds ratio 1.2 (95% confidence, interval [CI] = 0.8-2.0) and 1.8 (95% CI = 1.1-3.2) for low and high.. time In dust. A borderline significant association between chronic bronchitis and dust exposure was found. Asthma was associated with keeping livestock, but not with dust exposure. Conclusions: Occupational dust exposure among California farmers, only one third of whom tended animals, was independently associated with chronic respiratory symptoms.
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The incidence of work-related asthma far exceeds that of other causes of occupational pulmonary disease in the industrialized world. An estimated 2% to 15% of all adult asthma cases are work related, and some 250 causal agents have been identified. Compared with other industrial disorders, work-related asthma frequently results in more persistent and sometimes permanent effects.
Article
Personal exposure to dust and endotoxin was measured among 198 Dutch pig farmers. For each participant 8-h measurements were made on 2 days, one in summer 1991 and one in winter 1992. Mean time-weighted average (TWA) exposure to dust was 3.0 mg m−3 (arithmetic mean, range 0.3–27 mg m−3) and mean TWA exposure to endotoxin was 130 ng m−3 (arithmetic mean, range 6–1503 mg m−3). Empirical statistical modelling was applied to identify activities and farm characteristics associated with exposure. In a multiple least-squares regression analysis, aspects of hygiene and feeding were major characteristics associated with dust exposure. Flooring and feeding were predominant characteristics explaining variation in endotoxin exposure. Activities performed frequently, like feeding and controlling, cleaning activities and activities in which very active animals were involved, such as teeth cutting and ear tagging, were associated with exposure to dust and endotoxin. The models were used to set priorities for the development of control measures to eliminate the dust and endotoxin hazard of pig farmers.
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The Acculturation Rating Scale for Mexican Americans (ARSMA) was revised for the purpose of developing an instrument that assessed acculturation processes through an orthogonal, multidimensional approach by measuring cultural orientation toward the Mexican culture and the Anglo culture independently. Two subscales, Anglo Orientation Subcale (AOS) and Mexican Orientation Subscale (MOS), were developed from items from the original ARSMA scale. The two cultural orientation subscales were found to have good internal reliabilities (Cronbach's Alpha = .86 and .88 for the AOS and the MOS, respectively. The revised scale (ARSMA-JJ) yielded a high Pearson correlation coefficient (r = .89) with the original scale. Strong construct validity of ARSMA -II was demonstrated using a sample of 379 individuals representing generations I to 5. ARSMA-II is multifactorial and capable of generating multidimensional acculturative types, for example, integrated, separated, assimilated and marginalized.
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The differential dignosis of asthma in farm workers is between a type I hypersensitivity to a pollen or dust allergen and a type III hypersensitivity to mould antigens. We describe asthma and rhinitis, and not farmer's lung, in a farming population due to the non-pyroglyphid grain storage mite. Before a diagnosis of farmers' lung due to mouldy hay is made in any patient whether or not precipitins to Micropolyspora faeni are present, skin tests for storage mite should be made. If these are positive a diagnosis of ‘barn allergy’ should be considered and a trial of sodium cromoglycate be given.
Article
To evaluate the association between birthplace (Mexico or U.S.) and obesity in men and women and to analyze the relationship between duration of U.S. residency and prevalence of obesity in Mexican immigrants. We used cross-sectional data from 7503 adults of Mexican descent residing in Harris County, TX, to evaluate the relationships among BMI, birthplace, and years of residency in the U.S., controlling for demographic characteristics, physical activity level, and acculturation level. U.S.-born adults had an increased risk (between 34% and 65%) of obesity compared with their Mexican-born counterparts. After controlling for recognized confounders and risk factors, this association was maintained in the highly acculturated only. Among highly acculturated obese U.S.-born men, 6% of the cases were attributable to the joint effect of birthplace and acculturation; in women, this proportion was 25%. Among Mexican-born women, there was an increasing trend in mean BMI with increasing duration of residency in the U.S.. Compared with immigrants who had lived in the U.S. for <5 years, Mexican-born women who had resided in the U.S. for >or=15 years had an adjusted BMI mean difference of 2.12 kg/m2 (95% confidence interval, 1.53-2.72). Mexican-born men and women have a lower risk of obesity than their U.S.-born counterparts, but length of U.S. residency among immigrants, especially in women, is directly associated with risk of obesity. Development of culturally specific interventions to prevent obesity in recent immigrants may have an important public health effect in this population.
Article
p>(Artikkelen er gjenopptrykket fra Scandinavian Journal of Work, Environment and Health 1997; 23: 271-280), og finnes derfor ikke online her) http://www.sjweh.fi/show_issue.php?issue_id=23 </p
Article
Background There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries. Methods We assessed data on 15637 people aged 20–44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed. Findings Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2·62 [95% CI 1·29–5·35]), painters (2·34 [1·04–5·28]), plastic workers (2·20 [0·59–8·29]), cleaners (1·97 [1·33–2·92]), spray painters (1·96 [0·72–5·34]), and agricultural workers (1·79 [1·02–3·16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%–10%. Interpretation The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0·2%–0·5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.
Article
To quantify the respiratory disease burden among agricultural workers, we examined the 1988-1998 National Center for Health Statistics (NCHS) "Multiple Cause of Death Data" and the 1988-1994 Third National Health and Nutrition Examination Survey data (NHANES III). Proportionate mortality ratios (PMRs) were determined for 11 respiratory conditions among 6 agricultural groups: crop farm workers, livestock farm workers, farm managers, landscape and horticultural workers, forestry workers, and fishery workers. Prevalence ratios (PRs) were determined for 12 respiratory conditions among 3 agricultural groups: farm workers, farm managers, and other agricultural workers. Disease categories groups were based on the 9th International Classification of Diseases and the agricultural groups on the NCHS or NHANES III industry and occupation codes, respectively. Crop farm workers and livestock farm workers had significantly elevated mortality for several respiratory conditions, with mortality for hypersensitivity pneumonitis being 10 and 50 times higher than expected. Landscape and horticultural workers had significantly elevated mortality for abscess of the lung and mediastinum and chronic airways obstruction. Forestry workers had significantly elevated mortality for pulmonary tuberculosis, chronic airways obstruction, and pneumonia. Prevalence of wheeze was elevated for female farm workers, shortness of breath was elevated for farm workers who had ever smoked, and hay fever was elevated for black, non-Hispanic farm workers. Prevalence of asthma was elevated for other agricultural workers who had ever smoked. Farm workers had a PR of 173 for obstructive respiratory abnormality. Continued improvement in occupational health surveillance systems for agriculture is essential to help guide prevention efforts for respiratory disease.
Article
The differential diagnosis of asthma in farm workers is between a type I hypersensitivity to a pollen or dust allergen and a type III hypersensitivity to mould antigens. We describe asthma and rhinitis, and not farmer's lung, in a farming population due to the non-pyroglyphid grain storage mite. Before a diagnosis of farmers' lung due to mouldy hay is made in any patient whether or not precipitins to Micropolyspora faeni are present, skin tests for storage mite should be made. If these are positive a diagnosis of 'barn allergy' should be considered and a trial of sodium cromoglycate be given.
Article
To study genetic and environmental determinants of non-insulin-dependent (type II) diabetes, we compared a random sample of 35- to 64-yr-old Mexican-American men and women living in several low-income barrio neighborhoods of San Antonio to similarly aged Mexicans living in a low-income colonia of Mexico City (Colonia Liberales). A total of 1138 Mexican Americans, representing 64.3% of the original sample, and 646 Mexicans, representing 69.2% of the original sample, participated in the survey. Diabetes was diagnosed using World Health Organization criteria. Genetic susceptibility to type II diabetes was inferred from the percentage of Native American genetic admixture as estimated from skin reflectance measurements. The prevalence of diabetes was 36% higher among San Antonio Mexican Americans than among Mexicans in Mexico City; this difference was highly statistically significant (age- and sex-adjusted prevalence ratio 1.36, P = 0.006). This excess was observed despite the fact that genetic susceptibility, as inferred from the admixture estimates, was similar in the two cities. On the other hand, Mexicans were somewhat leaner as measured by body mass index and skin folds. Mexican women consumed fewer total calories than Mexican-American women, but there was no difference in the caloric intake of men. Mexico City residents ate less fat (18-19% of total calories vs. 31-32% in San Antonio, P less than 0.001), more carbohydrate (64-65 vs. 49%, P less than 0.001), and performed more physical activity than San Antonio Mexican Americans. Mexicans appeared to consume more refined sugar than Mexican Americans.(ABSTRACT TRUNCATED AT 250 WORDS)
Article
The purpose of our study was to describe the relationship between acculturation and hypertension in elderly Mexican Americans. Two age groups, 55-64 and 65-74, were examined from data provided in the Hispanic Health and Nutrition Examination Survey (HHANES). The prevalence of hypertension among subgroups of different acculturation was ascertained based on the modified Cuellar Acculturation Scale. Each age group was also stratified using the HHANES poverty index, with those above the index compared to those below. A stepwise logistic regression was performed among the variables of poverty, gender, age, and acculturation in relation to hypertension. The results indicate that acculturation and age are stronger predictors of hypertension than poverty in elderly Mexican Americans, with acculturation being a stronger predictor among those age 55-64. Factors related to acculturation may have a stronger influence on the prevalence of hypertension in older Mexican Americans than differences related to socioeconomic status.
Article
An analysis of the relationship between generational status, or migrational experience, and adolescent drug use takes advantage of a natural experiment—the migration of Puerto Ricans to the continental United States and their immigration back to the island. Although researchers have studied different sources of variation in adolescent drug use behavior, few have examined the drug use experience of the same ethnic group in varying sociocultural settings. The present study focussed on the drug use involvement of four generational status groups of Puerto Rican adolescents in two different settings—New York City and San Juan, Puerto Rico. The groups surveyed in New York City were: New York Ricans (New York City-born Puerto Ricans) and New York migrants (island-born Puerto Rican adolescents). The two groups identified in Puerto Rico were: Puerto Rican islanders (adolescents who had never lived outside of Puerto Rico) and Puerto Rican immigrants (New York City-born youngsters of Puerto Rican parentage whose families had returned to live on the island).
Article
One hundred thirty-three grain-store workers employed at a regional grain store in Essex, U.K., participated in a survey of respiratory symptoms, lung function, bronchial responsiveness to methacholine and skin tests, and specific IgE to occupational allergens, including extracts of five storage-mite (SM) species and grain extracts. Previously reported associations between occupational respiratory symptoms and cigarette smoking, and symptoms of bronchial hyperresponsiveness to methacholine were confirmed. This study also disclosed significant associations between work-related symptoms (WRS) and positive skin tests and/or specific IgE to SMs, but not between WRSs and positive skin tests or specific IgE to Dermatophagoides pteronyssinus, or between WRSs and positive skin tests to grain. These findings suggest that in United Kingdom grain workers, allergic responses to SMs may be another factor responsible for WRSs in grain-store workers.
Article
Current knowledge is scarce on Latino dietary practices. This study compared the dietary practices, alcohol consumption, and smoking behavior of Latinos and non-Latino whites in two randomly selected samples. Telephone surveys of adults 35-74 years of age from the Kaiser Permanente Medical Care Program (Latinos = 844; non-Latino whites = 510) and from census tract-based areas (Latinos = 806; non-Latino whites = 436) were conducted in the San Francisco Bay Area. Latino ethnicity was a significant predictor of dietary and alcohol consumption practices in multivariate logistic regression models after adjustment for sex, education, age, employment, health insurance, martial status, county of residence, and self-perceived health status. Compared with non-Latino whites, Latinos were significantly less likely to report eating vegetables and more likely to eat rice, beans, and fried foods and to drink whole milk. Less acculturated Latinos were more likely to eat fruits, rice, beans, meat, and fried foods and to drink whole milk than more acculturated Latinos. Latino men were significantly more likely to be binge drinkers, and Latina women were significantly more likely to abstain from drinking alcohol during the month prior to the interview. As Latina women acculturate to the U.S. mainstream, they report more cigarette smoking and alcohol consumption. Although Latinos reported higher levels of selected high-fiber foods, the low consumption of vegetables, widespread use of saturated fat, and the heavy drinking and smoking among Latino men, which are associated with the level of acculturation, may increase the risk for cancer. Educational messages targeting less acculturated Latinos should focus on maintaining their current healthy dietary practices of eating fruits, rice, and beans and decreasing their fat consumption. For more acculturated Latinos, emphasis should be placed on resuming the traditional diet.
Article
With data from the Hispanic Health and Nutrition Examination Survey (HHANES), we examined several health risk behaviors (cigarette smoking, alcohol use, dietary practices, and recency of health screening) of Mexican American, Cuban American, and Puerto Rican adults (ages 20-74). For each sample, a greater percentage of men than women smoked cigarettes and used alcohol. Heavy smoking (20+ cigarettes per day) was most prevalent for Cuban American males, and heavy drinking (1.00+ oz ethanol per day) was most prevalent for Mexican American and Puerto Rican men. Acculturation correlated positively with alcohol use (particularly for females) and negatively with dietary balance (for Mexican American men and women). The Puerto Ricans' diet was less balanced than that of the other two groups. For each sample, more men than women had not had a routine physical or dental examination within the past five years; the recency of screening was lowest for Mexican American men. Screening (including Pap smear for the women) was lower for those who smoked cigarettes and for those with poor dietary practices, indicating that many Hispanics at special risk of disease underutilize preventive health services, increasing the likelihood of diagnosis at a later stage of illness.
Article
There are no large population-based studies on occupational asthma, and few estimates of the proportion of asthma attributed to occupation, even though asthma is the most common occupational respiratory disorder in industrialised countries. We assessed data on 15,637 people aged 20-44, randomly selected from the general population of 26 areas in 12 industrialised countries. Asthma was assessed by methacholine challenge test and by questionnaire data on respiratory symptoms and use of medication. Occupation was defined by job-titles and a job exposure matrix was constructed. Highest risk of asthma, defined as bronchial hyperresponsiveness and reported asthma symptoms or medication, was shown for farmers (odds ratio 2.62 [95% CI 1.29-5.35]), painters (2.34 [1.04-5.28]), plastic workers (2.20 [0.59-8.29]), cleaners (1.97 [1.33-2.92]), spray painters (1.96 [0.72-5.34]), and agricultural workers (1.79 [1.02-3.16]). Similar risks were shown for asthma defined as reported asthma symptoms or medication. The most consistent results across countries were shown for farmers and cleaners. Excess asthma risk was associated with high exposure to biological dusts, mineral dusts, and gases and fumes. The proportion of asthma among young adults attributed to occupation was 5%-10%. The prevalence of occupational asthma in women and in specific occupations has been underestimated. Given a mean prevalence of asthma of about 5%, about 0.2%-0.5% of young adults become asthmatics or have their asthma exacerbated because of their occupations.
Article
To examine the relationship between acculturation and five health practices, including cigarette smoking, alcohol consumption, exercise, obesity, and sleeping habits. The study sample consisted of 573 Latinas, aged 46 to 92 years. Participants were recruited from 17 publicly subsidized housing projects in Los Angeles, Calif. Health practices information was obtained through an interview. Regression analyses showed an interaction between age and acculturation: the effects of acculturation on health practices were stronger among Latinas aged 64 years and under than among their 65 to 74 year-old counterparts. Level of acculturation did not affect the likelihood of engaging in healthy practices for elderly women (aged 75 and over). The data indicate that acculturation negatively affects the health practices of middle-aged Latinas, who are at a particularly critical age during which chronic diseases emerge. Intervention programs are needed to encourage adoption of healthy practices, particularly exercise and weight control, at an earlier stage in life.
Article
The prevalence rate of diabetes is probably higher in Hispanics than in Caucasians, although there is controversy about differences in the risk of diabetic retinopathy. The purpose of the study is to determine the prevalence rates of diabetes and diabetic retinopathy in a population-based study of Hispanics aged > or = 40 years. Proyecto VER is a random sample of Hispanic populations aged > or = 40 years in Arizona. A total of 4,774 individuals (71.6% of the eligible sample) completed the examinations. Diabetes was defined as self-report of a physician diagnosis or HbA(1c) value of > or = 7.0%. Diabetic retinopathy was assessed on stereo fundus photographs of fields 1, 2, and 4. The prevalence rate of diabetes in the Hispanic community (individuals > or = 40 years of age) was 22%. The prevalence rate of diabetic retinopathy (DR) was 48%; 32% had moderate to severe nonproliferative and proliferative retinopathy. DR increased with increasing duration of diabetes and increasing level of HbA(1c). The prevalence rate of DR-like changes in the sample of individuals without diabetic retinopathy was 15% and was not associated with hypertension, systolic blood pressure, or diastolic blood pressure. The prevalence rate of diabetes in this population of Hispanics is high, almost twice that of Caucasians. The prevalence rate of DR is high but similar to reports in a Caucasian population. The prevalence rate of 9% moderate to severe retinopathy in the newly diagnosed group suggests that efforts to improve detection and treatment of diabetes in Hispanics may be warranted.
Article
Risk factors for type II diabetes and diabetic retinopathy were determined in a population-based study of Mexican-Americans. Proyecto VER (Vision, Evaluation, and Research) is a cross-sectional study in a random sample of the self-described Hispanic populations in Tucson and Nogales, Arizona, age 40 and older. Of 6,659 eligible subjects, 4,774 (72%) participated in the home questionnaire and clinic visit. Diabetes was defined as self-report of a physician diagnosis or hemoglobin A(1c) value of > or = 7.0%. Only type II diabetes was included. Diabetic retinopathy was assessed on stereo fundus photographs of all persons with diabetes. Questions were asked about demographic, personal, socioeconomic, and diabetes related variables. 1023 (21.4%) of the sample had type II diabetes, and 68% were in the low-income group (annual income less than $20,000). Diabetes was associated with Native-American ancestry, higher acculturation, low income, less education, and increasing body mass index after age and gender adjustment. Persons with previously undiscovered diabetes were more likely to have no regular source of care, no insurance, and currently smoke compared with persons with known diabetes. Only low income was related to proliferative retinopathy, once adjusted for other factors (odds ratio [OR] = 3.93, 95%, confidence limitations [CL] = 1.31-11.80). Several socioeconomic and other factors were associated with diabetes, but few were related to diabetic retinopathy. Persons in the low-income group appeared to be at greater risk of diabetes and the ocular complications of diabetes compared with those with more income. Further longitudinal studies in this population are needed to confirm the associations.
Article
Ammonia and endotoxin-rich dust are present in high concentrations in swine confinement facilities; exposure to this environment is linked to workers' respiratory problems. We hypothesized that experimental exposure to ammonia and dust would impair pulmonary function, and that these exposures would be synergistic. We exposed six normal subjects and eight subjects with mild asthma to ammonia (16-25 ppm) and/or endotoxin-rich grain dust (4 mg/m3). Pulmonary function and exhaled NOx were measured before and after exposure. There was no significant change in pulmonary function in the normal subjects following any of the exposure conditions. Among asthmatics, a significant transient decrease in FEV1 was induced by grain dust, but was not altered by ammonia; increased bronchial hyperreactivity was also noted in this group. In a vulnerable population, exposure to grain dust results in transient airflow obstruction. Short-term exposure to ammonia does not increase this response.
Article
Atopy and asthma result from the effects of environmental factors on genetically susceptible persons, and different prevalence rates have been documented worldwide. In developed and industrialized countries a higher prevalence of atopy and asthma is observed as compared with undeveloped and less affluent countries. Migration involves exposure to a new set of pollutants and allergens. In addition, it involves several socioeconomic and cultural issues such as housing conditions, diet and accessibility to medical services, all of which are likely to affect migrants' health. Migration studies provide information on the role of environmental factors in the development of atopy and asthma. Immigration to allergy-prevalent countries causes more allergies and asthma in immigrants as compared to the prevalence of atopy in their countries of origin. The increase in allergy and asthma is usually not related to ethnicity, but in certain populations may play an important role. Studies on migrants support the notion that lifestyle and environmental factors in western industrialized countries facilitate atopy and asthma. The effect is time-dependent. Acquiring allergy is influenced by the age at the time of immigration. Migrants, in general, are more prone to the development of allergies than the local population. Low hygiene prior to immigration does not seem to protect against the development of atopy or asthma. Vaccinations do not affect the development of atopy or asthma in the general population and in migrants. Migrants should be aware of the potential of developing allergies and/or asthma. Strategies for primary prevention in high-risk atopic individuals and secondary prevention guidelines should be developed both for populations in developing countries as well as for immigrants from such countries to atopy-prevalent developed countries.
Article
The design of questionnaires needs clear aims and objectives, a selection of items that need to be translated into questions, and a logical order. The words used in the questionnaire should be understood by the subjects, they should neither be too difficult nor too simple, and they should be clear, unambiguous, and concise. The format of the questionnaire is as important as the actual questions. Pilot testing is an extremely important part of questionnaire design, and a sufficient amount of time should be allocated to it. The validity and repeatability of the questionnaire should be assessed, where possible.
Article
Relative to non-Latino whites, Latinos in the United States have a lower socioeconomic status (SES) profile, but a lower all-cause mortality rate. Because lower SES is associated with poorer overall health, a great deal of controversy surrounds the Latino mortality paradox. We employed a secondary data analysis of the 1991 National Health Interview Survey to test the health behavior and acculturation hypotheses, which have been proposed to explain this paradox. These hypotheses posit that: (1) Latinos have more favorable health behaviors and risk factor profiles than non-Latino whites, and (2) Health behaviors and risk factors become more unfavorable with greater acculturation. Specific health behaviors and risk factors studied were: smoking, alcohol use, leisure-time exercise activity, and body mass index (BMI). Consistent with the health behaviors hypothesis, Latinos relative to non-Latino whites were less likely to smoke and drink alcohol, controlling for sociodemographic factors. Latinos, however, were less likely to engage in any exercise activity, and were more likely to have a high BMI compared with non-Latino whites, after controlling for age and SES. Results provided partial support for the acculturation hypothesis. After adjusting for age and SES, higher acculturation was associated with three unhealthy behaviors (a greater likelihood of high alcohol intake, current smoking, a high BMI), but improvement in a fourth (greater likelihood of recent exercise). Gender-specific analyses indicated that the observed differences between Latinos and non-Latino whites, as well as the effects of acculturation on health behaviors, varied across men and women. Results suggest that the health behaviors and acculturation hypotheses may help to at least partially explain the Latino mortality paradox. The mechanisms accounting for the relationship between acculturation and risky behaviors have yet to be identified.
Article
To conduct a systematic review of published studies investigating the association of acculturation and smoking patterns among Hispanic men and women in the United States. Online bibliographic databases were searched from 1985 to 2003 using three key search terms. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study population, study methods, exposure assessment, outcomes measured, acculturation measures used, and results. The literature search identified 78 articles from MEDLINE, PubMed, and PsychINFO databases; of these, 11 studies met the inclusion criteria. Seven regional studies based in the western United States and four nationwide studies were included in the review. Seven studies used formal acculturation scales, three used language spoken, and one used language spoken and country of birth to indicate acculturation status. Nine studies showed a positive association between acculturation and smoking among women, and one study involving men showed a negative association. The findings suggest that the association of acculturation and smoking is gender-specific. In this instance, increased smoking prevalence with increased acculturation is consistently observed among Hispanic women but not among men. As Hispanic women acculturate, their cigarette smoking may increase because their behavior becomes more strongly influenced by the norms and practices of the dominant group than among men. Immigrant- and gender-specific public health interventions need to be designed to combat the increase in smoking rates among Hispanics in the United States.