Hispanic Farmworkers Research Articles

Employment and family conditions are related to health care utilization among foreign-born farmworker men.

Despite their increased vulnerability to disease and injury, farmworkers have limited access to health services. The purpose of this study was to analyze the influence of employment and family conditions on health care utilization among foreign-born farmworker men. Using the Hispanic Farmworker Health model as the theoretical framework, a secondary data analysis was conducted among 397 foreign-born vineyard and winery worker men who attended the ¡Salud! Services mobile health screenings during the summer of 2009. Working full time (odds ratio [OR] = 2.49), being employed directly by the vineyard or winery (OR = 1.96), and having immediate family members (children, spouse) living in Oregon (OR = 2.65) were positively associated with health care utilization. Findings suggest that despite the many barriers farmworker men face, supportive employment and family conditions may increase health care utilization for this population. Implications of these results are discussed in the context of health care reform.

Migrant farm-workers and health

Many diseases are more common among Latinos/as than nonHispanic Whites. Rates of teenage pregnancies, sexually transmitted infections, diabetes, cirrhosis and cervical cancer are higher among Latinos/as. In particular, rates of alcohol abuse, motor vehicle accidents and interpersonal trauma are higher among Hispanic migrant farm workers. Furthermore, Latinas, including those in farming communities, use breast and cervical cancer screening services less than do women in other ethnic groups.

Cervical Cancer Screening Practice and Knowledge Among Hispanic Migrant and Seasonal Farmworkers of Michigan

High incidence of cervical cancer among Hispanics and low utilization of cervical screening among farmworkers led us to examine Pap test use and knowledge among Hispanic farmworkers in Michigan. Patients and potential patients of Northwest Michigan Health Services, Inc were surveyed in 2 communities (A and B) about their screening knowledge, attitudes, and practice. In all, 324 farmworkers participated, including 184 seasonal and 125 migrant farmworkers. Among the entire study population, 87.7% women reported receiving a Pap test recently, with no difference between migrant and seasonal farmworkers (88.0% and 87.4%, respectively, P = .088). More women from community B reported a recent Pap (93%) compared with those from community A (83%, P = .01). Only 35% of the participants had knowledge of any cervical cancer risk factors. Migrant farmworkers may not experience more difficulty in accessing Pap tests than seasonal farmworkers in Michigan. Knowledge about cervical cancer risk factors is low and needs to be addressed in future educational interventions.

Agricultural Injury in California Hispanic Farm Workers: MICASA Follow-up Survey

ABSTRACT The authors report here results from the first follow-up survey of the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) cohort of community-dwelling immigrant Hispanic farm workers in California's Central Valley. Among 560 participants the authors observed cumulative 1-year injury incidence of 6.6% (all injuries) and 4.3% (agricultural injuries). Increased prospective injury risk was associated with males, US birth, years lived in the United States, family income, and poor self-rated health. Agricultural injuries were associated most frequently with being struck by an object, falls, and cutting instruments, whereas over two thirds of nonagricultural injuries involved motor vehicles. Prevention should focus on safe handling of tools and materials, falls, and motor vehicle safety.

Development of a unique multi-contaminant air sampling device for a childhood asthma cohort in an agricultural environment

This research describes the design, deployment, performance, and acceptability of a novel outdoor active air sampler to provide simultaneous measurements of multiple contaminants at timed intervals for the Aggravating Factors of Asthma in Rural Environment (AFARE) study-a longitudinal cohort of 50 children in Yakima Valley, Washington. The sampler was constructed of multiple sampling media connected to individual critical orifices and a rotary vane vacuum pump. It was connected to a timed control valve system to collect 24 hours samples every six days over 18 months. We describe a spatially representative approach with both quantitative and qualitative location criteria to deploy a network of 14 devices at participant residences in a rural region (20 × 60 km). Overall the sampler performed well, as the concurrent mean sample flow rates were within or above the ranges of recommended sampling rates for each exposure metric of interest. Acceptability was high among the study population of Hispanic farmworker participant households. The sampler design may prove useful for future urban and rural community-based studies with aims at collecting multiple contaminant data during specific time periods.

Effectiveness of Pesticide Safety Training and Knowledge About Pesticide Exposure Among Hispanic Farmworkers

Pesticide poisoning rates remain high among farmworkers despite programs aimed at reducing pesticide exposure. A cross-sectional study was conducted among 187 Hispanic farmworkers in North Carolina. Farmworkers were interviewed to determine the association between pesticide safety training and knowledge about pesticides and use of personal protective equipment (PPE). Use of PPE was higher among farmworkers who reported wearing gloves reduced the harmful effects of pesticides (adjusted odds ratio, 5.73; 95% confidence interval, 2.20-14.92) and those who received pesticide safety training at the extension office or growers association (adjusted odds ratio, 44.62; 95% confidence interval, 3.96-503.33). Some farmworkers are still not using PPE. Evaluation of Environmental Protection Agency Worker Protection Standards pesticide safety training and requirements for providing PPE are crucial to encourage farm workers to use PPE.

Creating a Patient Navigation Model to Address Cervical Cancer Disparities in a Rural Hispanic Farmworker Community

This report describes the implementation of a pilot patient navigation (PN) program created to address cervical cancer disparities in a predominantly Hispanic agricultural community. Since November 2009, a patient navigator has provided services to patients of Catholic Mobile Medical Services (CMMS). The PN program has resulted in the need for additional clinic sessions to accommodate the demand for preventive care at CMMS.

Abstract A28: Latino farm workers and non-farm workers and their experiences in providing biospecimens for research.

Abstract Objectives: The goal of this project was to re-contact 40 of the 100 adult participants (Hispanic farm worker and non-farm workers), who participated in a pesticides exposure study, to learn about their experience providing biospecimens for research. The 40 randomly selected participants are members of a larger cohort that has been participating in pesticides exposure research for over 10 years. During their participation in the pesticides exposure study these participants were asked to provide two 10mL tubes of blood, two buccal cell samples and four urine samples during the seven-day collection period. Two dust samples were also collected from the home and a 7-day dust sample was collected from the vehicle. This protocol was repeated a total of three times (during two different pesticide spray seasons and one non-spray season) over the course of one year. Twelve of the 40 participants interviewed also provided 20 saliva samples, 2 hair samples and one blood sample over 10 weeks for a stress and cortisol study. Methods: Two months after completing the pesticides exposure study, we re-contacted a random selection of 40 participants to take part in a one-on-one interview. All participants are Hispanic farm workers and non-farm workers and all live in the Yakima Valley of Washington. Interview questions were selected to learn about the participant's feelings toward research, the barriers and facilitators to participating in research and providing biological samples, expectations surrounding their biological samples and thoughts about providing tumor samples. Results: A total of 42 participants were re-contacted; 40 agreed to participate and completed an interview, 1 refused and 1 was lost to follow-up. Each participant who completed an interview was provided a $20 gift card. Qualitative analysis is summarizing the beliefs and opinions of Hispanics about donating biospecimens and their understanding of what such donation means. Their attitudes to research are also being explored. Results will be available in mid-July, 2012. Conclusion: Speculation about Latinos giving biospecimens suggests that Hispanics are more reluctant to participate than non-Hispanic Whites. This was not our experience. The personal meaning of donation and the meaning of research is important to better understand Latinos participation in biobanking. Citation Format: Beti Thompson, Elizabeth Carosso, Ilda Islas, Genoveva Ibarra. Latino farm workers and non-farm workers and their experiences in providing biospecimens for research. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A28.

Abstract 3570: Cervical cancer screening practices among Hispanic migrant and seasonal farmworkers of Michigan

Abstract Cervical cancer incidence among all racial/ethnic groups in the United States is highest among Hispanics. Previous studies have found that migrant and seasonal farmworkers have limited access to health care and may therefore be less likely to follow screening recommendations for early cervical cancer detection. The objective of this study was to describe Pap test utilization and identify barriers, attitudes and knowledge regarding cervical cancer screening among Hispanic migrant and seasonal farmworkers served by Northwest Michigan Health Services, Inc (NMHSI) in Shelby and Traverse City, Michigan. This cross-sectional study surveyed the patient population of NMHSI. A questionnaire addressing knowledge, attitude and practice of cervical cancer screening was administered to 309 participants in NMHSI clinics or in participants’ residences. The Hispanic study population included 184 seasonal and 125 migrant farmworkers. Of all Hispanics surveyed (mean age 38.7), 94.2% had ever received a Pap test. Comparatively, 87.7% had received a Pap test recently (in the last two years for 21-29 year olds, in the last three years for those over 30) and 14.5% had an abnormal Pap test result in the last ten years. There was no significant difference between migrant and seasonal farmworkers in terms of ever having had a Pap test or having had a recent Pap test (p-value 0.88 for both comparisons). Consistent with these findings, participants reported that they understood the benefits of and experienced few barriers to getting Pap tests. These findings suggest that migrant farmworkers may not experience more difficulty in receiving Pap tests than seasonal farmworkers in Michigan. Farmworkers in general recognize the importance of receiving Pap tests even though both groups of women have low levels of acculturation. Furthermore, findings suggest that recent efforts to increase cervical cancer screening have been effective. While cervical cancer screening rates are high, knowledge is low and this continuing research will aid in identifying specific gaps in cervical cancer screening knowledge and attitudes to address in future interventions. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3570. doi:1538-7445.AM2012-3570

Impact of a Community Gardening Project on Vegetable Intake, Food Security and Family Relationships: A Community-based Participatory Research Study

This community-based participatory research project used popular education techniques to support and educate Hispanic farmworker families in planting and maintaining organic gardens. Measures included a pre- post gardening survey, key informant interviews and observations made at community-based gardening meetings to assess food security, safety and family relationships. Thirty-eight families enrolled in the study during the pre-garden time period, and four more families enrolled in the study during the post-garden period, for a total of 42 families enrolled in the 2009 gardening season. Of the families enrolled during the pre-gardening time period there were 163 household members. The mean age of the interviewee was 44.0, ranging from 21 to 78 years of age. The median number of occupants in a household was 4.0 (range: 2-8), Frequency of adult vegetable intake of "Several time a day" increased from 18.2 to 84.8%, (P < 0.001) and frequency of children's vegetable intake of "Several time a day" increased from 24.0 to 64.0%, (P = 0.003). Before the gardening season, the sum of the frequencies of "Sometimes" and "Frequently" worrying in the past month that food would run out before money was available to buy more was 31.2% and the sum of these frequencies dropped to 3.1% during the post garden period, (P = 0.006). The frequency of skipping meals due to lack of money was not statistically significantly different before and after the gardening season for either adults or children. Analysis of text responses and key informant interviews revealed that physical and mental health benefits were reported as well as economic and family health benefits from the gardening study, primarily because the families often worked in their gardens together. A community gardening program can reduce food insecurity, improve dietary intake and strengthen family relationships.

Salud es Vida:Development of a Cervical Cancer Education Curriculum forPromotoraOutreach With Latina Farmworkers in Rural Southern Georgia

We developed and evaluated a lay health worker curriculum intended to educate Hispanic farmworker women on cervical cancer, human papillomavirus (HPV), and the HPV vaccine. We pilot tested the curriculum in 2010 with 7 volunteer promotoras for readability, attractiveness, content, comprehension, cultural appropriateness, persuasion, structure and organization of lessons, balance between didactic and participatory activities, and ease of diffusion to community members. Peer-led cervical cancer prevention education is a practical option for low-income, Hispanic farmworker women in newer immigrant-receiving areas of the United States with fewer Spanish-speaking health professionals.

Increasing cervical cancer screening in a Hispanic migrant farmworker community through faith-based clinical outreach.

Partnerships between academic medical centers and faith-based community organizations have been associated with increased screening rates in low-income minority women. We describe clinical outcomes of an outreach partnership between a cancer center and a faith-based outreach clinic offering gynecologic screening services in central Florida to increase cervical cancer screening adherence in a priority population of primarily Hispanic farmworker women. Data sources included a retrospective chart review. This descriptive study examined patterns of cervical cancer screening behavior among the patient population of the faith-based outreach clinic. Findings suggest that among this group of patients, the demographic factors that predict adherence with cervical cancer screening recommendations are number of years having lived in the United States and marital status. Women residing in the United States for more than 5 years were significantly more adherent with cervical cancer screening recommendations compared with women who have resided in the United States for 5 years or less (p = .05), and married women were more likely to be adherent than unmarried women (p = .02). The partnership was successful in increasing cervical cancer screening adherence in this medically underserved population. When enabling barriers to screening adherence are removed through faith-based clinical outreach and engaged continuously for a number of years, uninsured, low-income Hispanic women are more likely to receive recommended preventive services.

Promotores as Researchers

The community health worker, known as promotor in the Hispanic community, is an accepted member of the public health team whose core role is that of bridging target communities with health services. However, the promotor's role in research has not been considered a core function of their work. This article will present the promotor in the additional role of researcher, as conceived by the Migrant Clinicians Network for the Hombres Unidos Contra La Violencia Familiar (Men United Against Family Violence) sexual violence/intimate partner violence project. The Hombres Unidos project used promotores as survey facilitators, gathering male Hispanic farmworkers' perspectives on the sensitive topic of sexual violence and intimate partner violence. This article demonstrates that when trained, the promotores' linguistic and cultural competence make them a valuable addition to the research team, especially when collecting sensitive information.

A Study of Perinatal Outcomes of Hispanic Migrant Farmworkers Using the Optimality Index-US

A Study of Perinatal Outcomes of Hispanic Migrant Farmworkers Using the Optimality Index-US

Preventing Heat-Related Illness Among Hispanic Farmworkers

Hispanic and Latino farmworkers are at risk for negative occupational health and safety outcomes due to issues such as their extreme work conditions, their reliance on employer beneficence, and cultural barriers. The purpose of this article is to explain the unique characteristics of heat-related illness in the Hispanic agricultural work force and to provide an overview of the problems of poor hydration and heat exposure in this population. Culturally appropriate preventive strategies are discussed because industrial-type solutions may not work in a crop production environment where language and beliefs may interfere with adaptation.

Preventing Heat-Related Illness among Hispanic Farmworkers

Hispanic and Latino farmworkers are at risk for negative occupational health and safety outcomes due to issues such as their extreme work conditions, their reliance on employer beneficence, and cultural barriers. The purpose of this article is to explain the unique characteristics of heat-related illness in the Hispanic agricultural work force and to provide an overview of the problems of poor hydration and heat exposure in this population. Culturally appropriate preventive strategies are discussed because industrial-type solutions may not work in a crop production environment where language and beliefs may interfere with adaptation.

Abstract A29: Community-based approach to developing a cervical cancer patient navigator program: A pilot

Abstract Background: Patient navigation (PN) focuses on identifying and resolving logistical, emotional, and health system barriers to obtaining cancer-related healthcare with the goal of increasing the number of patients who receive recommended cancer care services. Employing a community-based participatory research approach and building on an existing Patient Navigation Research Program, the Tampa Bay Community Cancer Network (TBCCN) Cervical Cancer Patient Navigator Program (CCPNP) was developed based on needs identified by a TBCCN community partner, Catholic Mobile Medical Services (CMMS). CMMS is located in a rural area of central Florida and provides free health care to a population of primarily Spanish-speaking Hispanic farmworker families. Methods: The TBCCN CCPNP targets the prevention of cervical cancer by facilitating access to care and providing education about cervical cancer prevention and early detection. To date, the focus of the TBCCN CCPNP has been improving the provision of timely cervical cancer screening and follow-up for women who have abnormal Pap tests. The TBCCN CCPNP is implemented at the CMMS clinic and evaluated using both process (navigator activity logs) and outcome (patient medical record) data. Using a pre-post design, outcome data are collected from medical records before and after the PN intervention. It is expected that, compared to women who received care at CMMS prior to the PN intervention, women who receive care at CMMS that included the PN intervention: (1) will be more likely to receive the results of their Pap test; (2) will receive the results of their Pap test in less time; (3) will be more likely to adhere to all recommended follow up diagnostic tests and treatment after receiving an abnormal pap test; (4) will obtain all recommended diagnostic and treatment care in less time following an abnormal pap test; and (5) will be more likely to adhere to a recommended surveillance Pap test following an abnormal Pap test. Results: Data from the process evaluation of the Spanish-English bilingual patient navigator's activity logs indicate that since completing navigator training in February 2010, the patient navigator has provided PN services through 323 patient encounters, and has coordinated the follow up care of 12 patients with an abnormal Pap test. The majority of the navigator's services entail: addressing communication barriers [i.e., making calls to schedule (42 calls), reschedule (21 calls), and remind patients about appointments (60 reminders) and mail Pap test results (133 results)]. The navigator also provides education about cervical cancer and Pap tests and accompanies patients to appointments for specialty care. Baseline data collected from 82 medical records of patients who received gynecological care at CMMS in 2007 and 2008 (99% Hispanic, mean age = 39.6; mean years of education = 8) indicate that 6.1 % of patients had an abnormal pap. The average length of time it took to mail Pap test results to patients was 69.16 days (SD: 38.33). Undeliverable mailed results were returned for 12.5% of patients because their address was incorrect. Conclusions: The implementation of a PN program in a rural, Hispanic farmworker population is feasible and may be effective in reducing barriers to cancer care. Future areas of development of the PN intervention include the provision of educational sessions about HPV and cervical cancer. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A29.

Abstract B27: Developing promotora curriculum modules for cervical cancer prevention and control

Abstract Aim: Cervical cancer is a disease characterized by health disparities in incidence and mortality, disproportionately affecting Hispanic women compared to whites. This research presents the initial findings of the second phase of a two-phase, multi-year study to gain a better understanding of knowledge, risk perceptions, and cultural attitudes among different Hispanic subethnicities in order to develop pilot curriculum modules on HPV and cervical cancer for promotora (lay health advisor) programs. The aim of phase 2 is to develop and evaluate pilot curriculum modules on cervical cancer and HPV using feedback from a group of promotoras in southern Georgia. The development of the pilot modules was designed and conceptualized by a multidisciplinary team with expertise in health literacy, health communication, and Spanish/English translation. The curriculum will be further modified after pilot testing and analysis of the evaluation findings. Methods: In partnership with a Hispanic-serving nonprofit agency in southern Georgia, the team developed pilot curriculum modules, guided by promotora curricula developed for Hispanic populations in Texas, as well as survey results from phase 1 with Mexican and Honduran farm worker women in Florida, and added the most recent information on cervical cancer, HPV, and the HPV vaccine. Six Spanish-speaking promotoras have been recruited to pilot test curriculum modules to ensure comprehensibility, and cultural and literacy-level appropriateness. The curriculum will be evaluated both quantitatively through a pretest/posttest instrument and qualitatively through a post-training focus group and written evaluations. Results: Survey results from phase 1 found that Mexican and Honduran farm worker women were less likely to have heard of HPV or the HPV vaccine than Puerto Rican or Anglo American women recruited from similar low-income clinic settings. Based on this finding, when designing the curriculum for Mexican farm worker women in Georgia, a separate module was developed on HPV and the HPV vaccine. The curriculum is divided into two lessons of three hours instruction each. The curriculum is delivered by a female, native Spanish speaker trained in pedagogical techniques. The first lesson covers cervical cancer screening, and the second lesson covers HPV and the HPV vaccine. Each lesson contain five topics, with accompanying slide presentations, vocabulary cards, problem cards for discussion, and list of local and national resources to facilitate access to cervical cancer screening. The curriculum modules are designed with a Popular Education framework and coded throughout with cues for listening, dialogue, and action. Each lesson begins with icebreakers and includes interactive exercises to facilitate co-learning. The curriculum is also coded by constructs from Social Cognitive Theory, with activities and lessons linked to the appropriate construct. Conclusion: Future cervical cancer educational interventions should address distinct cultural belief factors about cervical cancer in order to target materials to Hispanic farm worker women. This project is distinguished for its focus on community collaboration with the goal of building sustainable outreach programs to reduce barriers to cervical cancer screening, while addressing both culture and literacy in the development of educational materials to reduce cancer disparities. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):B27.

Dental utilization among Hispanic adults in agricultural worker families in California's Central Valley

To examine past-year dental visits among underserved, Hispanic farm-worker families using the Andersen Behavioral Model of Health Services Utilization, which posits that predisposing, enabling, and need factors influence care-seeking behavior. Oral health survey and clinical data were collected in 2006-2007 from families in Mendota, California (Fresno County) as part of a larger, population-based study. Generalized estimating equation logit regression assessed effects of factors on having a dental visit among adults (N = 326). Predisposing variables included sociodemographic characteristics, days worked in agriculture, self-rated health status, and dental beliefs. Enabling factors included resources to obtain services (dental insurance, income, acculturation level, regular dental care source). Need measures included perceived need for care and reported symptoms, along with clinically determined untreated caries and bleeding on probing. Only 34% of adults had a past-year dental visit, despite 44% reporting a regular dental care source. Most (66%) lacked dental insurance, and nearly half (46%) had untreated caries. Most (86%) perceived having current needs, and on average, reported a mean of 4.2 dental symptoms (of 12 queried). Regression analyses indicated those with more symptoms were less likely to have a past-year dental visit. Those who would ask a dentist for advice and had a regular dental care source were more likely to have a past-year dental visit. The final model included predisposing, enabling, and need factors. Despite low utilization and prevalent symptoms, having a regular source of care helps break this pattern and should be facilitated.

North Carolina Hispanic farmworkers and intestinal parasitism: a pilot study of prevalence and health-related practices, and potential means of foodborne transmission.

Migrant and seasonal farmworkers provide much of the necessary labor to harvest and process agricultural commodities desired by consumers. Little is known about the health status (especially the parasitic burden) of farm laborers, who handpick agricultural items such as fruits and vegetables, despite being implicated as a means of foodborne pathogen transmission. The goal of this research was to develop a framework to investigate enteric parasitic infections among Hispanic farmworkers in Eastern North Carolina. Seventy-one interviews were conducted, 16 stool samples were collected, and two parasite-positive workers were found. In addition, some potentially harmful health practices (e.g., self-medication) were identified. Further research is necessary to fully understand the scope of farmworker health issues and the potential risk of disseminating foodborne pathogens to humans. The study model presented provides a geographically expandable format to allow for various types of health investigations including the prevalence of other pathogens.