Depression, social factors, and farmworker health care utilization.

PURPOSE: Farmworkers frequently live in rural areas and experience high rates of depressive symptoms. This study examines the association between elevated depressive symptoms and health care utilization among Latino farmworkers. METHODS: Data were obtained from 2,905 Latino farmworkers interviewed for the National Agricultural Workers Survey. Elevated depressive symptoms were measured using the Center for Epidemiologic Studies Depression short-form. A dichotomous health care utilization variable was constructed from self-reported use of health care services in the United States. A categorical measure of provider type was constructed for those reporting use of health care. RESULTS: Over 50% of farmworkers reported at least 1 health care visit in the United States during the past 2 years; most visits occurred in a private practice. The odds of reporting health care utilization in the United States were 45% higher among farmworkers with elevated depressive symptoms. Type of provider was not associated with depressive symptoms. Women were more likely to seek health care; education and family relationships were associated with health care utilization. CONCLUSIONS: Latino farmworkers who live and work in rural areas seek care from private practices or migrant/Community Health Clinics. Farmworkers with elevated depressive symptoms are more likely to access health care. Rural health care providers need to be prepared to recognize, screen, and treat mental health problems among Latino farmworkers. Outreach focused on protecting farmworker mental health may be useful in reducing health care utilization while improving farmworker quality of life.

Mental health research with Latino farmworkers: a systematic evaluation of the short CES-D.

Mental health research among Latino farmworkers is hampered by the absence of measurement evaluation that ensures farmworkers understand and can consistently and appropriately respond to questions about mental health. Cross-sectional data were obtained from 409 farmworkers via interviewer-administered survey questionnaires. Mental health was operationalized with the short-form Center for Epidemiologic Studies, Depression (CES-D) scale. The structured interviewer-administered survey questionnaires included measures to capture personal and work-related factors that could affect farmworkers' ability to understand and respond to mental health questions probed by the CES-D. Good variability in item response was observed across the 10 short-form CES-D items. There was no evidence of differential response across sub-groups of farmworkers for six of the 10 items. Responses to four of the 10 items differed by educational attainment, country of origin, and language preference. Overall, the internal consistency of the 10 items exceeded standard conventions, and observed differences in depressive symptoms were as expected. Researchers in farmworker mental health must remain attentive to the strength and validity of available measures for migrants, different ethnic groups and different socioeconomic backgrounds. Nevertheless, the overall pattern suggests that the CES-D is a viable tool for advancing farmworker mental health research.

Planning a multilevel intervention to prevent hearing loss among farmworkers and managers: a systematic approach.

Noise-induced hearing loss (NIHL) is the second most prevalent self-reported occupational illness or injury in the U.S., and agricultural workers experience high rates of hearing loss. This article uses Intervention Mapping (IM), a systematic approach to intervention development, to make recommendations for a program to improve hearing loss protection among farmworkers and managers. Final recommendations, based on previous work in the literature on hearing loss prevention, qualitative formative research, and theoretical considerations, include a specification of a multilevel theory- and evidence-based hearing protection program for farmworkers and farm managers. Twelve performance objectives (e.g., "monitor hearing and hearing loss with regular hearing testing") are specified and crossed with six relevant determinants (knowledge and behavioral capability; perceived exposure and susceptibility and noise annoyance; outcome expectations; barriers; social influence; skills and self-efficacy) to create a highly detailed matrix of change objectives for farmworkers and for their managers. These change objectives are then grouped into five categories: two for both farmworkers and their managers (noticing exposures, taking action) and three only for the latter (surveying and planning, implementation and evaluation, and communication). Theoretical methods and practical strategies, including program materials and activities, are then delineated.

Expanded analysis of injury mortality among unionized construction workers.

BACKGROUND: To evaluate the utility of expanding the number and precision of injury categories used in previous occupational mortality studies, this study reanalyzed data from four previous studies of unionized construction workers (construction laborers, ironworkers, sheet metal workers, and operating engineers), by expanding the number of injury categories from 6 to 33. METHODS: Proportionate mortality ratios (PMRs) were computed using the distribution of deaths from the National Occupational Mortality Surveillance System, a mortality surveillance system from 28 states, as a comparison. A blue collar comparison group was also used in additional analyses to adjust for socioeconomic and other factors. RESULTS: This reanalysis identified significantly elevated PMRs in at least one of the four worker groups for falls, motor vehicle crashes, machinery incidents, electrocutions, being struck by falling objects, being struck by flying objects, explosions, suffocation, and water transport incidents. Limiting the comparison population to deaths among blue collar workers did not change the results substantially. CONCLUSIONS: This study demonstrates that increasing the precision of categories of death from injury routinely used in mortality studies will provide improved information to guide prevention. Am. J. Ind. Med. 37:364-373, 2000. Published 2000 Wiley-Liss, Inc.

Worksite health promotion programs in the U.S.: factors associated with availability and participation.

PURPOSE: To examine how the availability of and participation in worksite health promotion programs varies as a function of individual (e.g., age), organizational (e.g., occupation), and health (e.g., high blood pressure) characteristics. Availability of worksite programs was also compared to that reported in two previous national surveys of private companies. DESIGN: Data analyzed were from the 1994 National Health Interview Survey (NHIS), a national cross-sectional probability sample of the U.S. civilian population. SUBJECTS: Five thousand two hundred nineteen NHIS respondents met the inclusion criteria of (1) being currently employed in a company of at least 50 employees, and (2) completing the NHIS section on worksite health promotion. MEASURES: Employees indicated the availability of, and their participation in, 33 different types of worksite programs. National Health Interview Survey data were also available regarding general health, blood pressure, body mass index, and medical conditions. RESULTS: Smoking cessation programs had the highest mean availability (43%), followed by health education programs (31%) and screening tests (31%). Overall, availability of worksite programs appeared comparable to that reported in a recent national survey. Participation ranged from 32% for health education programs to 5% for smoking cessation programs. Compared to availability, participation depended less on individual and organizational characteristics. Healthy employees were not consistently more likely to participate in worksite health promotion programs than nonhealthy employees. CONCLUSIONS: Although availability of worksite health promotion programs remains high, participation by employees in specific types of programs can vary widely. Attempts to increase participation should look beyond individual, health, and organizational variables, to specific features of the work environment that encourage involvement in health promotion activities.

Mortality patterns among female nurses: a 27-state study, 1984 through 1990.

OBJECTIVES: This study examined the mortality experience of 50,000 nurses using the National Occupational Mortality Surveillance database of death certificates. METHODS: Proportionate mortality ratios adjusted by race (White, Black, or other) and 5-year age groups were calculated for selected causes of death among female nurses vs all workers and white-collar workers. RESULTS: Excess deaths among nurses less than 65 years of age were seen in both comparison groups for viral hepatitis, cancer of the nasal cavities, accidental falls, suicide, and drug-related deaths. Among nurses 65 years old or older, deaths due to chronic myeloid leukemia were in excess. Proportionate mortality ratios for breast and colon cancers, diabetes, and heart disease varied by occupational comparison group. CONCLUSIONS: These findings confirm results of previous studies and identify new associations. Redoubled efforts are called for in overcoming obstacles to reducing workplace hazards.

Tuberculosis Mortality and Silica Exposure: A Case-Control Study Based on a National Mortality Database for the Years 1983-1992.

A case-control study (8,740 cases; 83,338 controls) was done to evaluate the association between potential occupational exposure to silica and risk of tuberculosis (TB) mortality, using the National Occupational Mortality Surveillance database for 1983-1992. Potential silica exposure was based on the decedent's usual industry and occupation. Assignment of potential exposure to silica was based on the entire range of industries and occupations. Odds ratios (ORs) for mortality from respiratory TB associated with potential high and intermediate exposures to silica were 1.30 (95% CI 1.14-1.48) and 1.07 (95% CI 0.77-1.47), respectively, adjusting for silicosis, other pneumoconioses, age, gender, race, socioeconomic status, and potential exposure to active TB. The elevated OR was seen in all subgroups: male, female, white, and black. The average age at death among respiratory TB cases with potential silica exposure was significantly younger by four years than that among cases without potential silica exposure. The findings suggest that potential occupational exposure to silica alone, in the absence of silicosis, is associated with respiratory TB mortality, with a dose-response relationship.

Occupation and cervical cancer: an opportunity for prevention.

Cervical cancer remains an important health problem for women. Few published studies have examined cervical cancer with respect to a woman's occupation. This study examines the association of cervical cancer mortality and occupation in a large national database. The purpose of the study is to recommend which occupations may most require health promotion activities. Mortality data from the National Occupational Mortality Surveillance System were used to calculate the proportion of deaths from cervical cancer according to occupation. This study is based on standardized death certificate data for almost 2 million deaths among women in 27 states, covering the period 1985-1990. Our results are consistent with those in previous studies, with service and apparel manufacturing workers showing elevated risk. Data presented show a difference in cervical cancer mortality by occupational group. Identification of these occupations suggests which women could be targeted for preventive services. Women in occupations with low socioeconomic status are less likely to have access to health promotion programs. Resources should be directed to these women.

Mortality patterns among construction workers in the United States.

Thirteen authors from the National Institute for Occupational Safety and Health contribute to this summary of recent and ongoing national occupational mortality surveillance studies of construction workers, including studies conducted under NIOSH's Fatality Assessment and Control Evaluation project, Sentinel Health Events project, National Occupational Mortality Surveillance System, and other projects.

Environmental tobacco smoke and lung cancer in nonsmoking women. A multicenter study.

OBJECTIVE: To determine the relative risk (RR) of lung cancer in lifetime never smokers associated with environmental tobacco smoke (ETS) exposure. DESIGN: Multicenter population-based case-control study. SETTING: Five metropolitan areas in the United States: Atlanta, Ga, Houston, Tex, Los Angeles, Calif, New Orleans, La, and the San Francisco Bay Area, Calif. PATIENTS OR OTHER PARTICIPANTS: Female lifetime never smokers: 653 cases with histologically confirmed lung cancer and 1253 controls selected by random digit dialing and random sampling from the Health Care Financing Administration files for women aged 65 years and older. MAIN OUTCOME MEASURE: The RR of lung cancer, estimated by adjusted odds ratio (OR) with 95% confidence interval (CI), associated with ETS exposure. RESULTS: Tobacco use by spouse(s) was associated with a 30% excess risk of lung cancer: all types of primary lung carcinoma (adjusted OR = 1.29; P < .05), pulmonary adenocarcinoma (adjusted OR = 1.28; P < .05), and other primary carcinomas of the lung (adjusted OR = 1.37; P = .18). An increasing RR of lung cancer was observed with increasing pack-years of spousal ETS exposure (trend P = .03), such that an 80% excess risk of lung cancer was observed for subjects with 80 or more pack-years of exposure from a spouse (adjusted OR = 1.79; 95% CI = 0.99 to 3.25). The excess risk of lung cancer among women ever exposed to ETS during adult life in the household was 24%; in the workplace, 39%; and in social settings, 50%. When these sources were considered jointly, an increasing risk of lung cancer with increasing duration of exposure was observed (trend P = .001). At the highest level of exposure, there was a 75% increased risk. No significant association was found between exposure during childhood to household ETS exposure from mother, father, or other household members; however, women who were exposed during childhood had higher RRs associated with adult-life ETS exposures than women with no childhood exposure. At the highest level of adult smoke-years of exposure, the ORs for women with and without childhood exposures were 3.25 (95% CI, 2.42 to 7.46) and 1.77 (95% CI, 0.98 to 3.19), respectively. CONCLUSION: Exposure to ETS during adult life increases risk of lung cancer in lifetime nonsmokers.

Decision latitude, psychologic demand, job strain, and coronary heart disease in the Western Electric Study.

The hypothesis that low decision latitude and high psychologic demand are associated with an increased risk of the incidence of and mortality from coronary heart disease was investigated in a 25-year follow-up study of 1,683 men aged 38-56 years who participated in the Chicago Western Electric Study (1957-1983). Scores for decision latitude and psychologic demand, which had been linked to the 1960 US Census occupation codes, were assigned to men in the Western Electric cohort based on job title at the initial examination (1957-1958). After adjustment for major coronary risk factors, the relative risk for 25-year coronary death was 0.76 (95% confidence interval (CI) 0.59-1.00) for a 20-point increase in the decision latitude score (approximate difference between tertiles) and was 0.78 (95% CI 0.48-1.26) for a 10-point increase in the psychologic demand score (approximate difference between three groups). For job strain (defined by low decision latitude and high psychologic demand), it was 1.40 (95% CI 0.92-2.14). Controlling for occupational class reduced the magnitude of the relative risks between job characteristics and coronary mortality. Analysis stratified by occupational class indicated that the effect of decision latitude was more pronounced for white-collar than for blue-collar workers. This study provided only limited evidence for associations between job characteristics and coronary heart disease mortality.

Lung cancer in nonsmoking women: a multicenter case-control study.

The association between exposure to environmental tobacco smoke and lung cancer in female lifetime nonsmokers was evaluated using data collected during the first 3 years of an ongoing case-control study. This large, multicenter, population-based study was designed to minimize some of the methodological problems which have been of concern in previous studies of environmental tobacco smoke and lung cancer. Both a cancer control group and a population control group were selected in order to evaluate recall bias. A uniform histopathological review of diagnostic material was conducted for case confirmation and detailed classification. Biochemical determination of current exposure to tobacco and screening of multiple sources of information to determine lifetime nonuse were utilized to minimize misclassification of smokers as nonsmokers. A 30% increased risk of lung cancer was associated with exposure to environmental tobacco smoke from a spouse, and a 50% increase was observed for adenocarcinoma of the lung. A statistically significant positive trend in risk was observed as pack-years of exposure from a spouse increased, reaching a relative risk of 1.7 for pulmonary adenocarcinoma with exposures of 80 or more pack-years. The predominant cell type of the reviewed, eligible lung cancer cases was adenocarcinoma (78%). Results were very similar when cases were compared to each control group and when separate analyses were conducted for surrogate and personal respondents. Other adult-life exposures in household, occupational, and social settings were each associated with a 40-60% increased risk of adenocarcinoma of the lung. No association was found between risk of any type of lung cancer and childhood exposures from a father, mother, or other household members.