Barriers and facilitators for promotoras' success in delivering pesticide safety education to Latino farmworker families: La Familia Sana.

Despite widespread use of lay health advisor (LHA) programs, factors related to success of LHAs remain largely unexamined. This study describes experiences and personal transformations of LHAs (promotoras de salud) in a pesticide safety education program targeting farmworker families in North Carolina, using postintervention in-depth interviews conducted with 17 LHAs. LHAs identified assets and barriers that affected their success. LHAs also described increases in self-efficacy and empowerment resulting in perceived improvements in ability to teach and impact their community. Such positive changes are essential benefits to the LHAs. Evaluations that address these topics are needed to better understand continuity and attrition in LHA programs.

Evaluating the effectiveness of a lay health promoter-led, community-based participatory pesticide safety intervention with farmworker families.

Pesticide safety training is mandated for migrant and seasonal farmworkers. However, none is required for family members, who implement home sanitation to protect against pesticide exposure and need to control pests in substandard housing. Controlled studies have demonstrated the efficacy of pesticide education programs for farmworker families, but no carefully evaluated demonstration projects have shown effectiveness in public health settings. This project evaluates a lay health promoter program to improve pesticide-related knowledge and practices. Promotoras from six agencies recruited families with children to deliver a six-lesson, in-home, culturally and educationally appropriate curriculum. Independently conducted pre- and posttests evaluated changes in knowledge and practices. Adults in 610 families completed the study. Most were from Mexico, with low levels of formal education. Significant improvements in knowledge were observed for all six lessons. Significant improvements were observed in practices related to para-occupational exposure and residential pest control. Lay health promoters with limited training and supervision can have significant impacts on families' knowledge and practices. They represent a workforce increasingly recognized as a force for reducing health disparities by providing culturally appropriate health education and other services. This study adds to the literature by demonstrating their effectiveness in a public health setting with rigorous evaluation.

Pesticide urinary metabolite levels of children in eastern North Carolina farmworker households.

BACKGROUND: In this investigation we documented the pesticide urinary metabolite levels of farmworker children in North Carolina, determined the number of different metabolites detected for each child, and delineated risk factors associated with the number of metabolites. METHODS: Urine samples were collected from 60 Latino farmworker children 1-6 years of age (34 female, 26 male). Interviews were completed by their mothers in Spanish. We analyzed urine samples for 14 pesticide metabolites, including the organophosphate pesticides chlorpyrifos, coumaphos, diazinon, isazaphos, malathion, pirimiphos, and parathion and its methyl counterpart; a common metabolite of at least 18 pyrethroid insecticides; the repellent DEET; and the herbicides 2,4,5-trichlorphenoxyacetic acid, 2,4-dichlorophenoxyacetic acid, acetochlor, atrazine, and metolachlor. Predictors included measures of paraoccupational, residential, and environmental exposure, child characteristics, and mother characteristics. RESULTS: Thirteen metabolites were present in the urine samples. Organophosphate pesticide metabolites were detected in a substantial proportion of children, particularly metabolites of parathion/methyl parathion (90.0%; geometric mean 1.00 microg/L), chlorpyrifos/chlorpyrifos methyl (83.3%; geometric mean 1.92 microg/L), and diazinon (55.0%; geometric mean 10.56 microg/L). The number of metabolites detected ranged from 0 to 7, with a mode of 4 detected (28.3%). Boys, children living in rented housing, and children with mothers working part-time had more metabolites detected. CONCLUSIONS: Children in farmworker homes experience multiple sources of pesticide exposure. Pesticides may remain in their environments for long periods. Environmental and occupational health changes are needed to address these exposures. Research is needed with more precise measures of exposure and on the health effects of concurrent exposure to multiple pesticides.

Experiences of Latino immigrant families in North Carolina help explain elevated levels of food insecurity and hunger.

Household food insecurity is higher among minority households in the U.S., but few data exist on households of recent minority immigrants, in part because such households are difficult to sample. Four studies of a total of 317 Latino immigrant families were conducted in different regions and during different seasons in North Carolina. A Spanish translation of the 18-item U.S. Food Security Survey Module was used to assess the prevalence of food insecurity and hunger. In 3 of the studies, a total of 76 in-depth interviews were conducted to gather information on immigrants' experiences of food insecurity. Households in the 4 studies classified as food secure ranged from 28.7 to 50.9%, compared with 82.4% in the U.S. in 2004. Food insecurity without hunger ranged from 35.6% to 41.8%, compared with 13.3% in the U.S. The highest rates of hunger reported were 18.8% (moderate hunger) and 16.8% (severe hunger) in an urban sample. Qualitative data indicate that food insecurity has both quantitative and qualitative effects on diet. Immigrants experience adverse psychological effects of food insecurity. They report experiencing a period of adjustment to food insecurity leading to empowerment to resolve the situation. Reactions to food insecurity differ from those reported by others, possibly because immigrants encounter a new and not chronic situation. Overall, these findings suggest that immigrant Latinos experience significant levels of food insecurity that are not addressed by current governmental programs.

Leaving family for work: ambivalence and mental health among Mexican migrant farmworker men.

Men migrating to the United States from Mexico and Central America confront opposing family norms. They need to leave their families to gain family economic security; yet, leaving renders their families vulnerable. We examined the mental health implications of the opposing family norms inherent in migration using an ambivalence framework. We interviewed 60 Latino migrant farmworkers working in North Carolina. Most were from Mexico; each had left a wife and children in his country of origin. Analysis indicated that family ambivalence was common. Ambivalence was associated with anxiety symptoms (but not depression or alcohol dependence), especially among men who were unable to contact their families regularly. Results show the usefulness of the ambivalence framework, and suggest that the origins of poor migrant mental health may reside in circumstances preceding migration. Study recommendations include facilitating family contact by expanding access to telephones among migrant workers.

Household food security among migrant and seasonal latino farmworkers in North Carolina.

OBJECTIVE: Food insecurity is defined as lack of access at all times, due to economic barriers, to enough food for an active and healthy lifestyle. The objective of this study was threefold: to characterize levels of food security, food insecurity, and hunger among migrant and seasonal Latino farmworkers; to assess predictors of food insecurity for this group; and to describe the strategies farmworkers use to cope with food insecurity. METHODS: Adults from 102 farmworker households in North Carolina responded to a survey that used a Spanish-language adaptation of the U.S. Household Food Security Survey Module and questions about sociodemographic characteristics and food behaviors. Twenty-five farmworkers participated in in-depth interviews in which they described their households' food security situation and coping strategies. RESULTS: Forty-eight of the 102 sample households (47.1%) were classified as food insecure, including 10 (9.8%) with moderate hunger and five (4.9%) with severe hunger. Households with children had a significantly higher prevalence of food insecurity than those without children (56.4% vs. 36.2%). Households with children accessed food programs such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) that were unavailable to those without children, while those without children were more likely to access food pantries and to consume wild game or fish. Coping strategies included borrowing money, reducing food variety, and adults consuming less food to protect children from hunger. Food insecurity was more than four times as prevalent among farmworker households as among the general U.S. population. CONCLUSION: Policy changes to increase economic resources and access to federal programs are needed to decrease this food insecurity.