Musculoskeletal injury symptoms among hired Latinx child farmworkers in North Carolina.

BACKGROUND: Although children 10-17 years can be hired to work in agriculture, little research has addressed possible musculoskeletal injuries. Children may be at particular risk for these injuries because of the repetitive and load bearing nature of work tasks. Existing research relies on child workers to self-report musculoskeletal injuries. METHODS: In 2017, 202 Latinx child farmworkers ages 10-17 employed across North Carolina completed survey interviews. In 2018, 145 of these children (94 [64.8%] current farmworkers) completed a physical examination and second interview. The examination obtained findings for upper and lower extremity as well as back injuries. RESULTS: Positive indicators for musculoskeletal symptoms were few in either current or former child farmworkers. The knee was most common site for positive indicators with 15.4% of children having at least one. Combining all anatomical sites, 29.0% of children had at least one positive indicator, with no significant difference between current and former farmworkers. Overall, boys had significantly more indicators of knee injuries than girls (21.3% vs. 4.1%), indicators of ankle injuries were found only in the youngest workers (9.5% of children 11-13 years), and significantly fewer current farmworkers had indicators of lower back injuries than former farmworkers (6.4% vs. 17.7%). CONCLUSIONS: Expectations of injuries come from previous studies using child farmworker self-reports, adult farmworker injury rates, and sports medicine pediatric findings. Hired child farmworkers may not perform activities as repetitious and load-bearing as children in sports training or adult farmworkers. Additional research using physical examination is needed to confirm these findings.

"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.

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.

Examining the association between musculoskeletal injuries and carpal tunnel syndrome in manual laborers.

INTRODUCTION: The association between musculoskeletal injuries and carpal tunnel syndrome (CTS) has not been investigated in a large, population-based study. METHODS: Latino manual laborers were recruited as part of a study of work-related health conditions. Each had a clinical examination, completed a hand diagram, and had nerve conduction studies. RESULTS: A total of 512 individuals completed all testing. An association was found between rotator cuff syndrome and CTS, with an adjusted odds ratio of 2.25 (P = 0.01) for the right arm, 2.08 (P = 0.03) for the left arm, and 1.84 (P = 0.03) for all individuals. Associations between epicondylitis and CTS did not reach statistical significance. CONCLUSIONS: Individuals with rotator cuff syndrome have a higher prevalence of CTS. Further investigations will be needed to examine for causation and to determine if 1 condition typically occurs first and leads to the other. Muscle Nerve 54: 31-35, 2016.

Good job, bad job: Occupational perceptions among Latino poultry workers.

OBJECTIVES: Immigrant workers frequently take jobs that are physically demanding, provide low wages, and result in injuries (e.g., poultry production and processing). Through a qualitative approach, this paper elicits poultry workers' evaluations of their jobs and set them in the larger context of their lives. METHODS: Semi-structured interviews were conducted with 65 poultry workers in western North Carolina. Workers were asked to discuss job characteristics, physical and psychological impacts of their employment, and perceived health risks. RESULTS: Immigrant workers valued the stability, benefits, upward mobility, and pay offered. They disliked the physical demands, the potential perceived effects of the job on their health, and the interactions with bosses and peers. CONCLUSIONS: Workers' willingness to endure dirty, dangerous, and demanding (3-D) conditions of poultry must be understood in the context of other employment options, structural violence, and their focus on immediate family needs that positive aspects of these jobs can fulfill. Am. J. Ind. Med. 59:877-886, 2016. © 2016 Wiley Periodicals, Inc.

Work safety climate, personal protection use, and injuries among Latino residential roofers.

BACKGROUND: This analysis describes work safety climate, personal protective equipment (PPE) use, and injuries among Latino residential roofers, and examines the associations of work safety climate with PPE use and injuries. METHODS: Eighty-nine North Carolina residential roofers completed a baseline interview and daily logs about perceptions and use of PPE, occurrence of injuries in last 12 months, and work safety climate. RESULTS: The mean work safety climate score was 26.5 (SD = 5.6). In the baseline interview, participants reported that the majority of employers provided PPE and that they used it most or all of the time; daily log data indicated that PPE was used for half or fewer of hours worked. 39.9% reported any injury in the last 12 months. Work safety climate was significantly correlated with the provision and use of most types of PPE, and was inversely associated with injury. CONCLUSIONS: Supervisors promoting safety may increase the PPE use and decrease injuries.

Muscle intrusion as a potential cause of carpal tunnel syndrome.

INTRODUCTION: The aim of this study was to determine whether there is an association between flexor digitorum and lumbrical muscle intrusion into the carpal tunnel and carpal tunnel syndrome (CTS). METHODS: Five hundred thirteen manual laborers (1026 wrists) were evaluated with ultrasound to determine whether those with CTS had more muscle intrusion into the carpal tunnel than those without CTS. One hundred ninety of the participants without CTS at baseline (363 wrists) were followed over 1 year to determine whether muscle intrusion at baseline predicted the development of CTS. RESULTS: Participants with CTS had more muscle within the carpal tunnel with the wrist in the neutral (P=0.026) and flexed (P=0.018) positions than those without CTS. Baseline muscle intrusion did not predict development of CTS at 1 year. CONCLUSIONS: Muscle intrusion into the carpal tunnel is associated with CTS, but muscle intrusion alone does not predict the development of CTS over the course of a year.

Work organization and health among immigrant women: Latina manual workers in North Carolina.

OBJECTIVES: We sought to describe work organization attributes for employed immigrant Latinas and determine associations of work organization with physical health, mental health, and health-related quality of life. METHODS: We conducted a cross-sectional survey with 319 employed Latinas in western North Carolina (2009-2011). Measures included job demands (heavy load, awkward posture, psychological demand), decision latitude (skill variety, job control), support (supervisor control, safety climate), musculoskeletal symptoms, mental health (depressive symptoms), and mental (MCS) and physical component score (PCS) health-related quality of life. RESULTS: Three fifths reported musculoskeletal symptoms. Mean scores for depression, MCS, and PCS were 6.2 (SE = 0.2), 38.3 (SE = 0.5), and 42.8 (SE = 0.3), respectively. Greater job demands (heavy load, awkward posture, greater psychological demand) were associated with more musculoskeletal and depressive symptoms and worse MCS. Less decision latitude (lower skill variety, job control) was associated with more musculoskeletal and depressive symptoms. Greater support (supervisor's power and safety climate) was associated with fewer depressive symptoms and better MCS. CONCLUSIONS: Work organization should be considered to improve occupational health of vulnerable women workers. Additional research should delineate the links between work organization and health among vulnerable workers.

Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers.

BACKGROUND: Manual labor employment occurs in environments with exposures likely to impact skin-related quality of life (SRQOL). OBJECTIVES: The objectives of this paper are to (1) document the dimensions of SRQOL, (2) examine its association with skin symptoms, and (3) identify the predictors of SRQOL in Latino manual workers. METHODS: A population-based survey of 733 Latino manual workers obtained Dermatology Life Quality Index (DLQI) and skin symptoms in the prior year. RESULTS: Two-thirds of workers were employed in production. Skin symptoms in prior year were reported by 23%. Impaired SRQOL was reported by 23%. In multivariate analyses, reduced SRQOL was associated with age, occupation, childhood indigenous language use, and experience of skin symptoms in the prior year. CONCLUSIONS: Despite overall high SRQOL exposures in some immigrant occupational groups produce reduce SRQOL. This rural, immigrant population faces significant obstacles to obtaining dermatological care; efforts are needed to improve their SRQOL.

Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina.

BACKGROUND: This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries. METHODS: Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics. RESULTS: Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS. CONCLUSIONS: Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.

One-year incidence of carpal tunnel syndrome in Latino poultry processing workers and other Latino manual workers.

OBJECTIVE: To determine the incidence of carpal tunnel syndrome (CTS) over 1 year in Latino poultry processing workers. METHODS: Symptoms and nerve conduction studies were used to identify Latino poultry processing workers (106 wrists) and Latinos in other manual labor occupations (257 wrists) that did not have CTS at baseline, and these individuals were then evaluated in the same manner 1 year later. RESULTS: Based on wrists, the 1-year incidence of CTS was higher in poultry processing workers than non-poultry manual workers (19.8% vs. 11.7%, P = 0.022). Poultry workers had a higher odds (1.89; P = 0.089) of developing CTS over 1 year compared to non-poultry manual workers. DISCUSSION: Latino poultry processing workers have an incidence of CTS that is possibly higher than Latinos in other manual labor positions. Latino poultry workers' high absolute and relative risk of CTS likely results from the repetitive and strenuous nature of poultry processing work.

Comorbidity of tinea pedis and onychomycosis and evaluation of risk factors in Latino immigrant poultry processing and other manual laborers.

OBJECTIVES: Latino immigrant workers experience elevated rates of skin disease that result from their working and living conditions. Working in manual occupations exposes workers to a variety of challenges, including occlusive shoes, vigorous physical activity, and wet conditions. These challenges predispose workers to fungal infection. The objectives of this article are to examine the comorbidity of tinea pedis and onychomycosis and to identify possible risk factors among Latino immigrant poultry and nonpoultry workers in western North Carolina. METHODS: Data were obtained from a cross-sectional study conducted between June 2009 and November 2010 in rural western North Carolina among 518 manual Latino immigrant workers to assess their occupational injuries. Participants completed a face-to-face interview and a dermatologic examination. RESULTS: Nearly one-third of the participants (32%) were diagnosed as having onychomycosis and more than one-third (37.8%) were diagnosed as having tinea pedis. There was a greater prevalence of tinea pedis in men than women (71.3% vs 28.7%, respectively). Of the 518 participants, 121 (23.5%) had both conditions. Participants who reported the use of occlusive shoes as "always" or "most of the time" had a higher prevalence of comorbid onychomycosis and tinea pedis than the rest of the group. CONCLUSIONS: Comorbidity of tinea pedis and onychomycosis is common among immigrant Latino men and women who perform manual labor. Further studies confirming the presence and type of dermatophyte should be conducted.

Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers.

INTRODUCTION: The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. METHODS: We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. RESULTS: A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. CONCLUSIONS: The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.

Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers.

BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration.

Employer, use of personal protective equipment, and work safety climate: Latino poultry processing workers.

BACKGROUND: This analysis describes the work safety climate of Latino poultry processing workers and notes differences by worker personal characteristics and employer; describes the use of common personal protective equipment (PPE) among workers; and examines the associations of work safety climate with use of common PPE. METHODS: Data are from a cross-sectional study of 403 Latino poultry processing workers in western North Carolina. RESULTS: Work safety climate differed little by personal characteristics, but it did differ consistently by employer. Provision of PPE varied; for example, 27.2% of participants were provide with eye protection at no cost, 57.0% were provided with hand protection at no cost, and 84.7% were provided with protective clothing at no cost. PPE use varied by type. Provision of PPE at no cost was associated with lower work safety climate; this result was counter-intuitive. Consistent use of PPE was associated with higher work safety climate. CONCLUSIONS: Work safety climate is important for improving workplace safety for immigrant workers. Research among immigrant workers should document work safety climate for different employers and industries, and delineate how work safety climate affects safety behavior and injuries.

Prevalence of epicondylitis, rotator cuff syndrome, and low back pain in Latino poultry workers and manual laborers.

BACKGROUND: The goal of this study is to improve understanding of immigrant Latino manual workers' occupational health, focusing on upper body musculoskeletal injury. METHODS: Physical exams were conducted with a representative sample of 516 Latino poultry workers and manual laborers in western North Carolina; outcome measures were prevalence of epicondylitis, rotator cuff syndrome, and low back pain. RESULTS: Low back pain (n = 89; 17.2%) and rotator cuff syndrome (n = 76; 14.7%) indicated by physical exam was common. Epicondylitis was less common, but still frequent (n = 30; 5.8%). Prevalence of each outcome did not differ between poultry processing workers and other manual workers. Workers >40 years old had greater incidence of rotator cuff syndrome and epicondylitis. CONCLUSIONS: Epicondylitis, rotator cuff syndrome, and low back pain are common in immigrant Latino workers, and may negatively impact long-term health and contribute to occupational health disparities.

A Qualitative Study Among Healthcare Providers on Risks Associated With the Use of Supportive Care for Cancer Treatment-Related Symptoms in Children and Adolescents.

INTRODUCTION: Although more than 300 000 children and adolescents worldwide are diagnosed with cancer yearly, little research has been conducted investigating how healthcare providers consider risk and patient safety connected with supportive care (including complementary and alternative medicine [CAM]) in this age group. This study aimed to explore how different healthcare providers perceive and evaluate risk when patients combine supportive care and conventional medicine in clinical practice and how they communicate and inform parents about the use of these modalities. MATERIALS AND METHODS: In-depth semi-structured interviews were conducted with 22 healthcare providers with expertise in treating pediatric oncology patients from 5 countries. Systematic content analysis was conducted using Nvivo 1.61. RESULTS: The analysis resulted in 3 themes and 8 subthemes. Generally, participants were cautious about implementing unproven new modalities or therapies when recommending supporting care modalities to parents of children and adolescents with cancer. The most important criterion when recommending a modality was evidence for safety based on a risk/benefit evaluation. Negative interactions with conventional medicine were avoided by using the half-life of a drug approach (the time it takes for the amount of a drug's active substance in the body to reduce by half). For patients with severe symptoms, less invasive modalities were used (ear seeds instead of ear needling). To enhance safety, participants practiced open and egalitarian communication with parents. CONCLUSION: Healthcare providers reported using a variety of approaches to achieve a safe practice when parents wanted to combine supportive care and conventional cancer treatment. They emphasized that these modalities should be foremost safe and not become an extra burden for the patients. Providers highlighted patient-centered care to meet the individual's specific health needs and desired health outcomes. A lack of national and regional standardized training programs for supportive care in pediatric oncology was considered a hazard to patient safety.

Supportive care for cancer-related symptoms in pediatric oncology: a qualitative study among healthcare providers.

BACKGROUND: The aim of this study is to gain insight into the clinical experiences and perceptions that pediatric oncology experts, conventional healthcare providers, and complementary and alternative medicine (CAM) providers in Norway, Canada, Germany, the Netherlands, and the United States have with the use of supportive care, including CAM among children and adolescents with cancer. METHODS: A qualitative study was conducted using semi-structured in-depth interviews (n = 22) with healthcare providers with clinical experience working with CAM and/or other supportive care among children and adolescents with cancer from five different countries. Participants were recruited through professional associations and personal networks. Systematic content analysis was used to delineate the main themes. The analysis resulted in three themes and six subthemes. RESULTS: Most participants had over 10 years of professional practice. They mostly treated children and adolescents with leukemia who suffered from adverse effects of cancer treatment, such as nausea and poor appetite. Their priorities were to identify the parents' treatment goals and help the children with their daily complaints. Some modalities frequently used were acupuncture, massage, music, and play therapy. Parents received information about supplements and diets in line with their treatment philosophies. They received education from the providers to mitigate symptoms and improve the well-being of the child. CONCLUSIONS: Clinical experiences of pediatric oncology experts, conventional health care providers, and CAM providers give an understanding of how supportive care modalities, including CAM, are perceived in the field and how they can be implemented as adaptational tools to manage adverse effects and to improve the quality of life of children diagnosed with cancer and the families.

Personal protective equipment and work safety climate among Latino poultry processing workers in Western North Carolina, USA.

BACKGROUND: Job-appropriate personal protective equipment (PPE) is important for decreasing the high rates of occupational injury experienced by poultry processing workers. OBJECTIVES: This analysis describes the job-appropriate PPE provided to poultry processing workers by their employers and the PPE used by these workers, and it delineates the association of work safety climate with job-appropriate PPE. METHODS: Data are from a cross-sectional study of 403 Latino poultry processing workers in North Carolina. RESULTS: Most poultry processing workers are not provided with nor use job-appropriate PPE; however, more workers use PPE than are provided. The provision and use of PPE differs by employer. Work safety climate was associated with use of job-appropriate PPE. CONCLUSIONS: Poultry processing workers should be provided with job-appropriate PPE. Workers' use of PPE is an indicator of safety climate. Further research about work safety climate and other work organization characteristics and job safety characteristics is needed.