Considerations from employed African-American and white prostate cancer survivors on prostate cancer treatment and survivorship: a qualitative analysis.

OBJECTIVE: To solicit information/suggestions from prostate cancer survivors to improve survivorship experiences specific to work/workability. DESIGN: The study employed a qualitative/phenomenological approach. Black/African-American and white prostate cancer survivors who: (1) had prostatectomy or radiation therapy 6-36 months prior, (2) were working for pay within 30 days before having treatment, and (3) expected to be working for pay 6 months later (n = 45) were eligible for this study. Survivors were engaged in 60-to-90-minute structured interviews. Content analysis was used to ascertain prominent themes. RESULTS: Participants had the following recommendations for survivors: ask about research on treatment options and side effects; speak with other survivors about cancer diagnosis; and inform family/friends and employers about needed accommodations. Considerations for family/friends emphasized the significance of instrumental (e.g. help finding information) and emotional support (e.g. encouragement). Employer/co-worker considerations most often related to work-related accommodations/support and avoiding stigmatization of the survivor. Considerations for healthcare providers commonly included the provision of unbiased, plain-language communication about treatment options and side effects. No major differences existed by race. CONCLUSIONS: Needs of employed PrCA survivors, regardless of their race or treatment type, are commonly related to their desire for informational, instrumental, and/or emotional support from family/friends, employers/co-workers, and healthcare providers. The requested supports are most often related to the side effects of prostate cancer treatment.

Salivary Cotinine Levels of Hired Latino Youth Tobacco Workers in North Carolina.

BACKGROUND: Limited research has examined the health implications for youth working in United States tobacco production. Agricultural labor is hazardous, yet youth are legally permitted to be hired as farmworkers. Many youth farmworkers are members of the vulnerable Latino farmworker community. In North Carolina, youth work in many agricultural crops including tobacco. METHODS: A sample of 152 Latino youth farmworkers ages 12-20 years (M = 16.7, SD = 2.0) across 19 North Carolina counties completed a cross-sectional survey and provided saliva samples in 2019. Surveys detailed personal and work characteristics. Saliva samples were analyzed for salivary cotinine and reported in geometric means (ng/ml). Bivariate associations were used to delineate the relationship between personal and work characteristics with salivary cotinine levels. RESULTS: Cotinine levels ranged from 0.05 to 313.5 ng/ml. Older age and working in tobacco were significantly associated with higher salivary cotinine levels. For every one year increase in age, there was a 31% increase in mean salivary cotinine levels (b = 1.31; 95% CI = [1.15-1.50]; p < .0001). Youth tobacco workers' (n = 15) salivary cotinine levels were 890% higher than those not working in tobacco (n = 137) (13.26, 95% CI = [5.95-29.56] ng/ml compared to 1.34, 95% CI = [1.03-1.75] ng/ml (p < .0001)). CONCLUSIONS: Latino youth tobacco workers are exposed to nicotine through their work. This exposure presents serious risk of Green Tobacco Sickness (acute nicotine poisoning) and other health concerns given the growing evidence for risk of epigenetic changes negatively affecting long-term cognitive function. Policy is urgently needed to protect this vulnerable population of adolescent workers.

Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study.

BACKGROUND: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A1c (HbA1c) screening has not yet been studied. It is imperative to gauge perceptions of "cold texts" to ensure that information and language are optimized to promote engagement with text messages that affect follow-through with health behaviors. OBJECTIVE: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA1c screening and walk them through the steps required to perform the behavior based solely on an automated text exchange. METHODS: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. RESULTS: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA1c screening. Plain language, personalization, and content, which highlighted perceived benefits over perceived susceptibility and perceived severity, were important to participants' understanding of and receptiveness to messages. The patient-physician relationship emerged as a recurring theme in which patients either had a desire or held an assumption that their provider would be working behind the scenes throughout each step of the process. Participants needed further clarification to understand the steps involved in following through with HbA1c screening and receiving results. CONCLUSIONS: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA1c in direct-to-patient alerts that use cold texting. Using plain and positive language, integrating elements of personalization, and defining new processes clearly were identified by participants as modifiable content elements that could act as facilitators that would help overcome barriers to engagement with these messages. A patient's relationship with their provider and the financial costs associated with texts and screening may affect receptiveness and engagement in this process.

Study of an Educational Telenovela to Teach Genomics among Latino Farmworkers and Nonfarmworkers: Lessons Learned.

BACKGROUND: Genomic knowledge is becoming increasingly relevant to health care. Development of linguistically and culturally appropriate educational resources for Latino adults with limited education and English skills is needed. OBJECTIVES: The effectiveness of a telenovela was analyzed and lessons learned provided. METHODS: The team developed a telenovela to convey key genomics concepts and delivered it to 100 Latino farmworkers and nonfarmworkers in North Carolina. Participants completed a pretest measuring genomic knowledge and self-efficacy, viewed the telenovela, then completed a post-test. Twenty-four participants repeated the post-test 6 months later. Changes in genomic knowledge and self-efficacy were calculated. RESULTS: Overall, genomic knowledge and self-efficacy increased significantly after viewing the telenovela. Responses to two items indicated that the emphasis on epigenetics overshadowed other genomic mechanisms. Six-month follow-up results were not significantly different from the pretest. CONCLUSIONS: Increased attention to graphic design principles, presentation across multiple sessions, and supplemental activities may increase telenovelas' impact.

Mental models about heredity among immigrant Latinx adults with limited education from Mexico and Central America.

An understanding of genetics is becoming increasingly relevant to receiving medical care. It is important for health care providers and educators, including genetic counselors, to understand patients' perceptions about trait transmission and their interpretation of terms used in biomedicine. Knowledge about the patient perspective about trait transmission is important when health care providers are not fluent in the patient's language. Sixty Latinx immigrant adults (30 men and 30 women) who were born in Mexico or Central America (MCA) and living in North Carolina were interviewed about their heredity beliefs. By design, most participants had limited education. Eight percent had a least a high school education; 45% had less than a seventh grade education. Semi-structured, in-depth interviews were conducted to examine how participants think and discuss trait transmission. The translated transcripts were systematically analyzed using a case-based approach, supplemented by theme-based coding. Five lay mental models of heredity were identified that varied in terms of involvement of genes. Four of the five heredity mental models encompass genes; four out of five mental models do not link DNA to heredity. The centrality of blood, whether used metaphorically or literally, varies widely across the models. One model references God and depicts that heredity involves blood and/or genes, but not DNA. The mental models of heredity for most adult immigrants with limited education do not include DNA. Trait transmission by blood appears to have a more prominent role in lay mental models held by Mexicans than Central Americans. Increased patient knowledge about genetics can facilitate shared decision-making as genetics becomes increasingly relevant to medical care. Efforts to educate people can be most effective when we first understand the layperson's conceptions or mental models. Health care providers and educators should be aware that MCA adults with limited formal education hold diverse mental models about heredity.

Genetic Knowledge and Communication Among Mexican Farmworkers and Non-farmworkers in North Carolina.

It is important to understand genetics within the context of health. This paper assesses (a) genetic knowledge among Mexican-born farmworker and non-farmworker adults; (b) their interpersonal and device sources of genetic knowledge; and (c) the association between their genetic knowledge and the sources of this genetic knowledge.Interviews were conducted with Mexican-born farmworkers (100) and non-farmworkers (100) in North Carolina. Participants answered 15 questions to assess genetic knowledge, and sources from which they had seen or heard about genes and genetics.Results show limited knowledge of genetics, with farmworkers and non-farmworkers providing a similar level of correct responses (6.6 versus 7.3), but with farmworkers providing more incorrect responses (4.0 versus 2.7). Important sources of genetic information for farmworkers were promotoras (47%), compared to teachers (49%) for non-farmworkers.This study demonstrates a need for increased dissemination of genetic information to Mexican-origin farmworkers and non-farmworkers.

Menstrual Cycle Patterns and Irregularities in Hired Latinx Child Farmworkers.

PURPOSE: This study identifies the menstrual cycle irregularities of Latinx child and adolescent farmworkers. METHODS: Child and adolescent farmworkers aged 13 to 20 years completed questionnaires about menstrual cycle patterns in 2019, and wore silicone passive collection wristbands for pesticide detection in 2018. Menstrual cycle irregularities were determined from the American College of Obstetricians and Gynecologists committee opinion. RESULTS: Half of participants experienced any menstrual cycle irregularity; the most frequent irregularities were cycle length (38.6%) and having gone 90 days or more without a menstrual period (20.4%). Pesticides were detected in 92.9% of the wristbands; most participants were exposed to an endocrine disrupting chemical (EDC) pesticide. CONCLUSION: Half of Latinx children and adolescents hired farmworkers experience irregular menstrual cycles, and most are exposed to EDCs. Inclusion of occupational and menstrual histories in child and adolescent medical visits is critical.

Work Safety Culture of Latinx Child Farmworkers in North Carolina.

Background: Little research has addressed the safety environment of child farmworkers. This analysis examines the work safety culture experienced by Latinx child farmworkers in North Carolina. Methods: Survey interviews were conducted in 2017 with 202 Latinx children aged 10 to 17 years employed on North Carolina farms. Analysis included measures of the behavioral, situational, and psychological elements of work safety culture. Results: The work culture on North Carolina farms employing Latinx child farmworkers places limited value on safety. Behaviorally, many did not wear appropriate work clothing (e.g., 47.5% wore gloves, 37.1% wore boots). Situationally, few received safety training for tools (40.6%), machinery (24.3%), or pesticides (26.0%); about one-third (33.7%) had worked piece-rate; and many did not have field sanitation services available (e.g., 37.1% had water for washing, 19.8% had soap). Safety attitudes were mixed, and work safety climate was low, with 21.8% stating that their supervisor was only interested in doing the job fast and cheaply. Greater safety training, field sanitation services, and work safety climate were associated with working in western North Carolina, migrant workers, limited English fluency, and working in tomatoes. Wearing appropriate work clothing, not working piece-rate, fewer unsafe work attitudes were associated with working in eastern North Carolina, seasonal worker, speaking English, and working in tobacco. Conclusions: This research makes it apparent that efforts are needed to improve safety culture wherever child farmworkers are employed. Current policy is not providing a safe environment for children working on farms in the United States.

"It's Worse to Breathe It Than to Smoke It": Secondhand Smoke Beliefs in a Group of Mexican and Central American Immigrants in the United States.

This analysis describes beliefs about secondhand smoke and its health effects held by Mexican and Central American immigrants in North Carolina. Data from 60 semistructured, in-depth interviews were subjected to saliency analysis. Participant discussions of secondhand smoke centered on four domains: (1) familiarity and definition of secondhand smoke, (2) potency of secondhand smoke, (3) general health effects of secondhand smoke, and (4) child health effects of secondhand smoke. Secondhand smoke was generally believed to be more harmful than primary smoke. Mechanisms for the potency and health effects of secondhand smoke involved the smell of secondhand smoke, secondhand smoke being an infection and affecting the immune system, and personal strength being protective of secondhand smoke. Understanding these health beliefs informs a framework for further health education and intervention to reduce smoking and secondhand smoke exposure in this vulnerable population.

Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina.

The aim of this study was to evaluate respiratory health problems, including suspected asthma, and healthcare provider utilization among a sample of Latinx hired child farmworkers in rural North Carolina (n = 140). In 2018, a respiratory health questionnaire and breathing tests were collected from Latinx child (11-19 years) farmworkers (35.0% girls and 65.0% boys). Overall, 21.4% of children reported having been told by a medical provider that they had asthma, yet based on a combination of responses to respiratory survey questions, 36.4% or 15% more were identified as having suspected asthma. While 56.4% reported having a regular medical doctor, 38% had not had a medical exam in the past year. Respiratory dysfunction, including suspected, or uncontrolled asthma was prevalent among this group. Latinx children working in agriculture are vulnerable to occupational hazards and exposures and require assurances that they will receive access to high quality healthcare services that include routine respiratory health screenings.

Patient Views of Behavioral Health Providers in Primary Care: A Qualitative Study of 2 Southeastern Clinics.

BACKGROUND: Limited research is available around patient experience of integrated behavioral health care in primary care settings. OBJECTIVE: We sought to identify the major themes through which patients described their integrated behavioral health care experiences as a means of informing and improving clinic processes of integrated health care delivery. METHODS: We captured viewpoints from 16 patients who experienced an integrated behavioral health care model from 2 primary care clinics and completed at least 3 visits with a behavioral health provider (BHP). Using grounded theory analyses, we coded and analyzed transcriptions for emergent themes. ANALYSIS: The interview process yielded 3 major themes related to the BHP including (a) the BHPs' clinic presence made behavioral health care more convenient and accessible, (b) BHPs worked within time and program limitations, and (c) BHPs helped with coping, wellness, and patient-care team communication. CONCLUSION: The BHPs serving in a large primary care practice and a Federally Qualified Health Center played an important role in connecting patients with behavioral health care and improving care team collaboration, both in terms of communication within the team and between the team and the patient/family.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study.

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

Older Adult Internet Use and eHealth Literacy.

We examine Internet use and eHealth literacy among older adults (aged 55+ years) who were patients at clinics serving low-income populations. Participants included 200 minority and White adults who completed interviews based on a technology acceptance conceptual model. A total of 106 participants (53.0%) used the Internet; utilization was associated with personal characteristics (age, ethnicity, education, poverty), computer characteristics (number of e-devices, computer stress), social support (marital status), and health knowledge and attitudes (health literacy, medical decision making, health information sources), but not health status. Of the 106 participants who used the Internet, 52 (49.1%) had high eHealth literacy; eHealth literacy was associated with computer characteristics (number of e-devices, computer stress), and health knowledge and attitudes (medical decision making, health information sources). In multivariate analysis, computer stress maintained a significant inverse association with eHealth literacy. Educational interventions to help older adults successfully use technology and improve eHealth literacy must be identified.

"Be careful!" Perceptions of work-safety culture among hired Latinx child farmworkers in North Carolina.

BACKGROUND: Children as young as 10 years of age can be hired to work on farms. Many of these hired child farmworkers are Latinx. Although these children experience high rates of injury, little research has addressed work-safety perceptions among hired Latinx child farmworkers. METHODS: For this qualitative study, we conducted in-depth interviews in North Carolina in 2016 with 30 Latinx child farmworkers, ages 10 to 17. Our analysis used the work-safety culture conceptual framework to delineate their perceptions of the psychological, behavioral, and situational elements of safety culture. RESULTS: The child farmworkers describe a weak work-safety culture. Psychologically, they understand that their parents want them to be safe, but they observe that safety is important to only a fraction of their supervisors and coworkers. Behaviorally, they recognize many of the hazards they confront while working, but it is not clear how well they use this knowledge to mitigate these hazards or to change their behaviors to avoid these hazards. Situationally, several children note that the only safety training they receive is the imperative to "be careful." Most receive little formal training, much of the training they receive is informally provided by family members and coworkers rather than supervisors, and their training is geared more toward how to complete a task than how to complete the task safely. CONCLUSIONS: Child farmworkers perceive that work-safety culture is of limited importance in agriculture. Regulations are needed that improve work-safety culture in agriculture, especially for those vulnerable due to minority age.

Hired Latinx child farm labor in North Carolina: The demand-support-control model applied to a vulnerable worker population.

BACKGROUND: US government child labor policies allow children as young as age 10 to be hired as workers on farms not operated by family members. Children may face substantial health risks in an industry known for high worker morbidity and mortality rates, due to high demands for productivity, and low control and little support because of the organization of the workplace. This paper examines how child farmworkers in North Carolina experience their work situation. METHODS: In-depth interviews conducted in 2016 with 30 Latinx child farmworkers, ages 10 to 17, were analyzed using concepts from the demand-control-support model. All had worked as either migrant or seasonal hired farmworkers within the past year. RESULTS: Children reported planting, cultivating, and harvesting crops including fruits, vegetables, and tobacco. The crew leader supervisory system, piece-rate pay, and coworker pressure produced significant demands to work quickly and take risks including lifting heavy loads, operating mechanical equipment, and working in excessive heat. Children had little control over work to counter demands they experienced; and they labored in a state of fear of firing, wage theft, and other sanctions. Support was variable, with younger children more likely to experience family and coworker support than older children. CONCLUSIONS: The high demands with limited control and, for some, little support, that these children experience place them at risk and show the possibility of injury and exploitation. Future research should systematically document the occupational injury and illness of hired child farmworkers, and consider whether changes in labor policy are warranted.

Engaging Youth Advocates in Community-Based Participatory Research on Child Farmworker Health in North Carolina.

BACKGROUND: Wake Forest School of Medicine (WFSM) investigators and Student Action with Farmworkers' (SAF) Levante Leadership Institute, a farmworker youth program, are collaborating on a community-based participatory research (CBPR) study. OBJECTIVES: 1) Describe the collaborative process between WFSM investigators and the Levante advisory board during the strategic planning and implementation phase and 2) highlight practices that support the collaboration and project success. METHODS: The longitudinal Hired Child Farmworker Study examines the health and safety of hired Latino child farm-workers in North Carolina. Two Levante alumni co- investigators lead research-related activities with the Levante advisory board. LESSONS LEARNED: Challenges to CBPR with youth are overcome by the longstanding partnership between WFSM and SAF, attention to logistical details, power sharing, building on shared values, and assessment of youth preferences. CONCLUSIONS: The partnership between WFSM and Levante demonstrates the mutual benefit of CBPR and will continue during the upcoming study phases.

Group Medical Visit Training in Family Medicine Residency: A 2015 CERA Program Directors Survey.

BACKGROUND AND OBJECTIVES: Group medical visits (GMV) have been shown to improve clinical outcomes and patient satisfaction and are included as a new tool in the patient-centered medical home (PCMH). The capacity for and interest in developing GMV skills in family medicine residency have not been assessed. This study aims to describe the extent of existing training in GMV as well as attitudes toward and barriers to this training. METHODS: The Council of Academic Family Medicine Educational Research Alliance (CERA) sent a survey in the fall of 2015 to all US family medicine residency program directors (PDs) containing questions about the status of GMV training for their residents. RESULTS: The survey response rate was 53%. Fifty-nine percent of program director respondents report access to GMV and 61% note some form of training in this model of care. Seventy-nine percent of respondents indicate that GMV training is important for residents. Multiple barriers exist to optimizing GMV as part of current family medicine training. CONCLUSIONS: A majority of family medicine PD respondents report both access to and curriculum for GMV. While program directors endorse this practice model as an important element in resident training, they acknowledge challenges that may limit its availability. Opportunities to better understand and overcome barriers may increase programs' capacity to deliver GMV skills.

Latinx child farmworkers in North Carolina: Study design and participant baseline characteristics.

BACKGROUND: Although children as young as 10 years can work in agriculture, little research has addressed their occupational health. This paper describes a large, multicomponent study of hired Latinx child farmworkers, and the characteristics of children participating in this study. METHODS: Survey interviews were conducted in 2017 with 202 Latinx children aged 10-17 years employed in agriculture across North Carolina (NC). RESULTS: Most (81.2%) participants were born in the United States, 37.6% were female, and 21.3% were aged 10-13 years. Most (95.1%) were currently enrolled in school. Thirty-six (17.8%) were migrant workers. 34.7% had worked in agriculture for 1 year; 18.3% had worked 4+ years. 33.7% worked piece rate. 57.4% worked in tobacco. Participants in western NC differed in personal and occupational characteristics from those in eastern NC. CONCLUSIONS: This study has enrolled a large and diverse child farmworker sample. This overview indicates several important issues for further analysis.

HPV Knowledge and Vaccine Initiation Among Mexican-Born Farmworkers in North Carolina.

The human papilloma virus (HPV) vaccine is an effective but underused cancer prevention tool. This study assessed knowledge of HPV and HPV vaccine initiation among Mexican-born farmworkers in North Carolina. Interviewer-administered questionnaires were conducted with 100 Latino farmworkers and 100 nonfarmworker Latino North Carolina residents in 2015 as part of an ongoing community-based participatory research project. Farmworkers had low levels of knowledge about HPV and the HPV vaccine. They had a similar amount of HPV and HPV vaccine knowledge compared to nonfarmworkers. Farmworkers and nonfarmworkers learned about the HPV vaccine from different sources. Adolescent children of farmworkers and nonfarmworkers had low HPV vaccine initiation. However, for children living in the United States with farmworker parents, vaccine initiation was high. To prevent HPV-related cancers and improve health equity, interventions are needed in order to increase HPV education and vaccine initiation among children of Mexican-born farmworkers and nonfarmworkers. Public health programs should look for partners outside the traditional health care setting to reach underserved populations. Other key strategies include promoting catch-up vaccines, improving patient-provider communication, and providing case management services.