Eva M. Shipp

Association of Externalizing Behavior Disorder Symptoms and Injury Among Fifth Graders

OBJECTIVE Injury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. METHODS Data were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome was injury frequency. Primary independent variables were ADHD and CD symptoms. Additional covariates included gender, race/ethnicity, and household income. Ordinal logistic regression examined correlates of injury frequency. The interaction between ADHD and CD symptoms also was examined. RESULTS In bivariate analyses, the odds of injury increased as ADHD symptoms (odds ratio [OR] 1.29; 95% confidence interval [95% CI] 1.18-1.41) and CD symptoms (OR 1.18; 95% CI 1.07-1.31) increased. However, in multivariate analysis, only ADHD symptoms were significantly associated with injury (OR 1.22; 95% CI 1.10-1.35). There was no statistically significant interaction between ADHD and CD symptoms. CONCLUSIONS ADHD symptoms are associated with increased odds of injury in fifth graders. Findings have implications for potential injury prevention strategies for mental health practitioners (for example, cognitive training with at-risk youth), pediatricians (ADHD screening), and parents (improved supervision).

Chronic Back Pain and Associated Work and Non-Work Variables Among Farmworkers from Starr County, Texas

ABSTRACT Objectives: This study estimated the prevalence of chronic back pain among migrant farmworker family members and identified associated work and non-work variables. Methods: Migrant farmworkers (n = 390 from 267 families) from Starr County, Texas were interviewed in their home once a year for 2 years. The original survey included items measuring demographics, smoking, sleep, farm work, and chronic back pain. For this cross-sectional analysis, multi-level logistic regression was used to identify associated work and other variables associated with chronic back pain while accounting for intraclass correlations due to repeated measures and multiple family members. Results: The prevalence of chronic back pain during the last migration season ranged from 9.5% among the youngest children to 33.3% among mothers. Variables significantly associated with chronic back pain were age (odds ratio [OR], 1.03, per year increase), depressive symptoms while migrating (OR, 8.72), fewer than 8 hours of sleep at home in Starr County (OR, 2.26), fairly bad/very bad quality of sleep while migrating (OR, 3.25), sorting crops at work (OR, 0.18), and working tree crops (OR, 11.72). Conclusion: The role of work exposures, depressive symptoms, and sleep in chronic back pain among farmworkers warrants further examination. Refinements in outcome and exposure assessments are also needed given the lack of a standardized case definition and the variety of tasks and crops involved in farm work in the United States.

Nontraditional Work Factors in Farmworker Adolescent Populations: Implications for Health Research and Interventions

Agriculture has been documented to be one of the most hazardous work environments for both adults and children. Adolescents may be especially vulnerable to adverse health effects from agricultural exposures due to the rapid growth and development experienced during those years. Separating the occupational, economic, and social issues in this population is difficult. Weak regulatory protection, lack of compliance with existing regulations, and gaps in service provision characterize the working conditions of adolescent farmworkers. Although there is increasing research on the impact of work organization on mental and physical health in adult working populations, there is a scarcity of research focused on this concept in young workers—and it remains virtually unaddressed in young farmworkers. Work characteristics of the informal work sector, better delineated in international literature, should be considered when planning research or interventions in this at-risk population. Further, the population of adolescent farmworkers is diverse, and research strategies and interventions need to be targeted and tailored to the heterogeneous groups. This article addresses some of the nontraditional work factors associated with the less-than-formal work organization and environments in the farmworker adolescent population and how these factors may inform the planning of research and interventions. Specifically, mobility, cultural patterns and social networks, alternative sampling strategies, alternative delivery of health care and education, and involvement of a wide range of players in the work environment of adolescent farmworkers should all be considered when conducting research or planning programs for this population.

Substance Use and Occupational Injuries Among High School Students in South Texas

This cross-sectional study examined the association between self-reported nonfatal occupational injuries among high school students in South Texas and their self-reported general use of substances. Data were collected using a self-administered, anonymous questionnaire (n = 3365). The independent variables included alcohol, marijuana, cocaine, inhalant, and steroid use. The dependent variable was occupational injury. Adjusting for grade, sex, ethnicity, and work intensity, odds ratios were calculated using logistic regression. Supporting an association with each substance, odds ratios consistently strengthened as use increased. Additional research is merited given the scant number of previous studies. The associations for inhalant (OR, 5.61) and steroid (OR, 7.63) use argue for their inclusion in future research.

Workplace Safety Interventions for Commercial Fishermen of the Gulf

ABSTRACT Commercial fishing continues to have one of the highest rates of occupational fatalities compared with other work sectors in the United States. Attitudes/beliefs among Vietnamese shrimp fishermen of the Gulf of Mexico may influence behaviors that are risk factors for fatal and nonfatal injuries. The study employs a community trial with quasi-experimental pretest/posttest intervention design. An advisory group made up of key stakeholders including representatives from the US Coast Guard was assembled. A survey was designed using the Theory of Planned Behavior as the theoretical framework. Three community groups at port sites along the Texas/Louisiana Gulf Coasts were identified. Focus groups were convened at each site to select priority areas for risk intervention using training and awareness measures. Initial and follow-up surveys were administered pre-/post-interventions for each of the three community groups (2008, n = 217 completed surveys; 2012, n = 206 completed surveys). The follow-up survey was condensed and “intent to act” questions were added for the priority concerns identified (noise-induced hearing loss, machinery/winches, and fatigue). Statistically significant changes (P ranging from .000 to .042) were observed in selective attitude/belief responses for hearing/noise and fatigue. Intent to action or to adopt the intervention was high among all three groups of shrimp fishermen (hearing conservation, 82.4%; machinery/winch safety, 94.6%; fatigue awareness, 95.3%). Simple, yet culturally appropriate training and awareness measures in the form of visual and written safety messages favorably influence attitudes, beliefs, and behavioral intent related to priority risk factors identified by Vietnamese commercial shrimp fishermen along the Texas and Louisiana Gulf Coasts.

The only thing I wish I could change is that they treat us like people and not like animals: injury and discrimination among Latino farmworkers

ABSTRACT Objective: This article describes how perceived discrimination shapes the way Latino farmworkers encounter injuries and seek out treatment. Methods: After 5 months of ethnographic fieldwork, 89 open-ended, semistructured interviews were analyzed. NVivo was used to code and qualitatively organize the interviews and field notes. Finally, codes, notes, and co-occurring dynamics were used to iteratively assess the data for major themes. Results: The primary source of perceived discrimination was the “boss” or farm owner. Immigrant status was also a significant influence on how farmworkers perceived the discrimination. Specifically, the ability to speak English and length of stay in the United States were related to stronger perceptions of discrimination. Finally, farm owners compelled their Latino employees to work through their injuries without treatment. Conclusions: This ethnographic account brings attention to how discrimination and lack of worksite protections are implicated in farmworkers’ injury experiences and suggests the need for policies that better safeguard vulnerable workers.

A pilot study of symptoms of neurotoxicity and injury among adolescent farmworkers in Starr County, Texas

Abstract Little is known regarding the relationship between neurotoxicity symptoms and injury, particularly among adolescent farmworkers. This pilot study utilized logistic regression to analyze injury prevalence in relation to self-reported symptoms of neurotoxicity among adolescent farmworkers along the US-Mexico border in Texas. Respondents reporting at least five symptoms had 8.75 (95%CI, 1.89–40.54) times the prevalence of injury compared with those reporting zero or one symptom. Significant associations were observed for six items: trouble remembering things, family noticing memory loss, making notes, irritated for no reason, heart pounding, and tingling. This pilot study suggests a relationship between symptoms of neurotoxicity and injury among adolescent farmworkers, supporting the need for more rigorous investigations.

Confirming the Environmental Concerns of Community Members Utilizing Participatory-Based Research in the Houston Neighborhood of Manchester

In the last few decades, there has been an increase in community-based participatory research being conducted within the United States. Recent research has demonstrated that working with local community organizations, interest groups, and individuals can assist in the creation of, and sustainability in, health initiatives, adoption of emergency protocols, and potentially improve health outcomes for at-risk populations. However little research has assessed if communal concerns over environmental contaminants would be confirmed through environmental research. This cross-sectional study collected survey data and performed surface water analysis for heavy metals in a small neighborhood in Houston, TX, which is characterized by industrial sites, unimproved infrastructure, nuisance flooding, and poor air quality. Surveys were completed with 109 residents of the Manchester neighborhood. Water samples were taken from thirty zones within the neighborhood and assessed for arsenic (As), barium (Ba), cadmium (Cd), chromium (Cr), lead (Pb), selenium (Se), silver (Ag), and mercury (Hg). Survey results showed that the vast majority of all respondents were concerned over proximity to industry and waste facilities, as well as exposure to standing surface water. Barium was discovered in every sample and many of the zones showed alarming levels of certain metals. For example, one zone, two blocks from a public park, showed levels of arsenic at 180 (μg/L), barium at 3296 (μg/L), chromium at 363 (μg/L), lead at 1448 (μg/L), and mercury at 10 (μg/L). These findings support the hypothesis that neighborhood members are aware of the issues affecting their community and can offer researchers valuable assistance in every stage of study design and execution.

Ergonomics and beyond: understanding how chemical and heat exposures and physical exertions at work affect functional ability, injury, and long-term health

Objective: To honor Tom Waters’s work on emerging occupational health issues, we review the literature on physical along with chemical exposures and their impact on functional outcomes. Background: Many occupations present the opportunity for exposure to multiple hazardous exposures, including both physical and chemical factors. However, little is known about how these different factors affect functional ability and injury. The goal of this review is to examine the relationships between these exposures, impairment of the neuromuscular and musculoskeletal systems, functional outcomes, and health problems with a focus on acute injury. Method: Literature was identified using online databases, including PubMed, Ovid Medline, and Google Scholar. References from included articles were searched for additional relevant articles. Results: This review documented the limited existing literature that discussed cognitive impairment and functional disorders via neurotoxicity for physical exposures (heat and repetitive loading) and chemical exposures (pesticides, volatile organic compounds [VOCs], and heavy metals). Conclusion: This review supports that workers are exposed to physical and chemical exposures that are associated with negative health effects, including functional impairment and injury. Innovation in exposure assessment with respect to quantifying the joint exposure to these different exposures is especially needed for developing risk assessment models and, ultimately, preventive measures. Application: Along with physical exposures, chemical exposures need to be considered, alone and in combination, in assessing functional ability and occupationally related injuries.

Community Based Research Network: Opportunities for Coordination of Care, Public Health Surveillance, and Farmworker Research

Introduction: The lack of aggregated longitudinal health data on farmworkers has severely limited opportunities to conduct research to improve their health status. To correct this problem, we have created the infrastructure necessary to develop and maintain a national Research Data Repository of migrant and seasonal farmworker patients and other community members receiving medical care from Community and Migrant Health Centers (C/MHCs). Project specific research databases can be easily extracted from this repository. Methods: The Community Based Research Network (CBRN) has securely imported and merged electronic health records (EHRs) data from five geographically dispersed C/MHCs. To demonstrate the effectiveness of our data aggregation methodologies, we also conducted a small pilot study using clinical, laboratory and demographic data from the CBRN Data Repository from two initial C/MHCs to evaluate HbA1c management. Results: Overall, there were 67,878 total patients (2,858 farmworkers) that were seen by two C/MHCs from January to August 2013. A total of 94,189 encounters were captured and all could be linked to a unique patient. HbA1c values decreased as the number of tests or intensity of testing increased. Conclusion: This project will inform the foundation for an expanding collection of C/MHC data for use by clinicians for medical care coordination, by clinics to assess quality of care, by public health agencies for surveillance, and by researchers under Institutional Review Board (IRB) oversight to advance understanding of the needs and capacity of the migrant and seasonal farmworker population and the health centers that serve them. Approved researchers can request data that constitute a Limited Data Set from the CBRN Data Repository to establish a specific research database for their project.