Jennifer W Talton

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

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Publications (46)169.09 Total impact

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    ABSTRACT: Objective: Heat exposure is an important hazard for workers in manual occupations, including farmworkers. This analysis delineates the prevalence of heat illness among farmworkers, and the factors associated with heat illness. Methods: North Carolina Latino male farmworkers completed interviews in August, 2013. They reported on heat exposure and behaviors over the previous 3 months while working both outdoors and indoors. Results: A third (35.6%) of the participants reported heat illness while working outside, and 13.9% while working inside. Factors associated with heat illness while working outside included working in wet clothes and shoes, harvesting and topping tobacco, and spending after-work time in an extremely hot house. Conclusions: Policy addressing heat illness is needed, as is more detailed research on occupational heat exposure that uses common measures.
    No preview · Article · Dec 2015 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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    ABSTRACT: Objectives: We used geographic information systems (GIS) to delineate whether farmworker labor camps were hidden and to determine whether hidden camps differed from visible camps in terms of physical and resident characteristics. Methods: We collected data using observation, interview, and public domain GIS data for 180 farmworker labor camps in east central North Carolina. A hidden camp was defined as one that was at least 0.15 miles from an all-weather road or located behind natural or manufactured objects. Hidden camps were compared with visible camps in terms of physical and resident characteristics. Results: More than one third (37.8%) of the farmworker labor camps were hidden. Hidden camps were significantly larger (42.7% vs 17.0% with 21 or more residents; P ≤ .001; and 29.4% vs 13.5% with 3 or more dwellings; P = .002) and were more likely to include barracks (50% vs 19.6%; P ≤ .001) than were visible camps. Conclusions: Poor housing conditions in farmworker labor camps often go unnoticed because they are hidden in the rural landscape, increasing farmworker vulnerability. Policies that promote greater community engagement with farmworker labor camp residents to reduce structural vulnerability should be considered. (Am J Public Health. Published online ahead of print October 15, 2015: e1-e6. doi:10.2105/AJPH.2015.302797).
    No preview · Article · Oct 2015 · American Journal of Public Health
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    ABSTRACT: This analysis describes (1) cell phone and smartphone ownership, (2) continuity of phone numbers, (3) use of specific technologies while inside and outside the U.S., and (4) perceived adequacy of specific formats to receive health research results among Latino farmworkers. Telecommunications questionnaires were administered to 165 and 102 farmworkers in North Carolina in 2012 and 2013, respectively. Univariate and bivariate analyses were completed. Increasing numbers of Latino farmworkers own cell phones and smartphones. Talk and text functions are used frequently. Relatively few farmworkers maintain consistent phone numbers. They prefer to receive study results through low technology formats. Strategies to use cell phones to improve health or to share research findings will face obstacles in this population. Public health officials who identify and implement effective strategies to overcome these barriers may be able to harness mobile technologies to address the needs of Latino farmworkers.
    No preview · Article · Oct 2015 · Journal of Immigrant and Minority Health
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    ABSTRACT: Objective: Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity. Methods: The NASS-CDS 2000-2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0-4, 5-9, 10-14, and 15-18 years. Next, the National Trauma Databank 2002-2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MRMAIS) for each injury within 6 age groups: 0-4, 5-9, 10-14, 15-18, 0-18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated. Results: MR and MRMAIS distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all P <.05). Head and thoracic injuries imparted the greatest mortality risk in all age groups with median MRMAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MRMAIS than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (P =.04; P <.01). Furthermore, though AIS was positively correlated with MR within each age group, less correlation was seen for children than for adults. Large MR variations were seen within each AIS grade, with some lower AIS severity injuries demonstrating greater MRs than higher AIS severity injuries. As an example, MRMAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture. Conclusions: Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.
    No preview · Article · Oct 2015 · Traffic Injury Prevention
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    ABSTRACT: Introduction: This analysis describes urinary cotinine levels of North Carolina Latino farmworkers, compares cotinine levels of farmworkers to those of Latinos non-farmworkers, determines factors associated with farmworker cotinine levels, and determines if differences in farmworker and non-farmworker cotinine levels are associated with smoking. Methods: Data are from 63 farmworkers and 44 non-farmworkers who participated in a larger study of occupational exposures. Questionnaire data and urine samples collected in 2012 and 2013 are analyzed. Results: Farmworkers had urinary cotinine levels that were far greater than the non-farmworker group. Geometric mean (GM) urinary cotinine levels for farmworkers were 1808.22ng/ml in 2012, and 396.03ng/ml in 2013; corresponding GM levels for non-farmworkers were 4.68ng/ml and 9.03ng/ml. Farmworker GM cotinine levels were associated with harvesting tobacco (1242.77ng/ml vs. 471.26ng/ml; P = .0048), and working in wet shoes (1356.41ng/ml vs. 596.93ng/ml; P = .0148). Smoking did not account for cotinine level differences; the GM cotinine level for farmworkers who did not smoke was 541.31ng/ml; it was 199.40ng/ml for non-farmworkers who did smoke. Conclusion: North Carolina farmworkers experience large nicotine doses. The long-term health effects of these doses are not known. Although procedures to reduce occupational nicotine exposure are known, no changes in work practices or in policies to protect workers have been implemented. Research on the health effects of occupational nicotine exposure must become a priority. Current knowledge of occupational transdermal nicotine exposure must be used to improve occupational safety practice and policy for tobacco workers. Implications: This study documents the heavy burden of nicotine exposure and dose experienced by tobacco workers in North Carolina. Hundreds of thousands of farmworkers and farmers in the United States and Canada, as well as agricultural workers around the world, share this burden of nicotine exposure and dose. These results support the need to change work practices and regulations to protect workers. They also document the need to delineate the health effects of long-term exposure to high transdermal nicotine doses.
    No preview · Article · Sep 2015 · Nicotine & Tobacco Research
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    ABSTRACT: Objective: Appropriate treatment at designated trauma centers (TCs) improves outcomes among injured children after motor vehicle crashes (MVCs). Advanced Automatic Crash Notification (AACN) has shown promise in improving triage to appropriate TCs. Pediatric-specific AACN algorithms have not yet been created. To create such an algorithm, it will be necessary to include some metric of development (age, height or weight) as a covariate in the injury risk algorithm. This study sought to determine which marker of development should serve as a covariate in such an algorithm and to quantify injury risk at different levels of this metric. Methods: Retrospective review of occupants <19yrs within the MVC dataset NASS-CDS 2000-2011 was performed. R(2) values of logistic regression models using age, height or weight to predict 18 key injury types were compared to determine which metric should be used as a covariate in a pediatric AACN algorithm. Clinical judgment, literature review and Chi Square analysis were used to create groupings of the chosen metric that would discriminate injury patterns. Adjusted odds of particular injury types at the different levels of this metric were calculated from logistic regression while controlling for gender, vehicle velocity change (delta V), belted status (optimal, sub-optimal or unrestrained) and crash mode (rollover, rear, frontal, near-side or far-side). Results: NASS-CDS analysis produced 11,541 occupants <19yrs with non-missing data. Age, height and weight were correlated with one another and with injury patterns. Age demonstrated the best predictive power in injury patterns and was categorized into bins of 0-4 years, 5-9 years, 10-14 years and 15-18 years. Age was a significant predictor of all 18 injury types evaluated even when controlling for all other confounders and when controlling for age and gender specific BMI classifications. Adjusted odds of key injury types with respect to these age categorizations revealed that younger children were at increased odds of sustaining AIS 2+ and 3+ head injuries and AIS 3+ spinal injuries, while older children were at increased odds of sustaining thoracic fractures, AIS 3+ abdominal injuries, and AIS 2+ upper and lower extremity injuries. Conclusions: The injury patterns observed across developmental metrics in this study mirror those previously described among children with blunt trauma. This study identifies age as the metric best suited for use in a pediatric AACN algorithm and utilizes 12 years of data to provide quantifiable risks of particular injuries at different levels of this metric. This risk quantification will have important predictive purposes in a pediatric-specific AACN algorithm.
    No preview · Article · Jun 2015 · Traffic Injury Prevention
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    ABSTRACT: Injury risk curves estimate motor vehicle crash (MVC) occupant injury risk from vehicle, crash, and/or occupant factors. Many vehicles are equipped with event data recorders (EDRs) that collect data including the crash speed and restraint status during a MVC. This study's goal was to use regulation-required data elements for EDRs to compute occupant injury risk for (1) specific injuries and (2) specific body regions in frontal MVCs from weighted NASS-CDS data. Logistic regression analysis of NASS-CDS single-impact frontal MVCs involving front seat occupants with frontal airbag deployment was used to produce 23 risk curves for specific injuries and 17 risk curves for Abbreviated Injury Scale (AIS) 2+ to 5+ body region injuries. Risk curves were produced for the following body regions: head and thorax (AIS 2+, 3+, 4+, 5+), face (AIS 2+), abdomen, spine, upper extremity, and lower extremity (AIS 2+, 3+). Injury risk with 95% confidence intervals was estimated for 15-105 km/h longitudinal delta-Vs and belt status was adjusted for as a covariate. Overall, belted occupants had lower estimated risks compared to unbelted occupants and the risk of injury increased as longitudinal delta-V increased. Belt status was a significant predictor for 13 specific injuries and all body region injuries with the exception of AIS 2+ and 3+ spine injuries. Specific injuries and body region injuries that occurred more frequently in NASS-CDS also tended to carry higher risks when evaluated at a 56 km/h longitudinal delta-V. In the belted population, injury risks that ranked in the top 33% included 4 upper extremity fractures (ulna, radius, clavicle, carpus/metacarpus), 2 lower extremity fractures (fibula, metatarsal/tarsal), and a knee sprain (2.4-4.6% risk). Unbelted injury risks ranked in the top 33% included 4 lower extremity fractures (femur, fibula, metatarsal/tarsal, patella), 2 head injuries with less than one hour or unspecified prior unconsciousness, and a lung contusion (4.6-9.9% risk). The 6 body region curves with the highest risks were for AIS 2+ lower extremity, upper extremity, thorax, and head injury and AIS 3+ lower extremity and thorax injury (15.9-43.8% risk). These injury risk curves can be implemented into advanced automatic crash notification (AACN) algorithms that utilize vehicle EDR measurements to predict occupant injury immediately following a MVC. Through integration with AACN, these injury risk curves can provide emergency medical services (EMS) and other patient care providers with information on suspected occupant injuries to improve injury detection and patient triage.
    Preview · Article · Jun 2015 · Traffic Injury Prevention
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    ABSTRACT: Despite recommendations for breast cancer survivorship care, African American women are less likely to receive appropriate follow-up care, which is concerning due to their higher mortality rates. This study describes differences in barriers to follow-up care between African American and White breast cancer survivors. We conducted a mailed survey of women treated for non-metastatic breast cancer in 2009-2011, 6-24 months post-treatment (N = 203). Survivors were asked about 14 potential barriers to follow-up care. We used logistic regression to explore associations between barriers and race, adjusting for covariates. Our participants included 31 African American and 160 White survivors. At least one barrier to follow-up care was reported by 62 %. Compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03). After adjustment for covariates, African Americans were three times as likely to report at least one barrier to care (odds ratio (OR) = 3.3, 95 % confidence interval (CI) = 1.1-10.1). Barriers to care are common among breast cancer survivors, especially African American women. Financial barriers to care may prevent minority and underserved survivors from accessing follow-up care. Enhancing insurance coverage or addressing out-of-pocket costs may help address financial barriers to follow-up care among breast cancer survivors. Psychosocial care aimed at reducing fear of recurrence may also be important to improve access among African American breast cancer survivors.
    No preview · Article · Mar 2015 · Supportive Care in Cancer
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    ABSTRACT: Decreased insulin sensitivity is a cardiovascular risk factor (CVRF) in youth with type 1 diabetes (T1D). Whether baseline insulin sensitivity is independently associated with changes in early arterial stiffness (pulse wave velocity (PWV)) over time in youth with T1D is not known. Two hundred ninety-eight youth with T1D in the SEARCH CVD study had PWV measured~five years apart. Insulin sensitivity and other CVRFs were measured at baseline. The association between baseline insulin sensitivity with PWV over time was explored using linear mixed models. Models were adjusted for baseline age, sex and race, with subsequent adjustment for CVRFs. There was a significant interaction (p=0.0326) between baseline insulin sensitivity and time on PWV, independent of CVRFs, indicating that higher insulin sensitivity levels were associated with lower rate of change in PWV over time. Other significant predictors of PWV change were baseline age [β=0.007 (p=0.03) increase in logPWV/year increase in age] and mean arterial blood pressure (MAP) [β=0.005 (p<0.01) increase in logPWV/mmHg increase in MAP] and smoking status (current vs. never smoker). Lower insulin sensitivity at baseline appears to be an important risk factor for increased arterial stiffness over time in youth with T1D. This identifies a potentially modifiable therapeutic target. Copyright © 2015 Elsevier Inc. All rights reserved.
    Preview · Article · Feb 2015 · Journal of Diabetes and its Complications
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    ABSTRACT: ABSTRACT Migrant farmworkers are a vulnerable population. Migrant farmworkers with H-2A visas are the only agricultural workers with temporary work permits. Little research has directly focused on the job characteristics and work safety of workers with H-2A visas. This analysis (1) describes their personal and job characteristics, job hazards, and stressors; (2) describes their perceived work safety climate; and (3) examines associations of perceived work safety climate with job characteristics, job hazards, and stressors. Data are from a cross-sectional component of a larger study of farmworker pesticide exposure; in 2012 interviews were conducted with 163 migrant farmworkers with H-2A visas in North Carolina. The sample was limited to men aged 30 to 70 years. Migrant farmworkers with H-2A visas experience the same hazards as do other farmworkers. Their mean score on the Perceived Work Safety Climate Scale 25.5 (SD = 3.7) is similar to that of other farmworkers and other immigrant workers. Perceived work safety climate is associated with hours worked per week (P = .02), precarious employment (P < .001), planting and cultivating (P = .002), topping tobacco (P = .0012), and stress (P = .02). Perceived work safety climate is particularly important for migrant farmworkers with H-2A visas because their labor contracts limit their options to change employers. Additional research on the status of work safety climate among agricultural workers is needed, as well as on the factors that affect work safety climate and on the safety characteristics that are affected by work safety climate. Policy changes that lead to improved work safety climate should be considered.
    No preview · Article · Jan 2015 · Journal of Agromedicine
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    ABSTRACT: Injury severity alone is a poor indicator of the time sensitivity of injuries. The purpose of the study was to quantify the urgency with which the most frequent motor vehicle crash injuries require treatment, according to expert physicians. The time sensitivity was quantified for the top 95% most frequently occurring Abbreviated Injury Scale (AIS) 2+ injuries in the National Automotive Sampling System-Crashworthiness Data System (NASS-CDS) 2000-2011. A Time Sensitivity Score was developed using expert physician survey data in which physicians were asked to determine whether a particular injury should go to a Level I/II trauma center and the urgency with which that injury required treatment. When stratifying by AIS severity, the mean Time Sensitivity Score increased with increasing AIS severity. The mean Time Sensitivity Scores by AIS severity were as follows: 0.50 (AIS 2); 0.78 (AIS 3); 0.92 (AIS 4); 0.97 (AIS 5); and 0.97 (AIS 6). When stratifying by anatomical region, the head, thorax, and abdomen were the most time sensitive. Appropriate triage depends on multiple factors, including the severity of an injury, the urgency with which it requires treatment, and the propensity of a significant injury to be missed. The Time Sensitivity Score did not correlate highly with the widely used AIS severity scores, which highlights the inability of AIS scores to capture all aspects of injury severity. The Time Sensitivity Score can be useful in Advanced Automatic Crash Notification systems for identifying highly time sensitive injuries in motor vehicle crashes requiring prompt treatment at a trauma center. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Nov 2014 · Journal of the American College of Surgeons
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    ABSTRACT: Increased availability of telecommunication devices may provide a means to distribute occupational health and safety (OSH) information. This analysis examined device ownership and actual and potential use of multiple modalities to present OSH information. Male Latino immigrant farmworkers and non-farmworkers in NC (n=177) completed a survey about actual and potential use of telecommunication devices in 2013. Almost all (171/177; 97%) reported they owned cell phones; 48% of cell phone owners had smartphones. The telephone numbers of 54% of cell phone owners had changed within the past year. Among all respondents, regardless of cell phone ownership, during the past two months 89%, 67%, 38%, and 28% of participants had spoken to someone on a cell phone, read a text message, accessed the internet, or used a social networking site, respectively, at least once a week. Among cell phone owners, 96% and 80% stated they would want to receive text messages about health information and severe weather within their area, respectively. Among smartphone owners, 86% and 74% stated they would want to have videos sent to their smartphones about health information and severe weather, respectively. Penetrance of cell phone ownership is high among Latino men in NC. Widespread ownership and use of cell phones and moderate ownership of smartphones may enable health workers and advocates to distribute general and occupational health information to Latino farmworkers and non-farmworkers. However, challenges imposed by impermanent phone numbers will need to be addressed before the OSH education potential of cell phones can be achieved.
    No preview · Conference Paper · Nov 2014
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    ABSTRACT: Food security is a managed process, negotiated in local places. Economic, or job, stability is key to food security. This analysis describes food security and food strategies of 101 male Hispanic rural farmworkers (guestworkers on H2-A visas) and 71 urban non-farmworkers of mixed employment in North Carolina. In 2013, participants responded to the USDA Household Food Security Survey module, with reference to the previous three months, and questions about obtaining food. Farmworkers were not accompanied by family; food security questions refer only to household adults. High food security was reported by more farmworker (82.2%) than non-farmworker households (64.8%). Non-farmworker, compared to farmworker, households reported excess marginal (22.5% vs. 11.9%) and combined low/very low food security (12.7% vs. 5.9%). Over half in both groups obtained most of their food at superstores. Most farmworkers reported shopping weekly, using employer-provided transportation. Non-farmworkers had more variability in grocery shopping frequency and transportation; 5.6% obtained most of their food from restaurants and food pantries. Farmworkers accessed flea markets (23% vs. 10%) and farmers markets (18% vs. 3%) more than non-farmworkers. Non-farmworkers reported more gardening and fishing than farmworkers (32%/15% vs. 10%/9%). Overall, farmworkers reported food security considerably better than the US in 2012, and non-farmworkers were at levels approximately the same as US households. These findings suggest that the H2A visa program provides farmworkers job stability, reflected in food security, that other Hispanics who may be undocumented are not afforded. Additional research into the why non-farmworker households are food insecure is warranted. Grant R01 ES008739.
    No preview · Conference Paper · Nov 2014

  • No preview · Article · Nov 2014 · Cancer Epidemiology Biomarkers & Prevention

  • No preview · Conference Paper · Oct 2014
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    ABSTRACT: ABSTRACT Farm labor housing has been described as among the worst in the nation, oftentimes with poor and unsanitary indoor living conditions. The objective of this study was to evaluate the association between indoor environmental risk factors and respiratory health among migrant farmworker occupants (N = 352) living in employer-provided housing. A cross-sectional sample of adult Latino male farm laborers were administered a questionnaire to identify the prevalence of major respiratory symptoms. Self-reported and independent observations were made to evaluate environmental respiratory risk factors and indoor housing conditions, including but not limited to, the presence of cockroaches, rodents, pesticides, and visible signs of mold. Spirometry was performed to evaluate lung function using FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), and FEV1 /FVC ratio. Bivariate analysis was applied to evaluate associations between respiratory symptoms and selected indoor environmental risk factors. Findings for respiratory health included prevalence of wheeze (11.4%), coughing up phlegm (17.3%), tightness of chest (16.8%), and runny or stuffy nose (34.4%). Respiratory risks identified inside the dwellings included the use of pesticides or bug sprays for cockroaches (31.5%), rat or mouse poison (19.5%), visible signs of water damage in the bathroom (22.5%), and mold in the sleeping room (11.1%). Spirometry values were normal for most occupants, although statistically significant associations were found between mold and coughing up phlegm when not having a cold (P = .0262); presence of mold and asthma (P = .0084); pesticides used in the home and tightness of chest (P = .0001); and use of tobacco and coughing up phlegm (P = .0131). Although causal inference can be difficult to establish from a cross-sectional study, findings from this study represents suggestive evidence that indoor environmental risk factors may be contributory factors for respiratory health problems among this vulnerable workgroup population.
    Full-text · Article · Oct 2014 · Journal of Agromedicine
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    ABSTRACT: Background While most motor vehicle crash (MVC)-related injuries have been decreasing, one study showed increases in MVC-related spinal fractures from 1994 to 2002 in Wisconsin. To our knowledge, no studies evaluating nationwide trends of MVC-related thoracolumbar spine injuries have been published. Such fractures can cause pain, loss of functionality or even death. If the incidence of such injuries is increasing, it may provide a motive for reassessment of current vehicle safety design. Questions/purposes We questioned whether the incidence of thoracolumbar spine injuries increased in the United States population with time (between 1998 and 2011), and if there was an increased incidence of thoracolumbar injuries, whether there were identifiable compensatory “trade-off injury” patterns, such as reductions in sacropelvic injuries. Patients and Methods Institutional review board approval was obtained for retrospective review of three national databases: the National Trauma Databank® (NTDB®), 2002–2006, National Automotive Sampling System (NASS), 2000–2011, and National Inpatient Sample (NIS), 1998–2007. In each database, the total number of MVC-related injuries and the number of MVC-related thoracolumbar injuries per year were identified using appropriate Abbreviated Injury Scale (AIS) or ICD-9 codes. Sacropelvic injuries also were identified to evaluate their potential as trade-off injuries. Poisson regression models adjusting for age were used to analyze trends in the data with time. Results All databases showed increases in MVC-related thoracolumbar spine injuries when adjusting for age with time. These age-adjusted relative annual percent increases ranged from 8.22% (95% CI, 5.77%–10.72%; p
    No preview · Article · Aug 2014 · Clinical Orthopaedics and Related Research
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    ABSTRACT: Background Pesticide exposure poses a health risk for farmworkers. This analysis documents lifetime and current pesticide exposure of North Carolina Latino migrant farmworkers, with comparison to non-farmworker Latino immigrants.Methods During May to October 2012, 235 Latino farmworkers and 212 Latino non-farmworkers completed interviews with items to construct measures of lifetime, current residential and occupational pesticide exposure.ResultsFarmworkers experience levels of lifetime and residential pesticide exposure that are consistently greater than among non-farmworkers. Farmworkers report a large number of occupational pesticide exposures. Lifetime exposure and current residential pesticide exposure are related to social determinants. Education is inversely related to lifetime pesticide exposure for farmworkers and non-farmworkers; farmworkers with H-2A visas report greater residential pesticide exposure than those without H-2A visas.Conclusions Occupational safety policy needs to consider these patterns of lifetime exposure when setting standards. Health care providers should be aware of the lifetime and current exposure of this vulnerable population. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Jul 2014 · American Journal of Industrial Medicine
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    ABSTRACT: The SEARCH for Diabetes in Youth Study prospectively identified youth less than 20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence rate and 95 percent CI, overall, by age group and by sex, were calculated per 100,000 person-years at risk for 2002 through 2009 for non-Hispanic white (NHW) youth. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9-24.8) in 2002 to 27.4/100,000 (95% CI 26.9-27.9) in 2009 (p for trend=0.0008). The relative annual increase in T1D incidence was 2.72% (1.18-4.28%) per year; 2.84% (1.12-4.58%) for males and 2.57% (0.68-4.51%) for females. After adjustment for sex, there were significant increases for those 5-9 years (p=0.0023), 10-14 years (p= 0.0008), and 15-19 years (p=0.004), but not among 0-4 year olds (p=0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age group. Continued surveillance of T1D in youth in the United States to identify future trends in T1D incidence and to plan for health care delivery is warranted.
    Preview · Article · Jun 2014 · Diabetes
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    ABSTRACT: Importance Despite concern about an “epidemic,” there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups.Objective To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009.Design, Setting, and Participants Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan.Main Outcomes and Measures Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years.Results In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes.Conclusions and Relevance Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases.
    No preview · Article · May 2014 · JAMA The Journal of the American Medical Association

Publication Stats

437 Citations
169.09 Total Impact Points

Institutions

  • 2010-2015
    • Wake Forest School of Medicine
      • Department of Biostatistical Sciences
      Winston-Salem, North Carolina, United States
    • Wake Forest University
      • Department of Biostatistical Sciences
      Winston-Salem, North Carolina, United States