Attending to Pesticide Exposure and Heat Illness Among Farmworkers: Results From an Attention Placebo-Controlled Evaluation Design.

OBJECTIVE: The aim of this study was to determine the effectiveness of curricula for improving knowledge and attitudes pertaining to pesticide exposure and heat illness among immigrant Latino farmworkers. METHODS: A pesticide safety curriculum informed by the revised Worker Protection Standard (WPS) was tested against an attention placebo-controlled curriculum (heat illness) in a sample of Latino farmworkers (N = 127). RESULTS: Pesticide safety knowledge increased in the overall sample, but did not differ by curriculum assignment. Pesticide safety behavioral intentions increased among participants in the pesticide safety curriculum but decreased among those in the other curriculum (P < 0.05). Heat illness knowledge and behavioral intentions increased more for farmworkers assigned to the heat illness than the pesticide safety curriculum. CONCLUSION: The developed curricula show good promise for meeting the spirit of the revised WPS and for reducing the burden of heat-related fatality and morbidity among Latino farmworkers.

Airway obstruction among Latino poultry processing workers in North Carolina.

This analysis was conducted to evaluate the prevalence of airway obstruction among Latino poultry processing workers. Data were collected from 279 poultry processing workers and 222 other manual laborers via spirometry and interviewer-administered questionnaires. Participants employed in poultry processing reported the activities they perform at work. Participants with forced expiratory volume in 1 second (FEV1) or FEV1/forced expiratory volume (FVC) below the lower limits of normal were categorized as having airway obstruction. Airway obstruction was identified in 13% of poultry processing workers and 12% of the comparison population. Among poultry processing workers, the highest prevalence of airway obstruction (21%) occurred among workers deboning chickens (prevalence ratio: 1.75; 95% confidence interval: 0.97, 3.15). These findings identify variations in the prevalence of airway obstruction across categories of work activities.

Social isolation among Latino workers in rural North Carolina: exposure and health implications.

Immigrant Latinos frequently experience social isolation in their receiving communities. This paper investigates the prevalence of social isolation among immigrant workers in a new settlement area and delineates the association between social isolation and physical and mental health outcomes. Interviews were conducted in Spanish with immigrant Latino manual workers (N = 743) in western North Carolina. The CES-D and the SF-12 questionnaires assessed health outcomes. A social isolation scale was used to assess degree of social isolation. Nearly 1 in 5 workers (19.5 %) reported the highest level of social isolation. Social isolation was associated with higher depressive symptoms and poorer physical and mental health, related to quality of life. Social isolation is a common experience among immigrant Latinos that may have negative implications for physical and mental health. Community outreach efforts to minimize experiences of isolation may be useful in protecting immigrant physical and mental health.

Ultrasound for carpal tunnel syndrome screening in manual laborers.

INTRODUCTION: Manual laborers are at increased risk for carpal tunnel syndrome (CTS), and a combination of history, physical examination, and nerve conduction studies is often used to screen for CTS in this population. Neuromuscular ultrasound may be a better screening tool, because it is painless. In this study we compare the accuracy of nerve conduction studies and ultrasound for CTS screening. METHODS: Five hundred thirteen manual laborers were screened prospectively for CTS using nerve conduction studies and neuromuscular ultrasound, and the accuracy of the 2 techniques was compared using the Katz hand diagram as the diagnostic standard. RESULTS: The ROC curves for the 2 techniques were not significantly different (P = 0.542), indicating that the approaches had similar diagnostic accuracy. CONCLUSIONS: Neuromuscular ultrasound is a painless technique that has diagnostic accuracy similar to nerve conduction studies and can be used to screen large populations at risk for CTS.

3-D jobs and health disparities: The health implications of Latino chicken catchers' working conditions.

OBJECTIVES: This study uses qualitative data to describe the tasks performed by chicken catchers, their organization of work, and possible health and safety hazards encountered. METHODS: Twenty-one Latino immigrant chicken catchers for North Carolina poultry-processing plants were interviewed to obtain their perceptions of the job and its hazards. Interviews were recorded and transcribed (n = 10) or detailed notes recorded (n = 11). Transcripts and notes were subjected to qualitative analysis. RESULTS: Chicken catching takes place in a highly contaminated and hazardous work environment. The fast pace of work, low level of control over work intensity, and piece rate compensation all result in high potential for work-related injury and illness, including trauma, electrical shock, respiratory effects, musculoskeletal injuries, and drug use. Workers receive little safety or job training. CONCLUSIONS: Chicken catching is characterized by a work environment and organization of work that promote injury and illness.

Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers.

BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration.

Work safety climate and safety practices among immigrant Latino residential construction workers.

BACKGROUND: Latino residential construction workers experience high rates of occupational fatality and injury. Work safety climate is an especially important consideration for improving the safety of these immigrant workers. This analysis describes work safety climate among Latino residential construction workers, delineates differences in work safety climate by personal and employment characteristics, and determines associations of work safety climate with specific work safety behaviors. METHODS: Data are from a cross-sectional survey of 119 Latino residential framers, roofers, and general construction workers in western North Carolina; 90 of these participants also provided longitudinal daily diary data for up to 21 days using an Interactive Voice Response (IVR) system. Measures included the Perceived Safety Climate Scale, and daily reports of five individual and five collective safety practices. RESULTS: Work safety climate was mixed among workers, with roofers (19.9) having lower levels than framers (24.3) or general construction workers (24.3). Days reported for several individual (glove-related risks, not doing something known to be unsafe) and collective safety practices (attended daily safety meeting, not needing to use damaged equipment, not seeing coworker create an unsafe situation) were positively associated with work safety climate. CONCLUSIONS: Work safety climate predicts subsequent safety behaviors among Latino residential construction workers, with differences by trade being particularly important. Interventions are needed to improve safety training for employers as well as workers. Further research should expand the number of workers and trades involved in analyses of work safety climate.

The prevalence of carpal tunnel syndrome in Latino poultry-processing workers and other Latino manual workers.

OBJECTIVE: To determine the prevalence of carpal tunnel syndrome (CTS) in Latino poultry-processing workers. METHODS: Symptoms and nerve conduction studies were used to prospectively assess 287 Latino poultry-processing workers and 226 Latinos in other manual-labor occupations. RESULTS: The prevalence of CTS was higher in poultry-processing (8.7%) compared with nonpoultry manual workers (4.0%; P < 0.0001). The adjusted odds ratio for the prevalence of CTS in poultry workers was 2.51 (95% confidence interval, 1.80-3.50) compared with nonpoultry workers. Within the poultry workers, those who performed packing, sanitation, and chilling had a trend toward less CTS than those who performed tasks requiring more repetitive and strenuous hand movements. DISCUSSION: Latino poultry-processing workers have a high prevalence of CTS, which likely results from the repetitive and strenuous nature of the work.

Poultry processing work and respiratory health of Latino men and women in North Carolina.

OBJECTIVE: To evaluate associations between poultry processing work and respiratory health among working Latino men and women in North Carolina. METHODS: Between May 2009 and November 2010, 402 poultry processing workers and 339 workers in a comparison population completed interviewer-administered questionnaires. Of these participants, 279 poultry processing workers and 222 workers in the comparison population also completed spirometry testing to provide measurements of forced expiratory volume in 1 second and forced vital capacity. RESULTS: Nine percent of poultry processing workers and 10% of workers in the comparison population reported current asthma. Relative to the comparison population, adjusted mean forced expiratory volume in 1 second and forced vital capacity were lower in the poultry processing population, particularly among men who reported sanitation job activities. CONCLUSIONS: Despite the low prevalence of respiratory symptoms reported, poultry processing work may affect lung function.

Hazardous materials on golf courses: experience and knowledge of golf course superintendents and grounds maintenance workers from seven states.

BACKGROUND: The golf course industry has a growing Latino work force. Little occupational health research has addressed this work force. This article examines golf course superintendents' and Latino grounds maintenance workers' pesticide knowledge, beliefs, and safety training. In particular, it focuses on knowledge of and adherence to OSHA Right-to-Know regulations. METHODS: In person, in-depth interviews were conducted with 10 golf course superintendents in five states and with 16 Latino grounds maintenance workers in four states. RESULTS: Few superintendents were in compliance with Right-to-Know regulations or did pesticide safety training with all of their workers. Few workers had any pesticide safety knowledge. Most safety training on golf courses was rudimentary and focused on machine safety, and was usually conducted in the off-season or on rainy days, not before workers were assigned tasks. CONCLUSIONS: More Right-to-Know training is necessary for superintendents and grounds maintenance workers. Culturally and linguistically appropriate Spanish language materials need to be developed or made more widely available to train workers. Better enforcement of safety and training regulations is necessary.

Mental health in immigrants from nontraditional receiving sites.

The mental health of Latinos immigrating to nontraditional settlements may be compromised by limited contextual resources. Stressors and strengths related to anxiety and depression were examined among 150 Mexican adults (45.3% women) in nontraditional areas. Normative stress was associated with anxiety (beta = .24) after controlling for depression. Normative and acculturative stressors were associated with depression after controlling for anxiety (betas = .36 and .17, respectively). Links between normative stress and depression were particularly strong for women. Social support provided resilience, being linked with lower depression (beta = -.20, p < .01). Acculturative stress and meeting economic expectations were associated with greater depression, but only for recent immigrants. Acculturative and normative stress increased the odds of clinical caseness for comorbidity by 4% and 62%, respectively, whereas social support decreased risk. Contextual implications and the need for resources to aid cultural adaptation are discussed.

Evidence of organizational injustice in poultry processing plants: Possible effects on occupational health and safety among Latino workers in North Carolina.

BACKGROUND: Over 250,000 workers are employed in poultry processing, one of the most dangerous industries in the US. These jobs are increasingly held by immigrant workers who are frequently undocumented, lack knowledge of workers' rights to workplace safety, and who are reluctant to pursue their rights. This situation creates the potential for organizational injustice, made visible through abusive supervisory practices, and leads to situations in which occupational illnesses and injuries are likely to occur. METHODS: This paper draws on data collected during the research phases of a community-based participatory research and social justice project. Two hundred survey interviews and 26 in-depth interviews were collected in representative, community-based samples in western North Carolina. Analyses describe associations between one aspect of organizational injustice, abusive supervision, and worker injuries. RESULTS: Workers' reports of abusive supervision are associated with a variety of specific and summary health indicators. The associations are stronger for women than for men. These suggest that the use of relative power within the plant may be the basis for injuries and illnesses. Three types of power relations are described that form the basis for these abusive interactions in the plant: ethnicity (American vs. Latino), immigration status ("good papers" vs. undocumented), and rank (supervisor vs. worker). Two factors modify these relations: kinship (preferences and privileges for family members) and gender. CONCLUSIONS: Among Latino immigrants working in poultry plants, power differences reflecting organizational injustice in the form of abusive supervision may promote occupational illnesses and injuries, particularly for women.

Working effectively with interpreters: a model curriculum for physician assistant students.

BACKGROUND: Effective patient-provider communication is crucial to achieving good health care outcomes. To accomplish this with patients of limited English proficiency, learning to work effectively with interpreters is essential. AIMS: The primary goal of this study was to determine if physician assistant students could effectively use interpreters to communicate with Spanish speaking patients after implementation of a cultural competency and Medical Spanish curriculum. METHOD: In year one of a three year implementation process, a module for teaching students to work effectively with interpreters was developed and implemented in the Wake Forest University School of Medicine Department of Physician Assistant Studies. After four hours of orientation, practice and role play, students were observed and recorded during a standardized patient assessment and evaluated by clinicians as well as by trained, bi-lingual evaluators. RESULTS: In the Class of 2007, 94% (43 students) and in the Class of 2008, 96% (47 students) demonstrated competence. CONCLUSIONS: Our findings highlight the feasibility and usefulness of training students to work effectively with interpreters. Evaluation and feedback from students and faculty have been positive. Cost for this curriculum enhancement was reasonable, making it feasible to introduce the training into a wide variety of medical and allied health programs.

Latino farmworker perceptions of the risk factors for occupational skin disease.

BACKGROUND: Farmworkers in the US constitute a medically underserved population at substantial risk for numerous environmental and occupational health problems. Most US farmworkers are Latino. Skin disease is one health problem to which farmworkers are particularly vulnerable. Interventions to reduce skin disease must be adapted to farmworkers' understanding of such disease, including their beliefs or knowledge of risk factors for skin disease. METHODS: Structured by the Explanatory Models of Illness framework, this analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (6 females, 24 males) to determine beliefs and perceptions of the causes of common occupational skin diseases in this population. Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. RESULTS: Skin disease is a major concern among farmworkers because it affects work, social interaction, and other aspects of their lives. Farmworker beliefs and perceptions of skin disease causation can be integrated into a general model in which perceived risk factors include sun and heat, chemicals, plants, insects, moisture, hygiene, and contagion. Each of these factors is moderated by the individual's personal susceptibility to that cause. The interaction or combination of two or more factors is thought to amplify their individual effects. CONCLUSIONS: The farmworker model of skin disease causation suggests important content for health education to reduce skin disease among farmworkers.

Spanish dermatological vocabulary used by Mexican workers.

Spanish is the second most common language spoken in the United States. Physicians can expect a growing population of patients who speak Spanish as their primary language. The purpose of this study was to develop a glossary of Spanish dermatological vocabulary commonly used by Mexican workers. Dermatologic terms were gathered from transcripts of in-depth interviews with 31 Latino farmworkers in North Carolina. Participants were asked to name and define words related to skin irritations. Farmworkers provided several definitions of some terms, and several Spanish equivalents exist for specific English words. This glossary is a supplement to other resources for learning medical Spanish and expands health care professionals' knowledge of dermatology-related Spanish vocabulary.