Hand problems in migrant farmworkers.

PURPOSE: We estimated the self-reported prevalence of hand problems and identified factors associated with them in this cross-sectional study including 390 farmworkers representing 180 migrant farmworker families from Starr County, Texas. METHODS: A two-year cohort study (1999-2001), "Injury and Illness Surveillance in Migrant Farmworkers (MANOS), "provided the data for this study. We calculated the prevalence for the two-year follow-up period, stratified by family member and survey year. The associated work and non-work factors were identified for the entire sample using multilevel mixed-effects logistic regression analysis. RESULTS: Prevalence for hand problems was 29.0% and 17.8% for the first and second study years, respectively. Significant factors (associated odds ratios) included increasing age (1.07), female gender (3.49), duration of sleep while migrating (0.68), participation group working in both study years 1 and 2 (0.21) or year 2 only (0.14), working on average more than 11 hours per day (8.23), moving heavy objects at work (3.97), working with hand-held vibrating tools/machinery (5.16), and working in meat processing (40.48). CONCLUSIONS: The prevalence of hand problems in migrant farmworkers reported by this study was notable for mothers, fathers, and children. Further research with refined ergonomic exposure and outcome assessments for investigating hand injuries in migrant farmworkers is indicated, specifically among youth. The role of sleep in preventing symptoms should also be explored.

Factors associated with depression symptoms in high school students in São Paulo, Brazil

OBJECTIVE: To assess factors associated with depression symptoms in high school students. METHODS: A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8 percent) and unemployed (22.9 percent) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status. RESULTS: Overall prevalence rate of depression was 7.5 percent. Rates according to gender were 39 (10.3 percent) in females and 15 (4.3 percent) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35). CONCLUSIONS: The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These ndings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

OBJETIVO: Investigar os fatores associados a sintomas depressivos em estudantes do ensino médio. MÉTODOS: Foi realizado estudo transversal com estudantes residentes no Município de São Paulo, Brasil, em 2001. O total de 724 estudantes com idades entre 14 e 18 anos preencheram questionários de condições de vida e saúde. Dentre eles, os estudantes trabalhadores (44,8 por cento) e desempregados (22,9 por cento) também responderam a um outro questionário de condições de trabalho. A regressão logística foi utilizada para determinar os fatores associados para apresentar distúrbios depressivos, utilizando-se a "situação ocupacional" para ajustar o modelo. RESULTADOS: A prevalência dos sintomas depressivos na população estudada foi de 7,5 por cento; as taxas de acordo com o sexo foram de 39 (10,3 por cento) e 15 (4,3 por cento) nos adolescentes dos sexos feminino e masculino, respectivamente. A regressão logística mostrou que os fatores associados aos distúrbios depressivos são: baixo escore na auto-avaliação da saúde (OR=5,78), ser do sexo feminino (OR=2,45) e consumo de bebidas alcoólicas (OR=2,35). CONCLUSÕES: Os resultados mostraram que variáveis sociodemográficas, de estilo de vida e de saúde estavam associadas aos distúrbios depressivos. Esses achados sugerem a importância de que profissionais de saúde mental em escolas de ensino médio efetuem rastreio para reconhecer precocemente problemas mentais e fornecer aconselhamento aos estudantes.

Factors associated with depression symptoms in high school students in São Paulo, Brazil.

OBJECTIVE: To assess factors associated with depression symptoms in high school students. METHODS: A cross-sectional study involving high school students was conducted in the city of São Paulo, Brazil, 2001. A total of 724 students aged 14-18 years answered questionnaires on life and health conditions. Another questionnaire was applied to working (44.8%) and unemployed (22.9%) students to collect information on working conditions. Factors associated to depressive disorders were analyzed using multiple logistic regression controlled for occupational status. RESULTS: Overall prevalence rate of depression was 7.5%. Rates according to gender were 39 (10.3%) in females and 15 (4.3%) in males. The multiple logistic regression analysis showed that factors associated with depressive disorders were: poor self-perception of health (OR=5.78), being female (OR = 2.45), and alcohol consumption (OR=2.35). CONCLUSIONS: The study results showed that sociodemographic, lifestyle and health variables were associated with symptoms of depression in this population. These findings suggest that it is important to have mental health professionals available in high schools for early detection of mental conditions and student counseling.

Pesticide safety training among farmworker adolescents from Starr County, Texas.

This study of adolescent farmworkers describes employer compliance with pesticide safety training, a requirement of the EPA-mandated Worker Protection Standard (WPS), and identifies variables associated with having received training within the prior five years. Data are from "A Study of Work Injuries in Farmworker Children, " a three-year cohort study of high school students living along the Texas-Mexico border in Starr County. Data were collected using a web-based, self-administered, confidential survey. Of 324 students who participated in field work between January 1 and September 30, 2003, 68 (21.0%) reported ever receiving pesticide safety training. Overall, the 61 (18.8%) students who reported training within the prior five years also reported that their most recent instruction covered at least three key WPS areas (i.e., entry into a recently treated field, pesticide-related injuries/illnesses, and emergency care for pesticide exposure). Based on a multiple logistic regression, students who were male (OR = 1.97), worked only outside of Texas (OR = 2.73), worked only for commercial growers/owners (OR = 4.35), worked only for contractors (OR = 3.18), worked corn crops (OR = 2.93), and worked potato crops (OR = 3.11) were more likely to report receipt of training within the prior five years. Results suggest that increased enforcement may be needed, especially in Texas, and special educational efforts may be needed to reach female farmworker youth.

Health risk behaviors and work injury among hispanic adolescents and farmworkers.

Adolescents may engage in health risk behaviors that increase their likelihood of injury. Employment places adolescents at risk of work-related injuries. This study responds to the paucity of data on the relationship between adolescent health risk behaviors and work-related injury. This cross-sectional study included the administration of anonymous surveys to ninth graders (n=4914) who attended high schools in south Texas. An aggregate risk score (ARS) was developed based on health risk behaviors. The ARS was analyzed as an outcome using linear regression. Associations between health risk behaviors and work-related injury were assessed with logistic regression. Of the respondents, 19% reported they had a job, and 14% reported that they had been employed in farmwork. Farmwork-related injury was reported by 9% of adolescents, and 12% reported other work-related injury. Mean ARS scores were significantly higher (p < 0.05) for both male and female adolescents who reported a work-related injury compared to nonworking adolescents, and for males who had done migrant farmwork compared to all other adolescent males. The ARS increased as hours worked per week increased. After controlling for confounding factors, a statistically significant association was found between ARS and non-farmwork, work-related injury, but not between ARS and farmwork-related injury. Farmworkers with high ARS were more likely to report non-farmwork, work-related injuries. The predictors of work-related injury in the adolescent groups, particularly for farmworkers and migrants who are under additional stress, remain an important occupational health area to be addressed.

Pesticide safety training and access to field sanitation among migrant farmworker mothers from Starr County, Texas.

Very little published research describes employer compliance with EPA-mandated Worker Protection Standard (WPS) pesticide safety training and the OSHA Field Sanitation Standard among farmworker women in general and mothers specifically. A goal of both standards is limiting farmworkers' exposure to potentially hazardous agricultural pesticides. Data from a NIOSH-supported cohort study ("Injury and Illness Surveillance in Migrant Farmworker Families") allowed for examining these issues. The cohort included 267 migrant farmworker families who usually reside along the Texas-Mexico border (Starr County, Texas). Data were collected in Starr County during in-home interviews. Of 102 mothers who participated in migrant farm work during summer 2001, 57 (55.9%) reported having ever received training/instruction in the safe use of pesticides, while 47 (46.1%) reported having received training within the previous five years, as required by WPS. Of trained mothers, 91.5% to 93.6% reported that their training covered key WPS areas: (1) entry into a recently treated field, (2) pesticide related injuries/illnesses, and (3) where to go and who to contact for emergency care following exposure. Regarding access to field sanitation, 67.5% to 84.2% of 77 mothers who worked outside Texas reported employer-provided decontamination supplies (e.g., soap, wash water, towels, and toilet facilities). However, a strikingly smaller proportion (12% to 28%) of 25 mothers who worked within Texas reported access to the same resources, suggesting discrepancies in compliance across the U.S. Due to the low level of employer compliance with both WPS and OSHA mandated standards, increased enforcement and an alternate delivery of pesticide training is recommended.

Lessons learned: geographic information systems and farmworkers in the Lake States.

Agencies serving the estimated 42,000 to 137,000 migrant and seasonal farmworkers in the Lake States (Wisconsin, Michigan, and Minnesota) face distinct challenges, including inadequate access to farmworker data to address their needs. This project developed and evaluated a geographical information system (GIS) database for compiling and displaying existing farmworker data in the Lake States. A three-step study was conducted in the Lake States: (1) a preliminary resource and needs assessment was conducted among agencies serving farmworkers, (2) a GIS product was created using data available from state agencies, and (3) the GIS product was evaluated by an advisory board of qualified occupational health and safety representatives for appropriateness, applications, and ease of use. Agencies participated by sharing their available farmworker data. The GIS product consisted of a CD-ROM with data displayed in a graphic format and downloadable spreadsheet files consolidated by county demographic, crop, housing, and migrant health clinic information. Evaluators of the GIS product found it to be an accessible, unique clearinghouse for farmworker-related data. The GIS product can become a valuable tool for agencies serving farmworkers and those researching farmworker-related issues. Agencies and health professionals require useful and comprehensive databases to track and serve farmworkers, and a multi-agency partnership using GIS technology could provide this capability. Further research is required with improved definitions and resources to apply the GIS product.

Statistical validation of a commonly used method for personnel dosimetry issuance determinations.

In 1992, the federal requirements for personnel monitoring of occupational radiation doses were modified, making monitoring compulsory only for individuals "likely" to exceed 10% of the applicable annual dose limits. This regulatory change served as a catalyst for many radiation protection programs to re-evaluate their personnel monitoring issuance criteria to determine if some monitoring services might be reduced or eliminated. But in the absence of any clear definition of the term "likely," radiation protection programs relied on adjustments largely based on reviews of previous monitoring results and professional judgment. Although such semi-quantitative assessments may have been appropriate, the approach was not without inherent programmatic risks, as radiation dosimetry programs have been shown to be a consistent source of regulatory non-compliance upon inspection and serve as essential elements in defense against litigation efforts purporting workplace-related radiation injury. The objective of this study was to subject this commonly used method for post-regulatory change dosimetry issuance determinations to statistical validation. Personnel monitoring data from The University of Texas Health Science Center at Houston Radiation Safety Program pre- and post-1992 regulatory changes were accessed and descriptively analyzed. The dynamic nature of the institutional environment made direct comparisons of individuals between years impractical, so 1990 mean dose levels for various independent variables were compared using the Kruskal-Wallis non-parametric ANOVA test at a significance level of alpha = 0.05. The data from 1998 were then analyzed to ascertain if the groupings identified as statistically different in 1990 were still being monitored. The analyses statistically validated the monitoring program reductions made by the University of Texas Health Science Center at Houston radiation protection program. In addition, statistical support for further monitoring program reductions were identified, if such reductions were deemed to be necessary in the future.

Effect of follow-up time on risk estimates: a longitudinal examination of the relative risks of leukemia and multiple myeloma in a rubber hydrochloride cohort.

BACKGROUND: Choice of follow-up time for an occupational cohort can influence risk estimates. We examined the effects of follow-up time on relative risk estimates for leukemia and multiple myeloma in a cohort of 1,845 rubber hydrochloride workers. MATERIALS AND METHODS: We generated standardized mortality ratios (SMRs) for yearly follow-ups, beginning each study in 1940 and increasing study end dates from 1950 through 1996. We used Cox proportional hazards modeling to explore the effects of follow-up time on the exposure-response relationship. RESULTS: The SMR for leukemia rose to 13.55 in 1961 and fell nearly monotonically to 2.47 by 1996. Cox modeling suggested interaction between cumulative exposure and time since exposure. A longer time to peak risk was seen for multiple myeloma. CONCLUSIONS: Because summary risk estimates change with follow-up time, exposure limits set using these estimates may not adequately protect workers. Consideration of appropriate follow-up time and use of more complex temporal models are critical to the risk assessment process.

Development of a life events/icon calendar questionnaire to ascertain occupational histories and other characteristics of migrant farmworkers.

BACKGROUND: Specialized methods are necessary to collect data from migrant farmworkers for epidemiologic research. METHODS: We developed a questionnaire that collected lifetime occupational histories and other lifestyle risk factors via a life events/icon calendar, and administered the questionnaire to a convenience sample of 162 migrant farmworkers in nine areas of the U.S. RESULTS: The average duration of the interviews was about 1 h 30 min, with an average of 45 min for the work history section. The occupational histories covered a median of 27.6 years per person for men and 20.8 years per person for women. The median number of years spent in farm jobs was 11.3 for men and 5.8 for women. The median number of farm jobs (crop/task combination) per person was 59 among men and 27 among women. Many farmworkers performed the same crop/task combinations at multiple times throughout their lives, yielding a median of 13 unique farm jobs and 8 unique crops among men and 7 jobs and 5 crops among women. CONCLUSIONS: The project demonstrated that it is feasible to collect detailed work histories and other risk factor data from farmworkers, documented the complexity of work histories encountered among farmworkers, and yielded recommendations for refining a questionnaire that will facilitate future epidemiologic research on farmworkers.

Ascertainment of pesticide exposures of migrant and seasonal farmworker children: findings from focus groups.

BACKGROUND: To design questionnaires for epidemiologic research among children of migrant farmworkers, researchers need to consider ways to best solicit information about pesticide exposures. METHODS: Bilingual facilitators conducted five focus groups with either migrant farmworker mothers or their children (age range 8-16 years) in southern Texas and northeastern Colorado. Guided questions were used to assess activities of migrant farmworker children and the ways to best elicit information about exposure to pesticides. RESULTS: Participants reported a large number of activities that may potentially expose children to pesticides through both direct and indirect routes. Prompting, indirect questions about chemical use, and use of local and trusted facilitators increased information elicited from focus group participants. CONCLUSIONS: These focus groups helped to provide information for developing questionnaire items related to pesticide exposure among migrant farmworker children, and highlighted the importance of using bilingual community interviewers and including children as respondents.

Prenatal exposure to pesticides: a feasibility study among migrant and seasonal farmworkers.

BACKGROUND: Migrant and seasonal farmworkers have a high potential for pesticide exposures, yet are rarely included in epidemiologic studies. This study examined the feasibility of assessing prenatal exposures to pesticides and other compounds in pregnant Hispanic farmworkers. METHODS: Nine women completed a survey about work experiences during pregnancy. Maternal urine, cord blood, and placenta samples were obtained at delivery for analysis of 51 analytes, including 6 phenoxy acid or triazine herbicides, 21 organochlorine insecticides, 10 PCBs, and 14 volatile organic compounds. RESULTS: Seven of 51 analytes were found in the biological samples. DDE, DDT, dichlorbenzene, toluene, trimethylbenzene, and endosulfan sulfate were detected in cord blood samples, and 2,4-D in urine from one or more women. CONCLUSIONS: We documented the feasibility of following farmworkers to assess in utero exposure to pesticides and other contaminants, and demonstrated exposure to these compounds. Difficulties in measuring pesticides with short half lives were noted.

Tracing migrant farmworkers in Starr County, Texas.

BACKGROUND: In response to The National Cancer Institute (NCI) concerns about the ability to conduct studies among migrant farmworkers, this study evaluated the feasibility of identifying migrant farmworkers in their home state and tracing them over an extended period of time. METHODS: In 1995, a group of 196 persons who had classified themselves as "migrant farmworkers" in two earlier chronic disease studies was identified. The primary objective of the current study was to determine the proportion of these farmworkers who could be located in 1995-1996. RESULTS: Of these farmworkers, 163 were located and were living (83.2%), 15 had died (7.6%), and 18 (9.2%) were lost to follow-up. CONCLUSIONS: The excellent follow-up rate was due in part to the high participation rates among persons contacted for information, stability of the farmworkers' permanent homes, predictable timing of migration, and a longstanding health research program with established community contacts.

Neural tube defects among Mexican Americans living on the US-Mexico border: effects of folic acid and dietary folate.

Populations of Mexican descent have high occurrences of neural tube defects (NTDs). A recent study suggested that folic acid supplements may not protect these populations from NTDs. In a case-control study, the authors investigated the role of folic acid and dietary folate intake in NTD risk among Mexican Americans living along the Texas-Mexico border. From January 1995 to February 1999, 148 Mexican-American women with NTD-affected pregnancies and 158 women with normal live births were interviewed in person about use of vitamin supplements and dietary intakes during a 6-month periconceptional period (from 3 months before conception to 3 months after conception). Daily preconceptional consumption of vitamin supplements containing folic acid was 2.5% in control women and 2.0% in case women (odds ratio = 0.77; 95% confidence interval (CI): 0.19, 3.22). With adjustment for maternal age, education, obesity, and previous stillbirth or miscarriage, the risk estimate was essentially null (odds ratio = 1.12; 95% CI: 0.22, 5.78). Combined folic acid intake from diet and supplements showed only a modest risk reduction for intakes of > or = 1.0 mg per day (adjusted odds ratio = 0.73; 95% CI: 0.31, 1.72). The fact that the primary folic acid exposure was in the form of dietary polyglutamates rather than the more easily absorbed supplemental monoglutamates may explain an apparent decreased effect in this population.

Adolescent occupational injuries: Texas, 1990-1996.

BACKGROUND: A comprehensive surveillance system for occupational injuries to adolescents does not exist in Texas, as in most states. Therefore, the magnitude, severity, nature, and source of injuries to working adolescents have not been well described in Texas. METHODS: The investigators used three data sources to investigate work-related injuries and deaths in Texas: (1) Texas Workers' Compensation Commission (TWCC) claims data from 1991 through April 1996; (2) 1993 TWCC/Bureau of Labor Statistics (BLS) Annual Survey of Occupational Injuries and Illnesses; and (3) work-related fatalities identified from Texas death certificates from 1990-1995. RESULTS: There were 9,027 injuries reported to the TWCC for adolescents 14-17 years of age during slightly more than 5 years. Injuries for which indemnity payments were made (more than 7 days out of work) occurred among 21.7% of the adolescents. Based on BLS data in 1993, of 992 non-fatal injuries involving days away from work, 35% were caused by contact with objects, 27% by bodily reaction, and 24% by falls. Two-thirds of these injuries occurred while working in eating and drinking places and grocery stores. Three-quarters of the 30 deaths from 1990-1995 were accounted for equally by motor vehicle and homicide. CONCLUSIONS: In conclusion, a substantial number of adolescents are injured or killed in the workplace each year in Texas. Although improved population-based surveillance is needed, sufficient knowledge exists to begin prevention efforts now.

Evaluating the relative status of health and safety programs for minority academic and research institutions.

The health and safety programs that support academic and research institutions face many challenges because of the wide variety of potential hazards present and the possibility of simultaneous exposures to several agents. This study investigated whether differences in health and safety programs exist between minority and nonminority state-funded academic and research institutions. A cross-sectional mail survey was conducted that included 24 minority and 51 nonminority schools. Questionnaires solicited information on descriptive institutional parameters, health and safety staffing, the hazards present, programs in place to address hazards, and medical surveillance services. The hazard types identified as present on both campus types were found to be very similar. The mean number of health and safety staff serving minority institutions was lower (1.14 versus 3.12), with the difference reliably predicted by the number of institutional employees, not minority status or regulatory environment. Other targeted parameters were found to be similar, with a consistent lack of awareness of specific medical evaluations noted for both groups. Since on average a single person is charged with controlling a diverse set of potential hazards on the minority campuses studied, the need for a comprehensive awareness of a variety of health and safety issues is discussed.

Assessing the burden of cancer in Texas using vital statistics data.

BACKGROUND: Vital statistics data were used to describe the burden of cancer in Texas. METHODS: Average annual age-adjusted mortality data in Texas (1986 to 1990) for 17 cancer types were compared with the US data for whites and blacks and with California data for Hispanics. Trends were examined from 1980 to 1990 for the entire state and from 1976 to 1989 for 24 geographic regions within the state. RESULTS: Mortality excesses were detected for lung and liver cancer, and deficits for colorectal, breast, and prostate cancers. Rates were generally stable from 1980 to 1990 with several exceptions (lung, liver, colon). Six areas of Texas, including four areas along the Gulf Coast, had relatively more excesses of various cancers, without a discernible pattern by cancer type. CONCLUSIONS: Overall, Texas has fared favorably in cancer mortality when compared with the United States. Enhanced evaluation of the frequency of cancer, as well as the conduct of etiologic research, must await the availability of statewide long-term cancer incidence data.

The effectiveness of a needleless intravenous connection system: an assessment by injury rate and user satisfaction.

OBJECTIVE: To assess the impact of a needleless intravenous (i.v.) connection system on the rate of reported intravenous-connection-related (IVCR) percutaneous injuries, and to assess user satisfaction, frequency of use, and barriers to use. DESIGN: A pre-post intervention design, with injury incidence rates being compared 3 years before and 1 year after hospital wide device implementation; and a cross-sectional descriptive user satisfaction survey. SETTING: Two tertiary-care teaching hospitals, one general and one pediatric, located in a large metropolitan medical center. OUTCOME VARIABLE: All IVCR percutaneous injuries reported to the employee health services at both hospitals during the years from 1989 to 1991 and 1993. STUDY POPULATION: Survey participants were selected randomly from licensed nursing employees at both hospitals. INTERVENTION: i.v. connection system consisting of blunt plastic cannulas and compressed latex injection sites. RESULTS: After device implementation, the IVCR injury rate was reduced 62.4% (rate ratio [RR], 0.38; 95% confidence interval [CI95], 0.27-0.53) at the general hospital and 70.2% (RR, 0.30; CI95, 0.17-0.53) at the pediatric hospital. After adjusting for the reduction in injury rate due to factors other than device implementation, the IVCR injury rate was reduced 54.5% (adjusted RR, 0.46; CI95, 0.32-0.65) at the general hospital and 57.2% (adjusted RR, 0.43; CI95, 0.24-0.78) at the pediatric hospital. Approximately 94% of survey respondents (n = 478, response rate = 51%) were satisfied with the device and recommended continued use. However, needles still were being used for activities that could have been performed with the needleless system because of compatibility, accessibility, and other technical problems related to the device. CONCLUSIONS: The device was effective in reducing the rate of reported IVCR percutaneous injuries and users were satisfied with the device, but barriers to universal use were identified.

Cancer mortality among petroleum refinery and chemical manufacturing workers in Texas.

Epidemiologic historical cohort studies of petroleum refinery and chemical manufacturing workers in Texas were reviewed to examine their cancer mortality in comparison to the U.S. and to assess the possible impact of cancer mortality among these workers on the State of Texas as a whole. Summary standardized mortality ratios and 95% confidence intervals were calculated for 20 cancer types, taking into account the heterogeneity of individual studies. There were 4314 cancer deaths among the 92,318 workers employed in 10 independent plant populations. Overall, there was a significant deficit in cancer mortality among petrochemical workers compared with the general U.S. population (SMR = 88, 95% CI = 80 to 96). Only the summary SMRs for brain cancer (SMR = 113, 95% CI = 96 to 133) and leukemias (SMR = 112, 95% CI = 94 to 130) approached statistical significance. Lung and liver cancer mortality excesses, noted for Texas as a whole, were decreased in these workers. Additional follow-up of these cohorts, their expansion to include minority and female workers, and additional study of possible occupational contributions to leukemia and brain cancer are recommended.