Maternal blood pressure and birth weight associations in U.S.-born and foreign-born Latinas.

OBJECTIVES: Research suggests that acculturating to the United States is detrimental for immigrants' health. Consistent with this pattern, higher levels of U.S. acculturation among Latina-American women have been associated with giving birth to lower birth weight babies. The mechanisms that shape this shift in pregnancy health are not clear, but researchers have begun to consider the role of physiological systems that are sensitive to social experience. The present study examined the association of cultural orientation with blood pressure (BP) trajectories over the course of pregnancy. METHOD: In a study of 1,011 U.S.- and foreign-born Latina-American women, cultural orientation was assessed and multiple BP measures were collected throughout pregnancy. Postpregnancy data, including gestational age-adjusted birth weight, were extracted from medical records. Bayesian structural equation models examined average BP and slopes of BP change during pregnancy while accounting for psychosocial stress, support, and pregnancy health-related factors (e.g., maternal age, smoking). RESULTS: We found evidence that greater U.S. orientation was associated with higher diastolic blood pressure (DBP) and steeper increases in DBP, which was associated with less fetal growth. CONCLUSIONS: This is the first evidence that BP may mediate the association between cultural orientation and pregnancy outcomes in Latina-American women. These findings advance our understanding of the biopsychosocial pathways through which acculturation to the U.S. links with health. As scholars seek to better understand the influence of U.S. acculturation on health, focusing on the cardiovascular system and other physiological systems that are sensitive to social experience is warranted and likely to prove valuable. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Stress, Mental Health, and Coping Among Workers in the Northern California Cannabis Industry: A Qualitative Descriptive Analysis.

California is home to a multibillion-dollar cannabis (marijuana) industry, but little is known about the occupational health and safety hazards faced by cannabis workers and even less of the stress, mental health, and coping mechanisms among these workers. Previous research has been based on long-term workers at legal businesses, but most California cannabis is produced and sold unlawfully. There are many seasonal workers whose experiences have not been studied. A qualitative study based on focus group discussions and key informant interviews was performed to understand cannabis workers' experiences, knowledge, and perceptions of occupational hazards. Participants reported sources of stress including production pressure and isolation, and mental health outcomes such as depression and mental fatigue. They described primarily maladaptive coping mechanisms. Unique characteristics of the cannabis industry, including criminalization and isolated, remote farms, make interventions challenging. However, policy approaches that involve community organizations could promote worker health.

How Does Environmental Temperature Affect Farmworkers' Work Rates in the California Heat Illness Prevention Study?

OBJECTIVE: Estimate the association between environmental temperature (wet bulb globe temperature [WBGT]) and work rate over the course of a workday. METHODS: Repeated-measures regression was used to identify characteristics impacting work rate in a cross-sectional study of Latino farmworkers. Minute-by-minute work rate (measured by accelerometer) and WBGT were averaged over 15-minute intervals. RESULTS: Work rate decreased by 4.34 (95% confidence interval [CI], -7.09 to -1.59) counts per minute per degree Celsius WBGT in the previous 15-minute interval. Cumulative quarter hours worked (2.13; 95% CI, 0.82 to 3.45), age (-3.64; 95% CI, -4.50 to -2.79), and dehydration at the end of workday (51.37; 95% CI, 19.24 to 83.50) were associated with counts per minute as were gender, pay type (piece rate vs hourly) and body mass index ≥25 kg/m 2 . The effects of pay type and body mass index were modified by gender. CONCLUSION: Increased temperature was associated with a decrease in work rate.

California cannabis cultivation and processing workers: A qualitative analysis of physiological exposures and health effects.

INTRODUCTION: Cannabis is a multi-billion-dollar California industry, but little is known about the occupational hazards or health experiences of cannabis cultivation workers. Respiratory and dermal exposures, musculoskeletal hazards, and other agricultural hazards have been identified in previous research. Even in a post-legalization framework, cannabis work is stigmatized and most cannabis is still produced illegally. Qualitative research is essential for establishing rapport with cannabis workers to understand their experiences and concerns. METHODS: We conducted semi-structured discussions with four focus groups including 32 cannabis workers total, and 9 key informants who were workers, industry experts, and business owners or managers. Transcribed results were analyzed to identify key themes on physiological exposures and health effects. RESULTS: The majority (81.3%) of focus group participants were seasonal migrant cannabis trimmers. Themes emerged of respiratory and dermal exposures and outcomes, musculoskeletal disorders, and physical hazards including living conditions. Workers reported respiratory symptoms and rashes from exposure to cannabis, mold, and pesticides. Musculoskeletal pain was ubiquitous due to inadequate seating and long shifts performing repetitive tasks. Seasonal workers experienced chronic exposure to cold conditions and unsanitary housing. Management-level interviewees and other industry stakeholders described concerns and experiences that differed from those of workers. DISCUSSION: The results were consistent with existing research on cannabis worker health, with workers reporting respiratory and dermal exposure and symptoms, musculoskeletal hazards, and physical hazards associated with agricultural work. In addition, we found that workers were affected by substandard living conditions, remote and isolated work environments, and an absence of training.

A Pilot Study of Respiratory and Dermal Symptoms in California Cannabis Cultivation Workers.

Cannabis (Cannabis sativa, marijuana) is the largest cash crop in California. While it is difficult to characterize the size of the industry, the total production is estimated at 15 to 16 million pounds per year, with total revenues exceeding $10 billion per year. Despite the huge size and rapid growth of the industry, there has been little research on the health and safety of cannabis workers. The goal of this pilot study was to explore the feasibility of collecting cannabis worker health data with a self-administered survey and to analyze the first systematically collected data on occupational health symptoms among California cannabis cultivation workers. We performed a cross-sectional survey of demographic and job characteristics as well as eye, nasal, respiratory, and dermal symptoms among 29 workers at two cannabis farms in the Sacramento area, California. Most participants were men aged less than 30 years, with 48% of participants self-identifying as non-Hispanic white and 58% reporting at least some college education. The most frequently reported work-related symptom was nasal irritation, and 38% of the participants reported symptoms suggestive of asthma. The participants had a demographic makeup distinct from traditional California agricultural workers, and a very high prevalence of current use of cannabis (93%). The high proportion of respondents with symptoms suggestive of asthma raises concern; sensitization to the cannabis plant has been reported among cannabis workers and users and there are many well-documented agricultural exposures causing asthma and asthma-like syndrome.

Chronic disease burden among Latino farmworkers in California.

Farmworkers are an essential workforce to maintain California's extensive agricultural production. However, this mostly Latino, immigrant population is affected by high poverty rates and food insecurity, which increases their risk of chronic diseases. We analyzed clinical and interview data from three studies of Latino farmworkers in California: (1) the Mexican Immigration to California: Agricultural Safety and Acculturation (MICASA) study, (2) the PASOS SALUDABLES pilot intervention (PASOS Pilot), and (3) the PASOS Study, a cluster-randomized, controlled trial (PASOS RCT). We aimed to determine the prevalence of diet-related chronic health outcomes (obesity, elevated waist circumference, high blood pressure, and high total cholesterol) and identify sociodemographic and socioeconomic factors associated with these conditions in this population. A total of 1,300 participants were included in this study (452 from MICASA, 248 from PASOS Pilot, and 600 from PASOS RCT). Obesity prevalence ranged from 29.2 to 54.5% across samples; elevated waist circumference was observed in 29.4-54.0% of participants; high blood pressure was detected in 42.0-45.5% of participants; 23.7-25.8% of participants had high total cholesterol. Age was positively associated with each health outcome, although not for each sample; each additional year in age increased odds by 3-9%, depending on the outcome and sample. Females were at higher risk of obesity (one sample) and elevated waist circumference, but at lower risk of high blood pressure and high total cholesterol. Single, divorced or widowed participants (vs. married/living together) had 35 and 47% reduced odds of obesity and elevated waist circumference, respectively. Each additional year living in the US was associated with 3-6% increased odds of obesity, depending on the sample. Higher household income was associated with a reduction in odds of high total cholesterol up to 76% (one sample). These findings highlight the increased risk of chronic health conditions in Latino farmworkers, in particular for obesity, and among farmworkers who may lack access to health care, which represents a large proportion of this population. Differences in chronic health risks by sex suggest that clinical and public health responses might need to be sex-specific. Expansion of eligibility for supplemental nutrition programs for this low-income population could reduce their disease burden.

Anemia, Weight Status, and Fatigue Among Farmworkers in California: A Cross-Sectional Study.

OBJECTIVE: This study aimed to determine the prevalence of anemia and overweight/obesity and assess the relationships between hematocrit (Hct) and body mass index (BMI), and between fatigue and Hct, among a sample of farmworkers in California. METHODS: We estimated the prevalence of anemia (using Hct), overweight/obesity (BMI ≥25 kg/m 2 ), and self-reported fatigue in 587 farmworkers. Multivariable linear and logistic regression models were used to examine the associations between Hct and BMI, and between fatigue and Hct. RESULTS: Anemia prevalence was 3.1%, overweight/obesity prevalence was 80.7%, and 78% of workers reported fatigue at work. There was no association between Hct and BMI or between Hct and reported fatigue. Women were more likely than men to have lower Hct and higher BMI. CONCLUSIONS: A majority of farmworkers in this sample were overweight/obese, but anemia was uncommon. Anemia among more vulnerable subgroups of farmworkers should be explored.

Effectiveness of a worksite lifestyle intervention to reduce BMI among farmworkers in California: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of PASOS SALUDABLES, a culturally tailored lifestyle intervention to prevent obesity and diabetes among Latino farmworkers, when implemented at large scale in the worksite. DESIGN: This study was a two-arm parallel group, cluster randomised controlled trial, where participants received either a twelve-session lifestyle intervention (intervention) or six-session leadership training (control) at their worksite. The intervention was delivered by Promotoras in Spanish. All sessions were conducted at the worksites (ranches) during meal breaks. Blinded, trained research assistants collected socio-demographic and outcome data (i.e. BMI as primary outcome and waist circumference, glycated Hb (HbA1c), cholesterol and blood pressure as secondary outcomes) at baseline and follow-up assessments (i.e. 3 months, 6 months, 1 year and 1·5 years). SETTING: Recruitment and intervention delivery occurred at twelve study ranches in Oxnard, California. PARTICIPANTS: We enrolled farmworkers hired by a large berry grower company, who were ≥18 years old, spoke Spanish and were free of diabetes at screening. RESULTS: A total of 344 workers were enrolled in the intervention and 271 in the control group. The intervention resulted in attenuated increase of BMI over time; however, the difference in trend between groups was not significant (ß = -0·01 for slope difference, P = 0·29). No significantly different trend by group was observed in secondary outcomes (P > 0·27). CONCLUSIONS: The worksite intervention, implemented during meal breaks, did not reduce BMI or other clinical indicators. Nevertheless, this study supports the feasibility of recruiting and engaging the Latino farmworker population in workplace health promotion interventions.

Compensation incentives and heat exposure affect farm worker effort.

Farm workers are exposed to high risk of heat-related illness, especially when their jobs require working outside at a fast pace during hot days. Climate change has increased the number of days with high temperatures, and thereby the amount of time that farm workers are likely exposed to extreme heat. To better understand how high heat exposure affects farm workers, this study investigates how crop workers respond to heat exposure and estimates the effects of different pay and work arrangements on workers' responses to heat exposure. We explore, specifically, whether piece-rate arrangements increase workers' effort during periods with high heat exposure compared to workers paid by hourly wages. We use observational data from detailed measurements of localized heat exposure and individual workers' effort in the field. First, these results show workers adjust their effort in response to heat exposure when the heat exposure level changes. Second, piece-rate arrangements increase workers' effort during work shifts. Third, piece-rate arrangements allow workers to modify their effort more easily during different heat exposure levels. When facing low levels of heat exposure, workers who were paid by piece-rate arrangements exert a higher effort than workers paid by hourly wages, up until WBGT is 26.6˚C. When facing high levels of heat exposure (with WBGT exceeding 29.6˚C), workers paid by piece-rate arrangements lower their effort compared to workers paid by hourly wage arrangements.

Are Cal/OSHA Regulations Protecting Farmworkers in California From Heat-Related Illness?

OBJECTIVE: Determine compliance with and effectiveness of California regulations in reducing farmworkers' heat-related illness (HRI) risk and identify main factors contributing to HRI. METHODS: In a cross-sectional study of Latino farmworkers, core body temperature (CBT), work rate, and environmental temperature (WBGT) were monitored over a work shift by individual ingestible thermistors, accelerometers, and weather stations, respectively. Multiple logistic modeling was used to identify risk factors for elevated CBT. RESULTS: Although farms complied with Cal/OSHA regulations, worker training of HRI prevention and hydration replacement rates were insufficient. In modeling (AOR [95% CI]) male sex (3.74 [1.22 - 11.54]), WBGT (1.22 [1.08 - 1.38]), work rate (1.004 [1.002 - 1.006]), and increased BMI (1.11 [1.10 - 1.29]) were all independently associated with elevated CBT. CONCLUSION: Risk of HRI was exacerbated by work rate and environmental temperature despite farms following Cal/OSHA regulations.

Gender differences in respiratory health outcomes among farming cohorts around the globe: findings from the AGRICOH consortium.

Purpose: Respiratory hazards of farming have been identified for centuries, with little focus on gender differences. We used data from the AGRICOH consortium, a collective of prospective cohorts of agricultural workers, to assess respiratory disease prevalence among adults in 18 cohorts representing over 200,000 farmers, farm workers, and their spouses from six continents.Methods: Cohorts collected data between 1992 and 2016 and ranged in size from 200 to >128,000 individuals; 44% of participants were female. Farming practices varied from subsistence farming to large-scale industrial agriculture. All cohorts provided respiratory outcome information for their cohort based on their study definitions. The majority of outcomes were based on self-report using standard respiratory questionnaires; the greatest variability in assessment methods was associated with chronic obstructive pulmonary disease (COPD).Results: For all three respiratory symptoms (cough, phlegm, and wheeze), the median prevalence in men was higher than in women, with the greatest difference for phlegm (17% vs. 10%). For asthma, women had a higher prevalence (7.8% vs 6.5%), with the difference associated with allergic asthma. The relative proportion of allergic asthma varied among cohorts. In two of eight cohorts for women and two of seven cohorts for men, allergic asthma was more common than non-allergic asthma.Conclusions: These findings indicate that respiratory outcomes are common among farmers around the world despite differences in agricultural production. As women in the general population are at higher risk of asthma, exploring gender differences in occupational studies is critical for a deeper understanding of respiratory disease among agricultural workers.

Migrant workers, essential work, and COVID-19.

Globally, migrant and immigrant workers have borne the brunt of the COVID-19 pandemic as essential workers. They might be a Bulgarian worker at a meat processing plant in Germany, a Central American farmworker in the fields of California, or a Filipino worker at an aged-care facility in Australia. What they have in common is they are all essential workers who have worked throughout the coronavirus pandemic and have been infected with coronavirus at work. COVID-19 has highlighted the inequitable working conditions of these workers. In many instances, they are employed precariously, and so are ineligible for sick leave or social security, or COVID-19 special payments. If these are essential workers, they should get at least the same health and safety benefits of all nonessential workers. Improving the working and living conditions of migrant workers can and should be a positive outcome of the coronavirus pandemic.

Examining the Impact of Two Dimensions of Precarious Employment, Vulnerability and Insecurity on the Self-Reported Health of Men, Women and Migrants in Australia.

Precarious employment is increasing and adversely affects health. We aimed to investigate how perception of precariousness in current employment impacts gender and migrant workers in Australia. Using cross-sectional interviews of 1292 workers born in Australia, New Zealand, India and the Philippines, data were collected on self-reported health, employment conditions and sociodemographics. Factor analysis of nine questions about perceptions of current employment revealed two dimensions, vulnerability and insecurity. Women had higher vulnerability scores (µ = 6.5 vs. µ = 5.5, t = 5.40, p-value (p) < 0.000) but lower insecurity scores (µ = 8.6 vs. µ = 9.3 t = -4.160 p < 0.0003) than men. Filipino-born workers had higher vulnerability compared with other migrant workers (µ = 6.5 vs. µ = 5.8 t = -3.47 p < 0.0003), and workers born in India had higher insecurity compared with other migrant workers (µ = 9.8 vs. µ = 8.9, t = -6.1 p < 0.0001). While the prevalence of insecurity varied by migrant status, the negative effect on health was higher for Australian-born workers than migrants. Increasing levels of vulnerability and insecurity impacted self-reported health negatively (Coefficient (Coef).0.34 p < 0.0001; Coef.0.25 p < 0.0001, respectively). The combination of high vulnerability and high insecurity had the greatest impact on health (Coef. 2.37 p = 0.002), followed by high vulnerability and moderate insecurity (Coef. 2.0 p = 0.007). Our study suggests that understanding both changes in employment conditions over time as well as knowledge of cultural patterns may offer the best chance of understanding the impact of precarious employment experiences.

Hydration Choices, Sugary Beverages, and Kidney Injury in Agricultural Workers in California.

PURPOSE: Agricultural workers working in high ambient temperatures are at risk for acute kidney injury. Despite recommendations to maintain hydration, workers likely do not drink enough to protect their renal function. Additionally, new research suggests that rehydration with sugary beverages adds additional risk to kidneys already stressed by high heat and workload. We assessed hydration choices during a work shift and tested associations of rehydration using sugary beverages with acute kidney injury. METHODS: We recruited a convenience sample of workers on farms over two summers. We estimated acute kidney injury via pre- and post-shift serum creatinine readings from capillary blood samples. We used self-reported measures of the volume and type of fluids workers consumed during their shifts. We also measured changes in core body temperature, ambient temperature, and workload. We used logistic regression to estimate associations of sugary drinks with acute kidney injury, while controlling for physiologic and occupational variables. FINDINGS: In our sample of 445 participants, we found that men drink more than women do overall, including more than a liter of water than women (2.9 L compared to 1.9 L, respectively). The total volume workers drank was associated with increased odds of acute kidney injury (adjusted odds ratio 1.47, 95% confidence interval 1.09-1.99). We found no association of sugary drinks with acute kidney injury. CONCLUSIONS: These findings provide important information about what men and women use to hydrate during the work day and suggest that they do not drink enough to maintain adequate hydration. Increased fluid intake during the work day may be a result of vigorous workload, which could explain the increased risk for acute kidney injury. Nurses play an important role in educating agricultural workers about the importance of maintaining hydration at work. CLINICAL RELEVANCE: This study advances current knowledge of occupational risk factors for acute kidney injury in agricultural workers. Nurses may be the only point of care for this vulnerable population and are therefore in a unique position to educate on the importance of proper hydration during work.

The Manila Declaration on Migration and Health: commentary of the Association of Pacific Rim Universities Global Health Program.

BACKGROUND: Migration has played, and continues to play, an important role in shaping our global economy. As of 2017, there were 258 million international migrants worldwide, over 100 million of whom came from the Asia-Pacific region. Migration is increasingly recognized as a social determinant of health, as migrants often experience vulnerabilities that make them susceptible to a range of negative health outcomes. Addressing the health and human rights concerns of migrants requires concerted and global efforts from many stakeholders, including universities. METHODS: The Global Health Program of the Association of Pacific Rim Universities (APRU), a non-profit network of more than 50 universities in the region, is an example of an avenue to foster research, innovation, collaborative engagement, and large-scale advocacy around migration and health. In 2017, a special half-day workshop was held in Manila, convening 167 participants from 10 economies and 21 disciplines. The goal of the workshop was to delineate the role of universities in promoting migrant health and well-being. The global health experts from a diverse set of backgrounds collaboratively developed a policy statement to be used to better address migrant health and human rights. The objective of this paper is to disseminate the policy statement, highlighted specific action items that universities can take to protect and promote migrant health. RESULTS: The Manila Declaration on Migration and Health highlights that universities must ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families. Universities are also urged to capitalize on their educational and research expertise to generate data on migrant experiences and communicate this research to policymakers. CONCLUSIONS: This commentary highlights how institutions of higher education can serve as powerful avenues for promoting migrant health and human rights. Universities can play a vital role in building awareness and sensitivity to migrant challenges and needs, as well as helping to develop policy frameworks appropriate to their diverse contexts to guide, promote, and reinforce commitment to migrant rights and health. Universities should also ensure that their campuses are safe, supportive, and empowering environments for all migrants and their families.

Acute kidney injury and workload in a sample of California agricultural workers.

BACKGROUND: Kidney damage is associated with an increased workload in high ambient temperatures and may represent a pathway to chronic kidney disease of unknown origin in agricultural workers. We tested the associations of workload and heat with acute kidney dysfunction in California agricultural workers. METHODS: We recruited a convenience sample of 471 agricultural workers from 29 farms in California during two summer harvest seasons. The sustained 3-minute maximum workload was estimated using accelerometer data collected from Actical monitors and individual heat load through elevations in core body temperature. Acute kidney injury (AKI) was defined by a change in serum creatinine of ≥0.3 mg/dL or ≥1.5 times the preshift creatinine over the course of the work shift. Associations between AKI and workload were modeled using logistic regression, controlling for demographic, physiologic, and occupational variables. RESULTS: Of the total, 357 workers (75.8%) had accelerometer readings in the moderate workload category, 93 (19.7%) had readings in the vigorous category. 177 (36%) had elevations of core body temperature ≥1°C; 72 workers (14.9%) demonstrated evidence of AKI after a single day of agricultural work. The workload category was associated with an increased adjusted odds of AKI (1.92; 95% confidence interval, 1.05-3.51). Piece-rate work was also associated with increased adjusted odds of AKI (3.02; 95% CI, 1.44-6.34). CONCLUSIONS: Heavy occupational workload and piece-rate work were associated with acute effects on the renal health of agricultural workers. This indicates that occupations requiring high physical effort put workers at risk for AKI, possibly independent of ambient and core body temperature. Changes to agricultural practices may reduce the risk of renal disorders for these workers.

Diagnosed and Undiagnosed Diabetes among Agricultural Workers in California.

Latino agricultural workers in California are a vulnerable population at risk for many undiagnosed health concerns. Principal among them is diabetes, and the prevalence of diagnosed and undiagnosed diabetes is difficult to estimate. In a convenience sample of 579 agricultural workers recruited through the California Heat Illness Prevention Study (CHIPS), we found HbA1c levels consistent with diabetes in 54 participants, of whom 33 (61.1%) were aware of their status. We found HbA1c levels consistent with pre-diabetes in 59 participants, of whom none was aware. Results indicate a health disparity between agricultural workers and other populations in the U.S. Many are unaware of having a chronic illness and lack resources or have other barriers to manage it. Nurses, midlevel providers, and health fairs are often the first or only point of health care contact for agricultural workers and can provide valuable information, screening, and support for this vulnerable population.

Impacts of weather, work rate, hydration, and clothing in heat-related illness in California farmworkers.

BACKGROUND: The primary aim of this study was to investigate the effects of work rate, hydration status, and clothing on core body temperature (CBT) on California farmworkers. METHODS: Two hundred and eighty-seven farmworkers were recruited in Summer 2015, with 259 participants having sufficient data for analysis. We collected CBT, ambient temperature, work rate, body weight loss, and clothing worn by each participant throughout the work day and demographic data from a questionnaire. RESULTS: Multiple regression with CBT as the outcome was used to determine the adjusted associations between CBT, environmental heat load, and worker characteristics. The multivariate regression model showed statistically significant associations of CBT with work rate (ß = .006, 95% CI [0.004, 0.009]) and wet-bulb globe temperature (ß = .03, 95% CI [0.017, 0.05]). CONCLUSION: Results suggest that among our population workload is the primary modifiable risk factor for heat-related illness. As expected, the ambient temperature was also associated with higher risk.