Local health department assurance of services and the health of California's seniors.

OBJECTIVE: To examine the extent to which local health department (LHD) assurance of select services known to promote and protect the health of older adults is associated with more favorable population health indicators among seniors. DESIGN: Data from the California Health Interview Survey (CHIS: 2003, 2005, and 2007) were linked with the 2005 wave of the National Association of County and City Health Officials profile survey and the Area Resource File to assess the association of LHD assurance and senior health indicators. Assurance was measured by an index of 5 services, either directly provided or contracted by LHDs: cancer screening, injury prevention, comprehensive primary care, home health care, and chronic disease prevention. Multilevel regression models estimated the association of LHD assurance of services and each of 6 older adult health indicators, controlling for individual, LHD, and county characteristics that included key social determinants of health, such as poverty. SETTING: Fifty-seven California counties. PARTICIPANTS: 33,154 older adults (age 65 and older). MAIN OUTCOME MEASURES: Colorectal cancer screening, mammography, healthy eating, physical activity, and multiple falls among older adults. RESULTS: Local health departments provided or contracted a median of 2 of the 5 services. In adjusted analyses, LHD assurance of services was generally unassociated with the seniors' health behaviors, screening, and falls. Greater LHD expenditures per capita were associated with significantly better mammography screening rates (adjusted odds ratio [AOR] = 1.22, P < 0.01) compared to jurisdictions in the bottom one-third of per capita LHD spending. Greater county-level poverty (a social determinant of health) was associated with greater junk food consumption (AOR = 1.14, P < 0.01) and worse fruit and vegetable consumption (AOR = 0.97, P < 0.01). Highly impoverished counties were consistently in the bottom quartile of performance across all indicators. CONCLUSIONS: The LHD's assurance of select services known to promote and protect the health of older adults does not appear to translate into higher rates of colorectal cancer screening, mammography, healthy eating, physical activity, and fewer falls among seniors. County-level poverty is most strongly associated with older adult health, underscoring a key barrier to address in local senior health improvement efforts.

"Pesticides protect the fruit, but not the people": using community-based ethnography to understand farmworker pesticide-exposure risks.

OBJECTIVES: We used community-based ethnography and public health risk assessment to assess beliefs about pesticide exposure risks among farmworkers in the Lower Yakima Valley of Washington State. METHODS: We used unstructured and semistructured interviews, work-site observation, and detailed field notes to gather data on pesticide exposure risks from 99 farmworkers. RESULTS: Farmworkers' pesticide-relevant beliefs and attitudes could be grouped into 5 major themes: (1) dry pesticides are often perceived as a virtually harmless powder, (2) farmworkers who identify themselves as allergic to pesticides are more acutely affected by exposure, (3) the effect of pesticide exposure is more severe for those perceived as physically weak, (4) protective equipment is used selectively in response to financial pressure to work rapidly, and (5) some farmworkers delay decontamination until they find water deemed an appropriate temperature for handwashing. CONCLUSIONS: We elucidated farmworkers' pesticide-relevant beliefs regarding perceived danger and susceptibility to pesticides, the need to put safety second to financial considerations, and reasons for delaying decontamination. Researchers and policymakers should incorporate these data in study designs and legislation concerned with farmworker exposure to pesticides.

Mexican immigrant male knowledge and support toward breast and cervical cancer screening.

BACKGROUND: We conducted a focus group study to assess the influence of partner communication on breast and cervical cancer screening and the perceived existing and potential support from male partners in participating in cancer screening. Secondarily, Mexican male and female views on health care and cancer were explored. METHODS: Seven focus groups (two female-only, three male-only, and two couples) were conducted in Spanish. RESULTS: Findings suggest that knowledge about cervical cancer was significantly less than knowledge about breast cancer among both men and women. Barriers to cancer screening included language barriers, lack of health insurance, and lack of awareness of the need for screening. Male partners expressed willingness to support their female partners in cancer screening activities. CONCLUSION: Cervical cancer education is desperately needed, including education on the availability of free and low cost screening services. Education efforts should include the male community members, especially as the males perceive themselves as responsible for the financial burden of care.

Health care providers' assessments of the quality of advanced-cancer care in Latin American medical institutions: a comparison of predictors in five countries: Argentina, Brazil, Cuba, Mexico, and Peru.

This paper describes an innovative Pan-American survey on advanced-cancer care and examines the quality-of-care provided by Latin American institutions. A convenience sample of 777 physicians and nurses who treat cancer patients in Argentina, Brazil, Cuba, Mexico, and Peru were surveyed. Providers were identified through mass mailings, distribution at professional meetings and conferences, collaboration with regional institutions, professional organizations, and PAHO and online posting. Multiple linear regression analyses were conducted to identify predictors of quality-of-care assessments in each country. The five predictive models were subsequently compared descriptively. Higher access to care ratings and greater availability of end-of-life services corresponded with improved institutional quality-of-care ratings for all five countries. Barring respondents from Cuba, providers from the other four nations who practice in public institutions rated the quality of advanced-cancer care in their own institutions lower than those practicing in private hospitals or specialized cancer centers. Other institutional quality-of-care predictors included type of city, affordability-of-care ratings, availability of opioid analgesics, where patients die, barriers to cancer pain management, and the provider's specialty and gender. These findings highlight the need for providing accessible care and services to improve the quality of advanced-cancer care in Latin American institutions. Efforts should be aimed at improving the care offered in public institutions and addressing other types of disparities that may exist within countries by creating supportive and palliative cancer care programs that are accessible and affordable to those most in need.

Community-Based Participatory Research and Gene-Environment Interaction Methodologies Addressing Environmental Justice among Migrant and Seasonal Farmworker Women and Children in Texas: "From Mother to Child Project"

The "From Mother to Child Project" is a molecular epidemiological study that employs a community- based participatory research (CBPR) approach and gene-environment interaction research to address environmental justice in migrant and seasonal farmworker (MSF) women and children of Mexican origin home-based in Baytown and La Joya, Texas. This paper presents the background and rationale for the study and describes the study design and methodology. Preliminary data showed that MSF women and children in Texas have measurable levels of pesticides in their blood and urine, some of which were banned in the United States decades ago and are possible human carcinogens. Polymorphisms in genes involved in chemical detoxification and DNA repair have been associated with susceptibility to genetic damage and cancer development in populations exposed to environmental toxins. The "From Mother to Child Project" is testing three hypotheses: (1) MSF women and children who are occupationally exposed to pesticides are at higher risk for DNA damage than are non-exposed women and children. (2) Both, the extent of pesticide exposure and type of polymorphisms in chemical detoxification and DNA repair genes contribute to the extent of DNA damage observed in study participants. (3) The mutagenic potency levels measured in the organic compounds extracted from the urine and serum of study participants will correlate with the total concentrations of pesticides and with the measured DNA damage in study participants. The study will enroll 800 participants: 200 MSF mother-child pairs; 200 children (one per family) whose parents have never worked in agriculture, matched with the MSF children by ethnicity, age ± 2 years, gender, and city of residence; and these children's mothers. Personal interviews with the mothers are used to gather data for both mothers and children on sociodemographic characteristics; pesticide exposure at work and home; medical and reproductive history; dietary assessment, and lifestyle factors. Blood and urine samples are collected from each participant and analyzed for (1) organochlorine and organophosphate pesticide levels, (2) genetic polymorphisms of chemical detoxification and DNA repair genes, (3) DNA damage (chromosomal aberrations), and (4) the mutagenic potential of pesticides in the serum and urine. Recruitment and data collection in Baytown is near completion, and over one third of the target population for the La Joya study site.

Attitudes, knowledge, and health-seeking behaviors of five immigrant minority communities in the prevention and screening of cancer: a focus group approach.

Despite an observed decrease in overall cancer death rates in the USA, immigrant minorities continue to experience disproportionately higher cancer incidence and mortality rates. Thirteen focus groups were conducted in the Haitian, English-Speaking Caribbean, Latino, Korean, and Chinese communities of New York City to better understand their health-seeking behaviors with respect to cancer prevention, screening, and treatment. Focus groups addressed the degree to which cultural, linguistic, and systematic barriers impact these behaviors and explored methods to support salutary behaviors. Findings underscored that, while there are many similarities across immigrant groups, there are significant variations between the immigrant groups to necessitate a tailored community-based approach. The prevalent misinformation observed among all groups warrants the prompt development of culturally competent programs for cancer control with immigrant minorities.