Grisel Trejo

Evaluating the Effectiveness of a Lay Health Promoter-Led, Community-Based Participatory Pesticide Safety Intervention With Farmworker Families

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

Nutritional strategies of Latino farmworker families with preschool children: identifying leverage points for obesity prevention.

Obesity and overweight are significant problems for children in the US, particularly for Hispanic children. This paper focuses on the children in families of immigrant Hispanic farmworkers, as farm work is the portal though which many immigrants come to the US. This paper (1) describes a model of the nutritional strategies of child feeding in farmworker families; and (2) uses this model to identify leverage points for efforts to improve the nutritional status of these children. In-depth interviews were conducted in Spanish with 33 mothers of 2-5 year old children in farmworker families recruited in North Carolina in 2010-2011. The purposive sample was balanced by farmworker status (migrant or seasonal), child age, and child gender. Interviews were transcribed and translated. Multiple coders and a team approach to analysis were used. Nutritional strategies centered on domains of procuring food, using food, and maintaining food security. The content of these domains reflected environmental factors (e.g., rural isolation, shared housing), contextual factors (e.g., beliefs about appropriate food, parenting style), and available resources (e.g., income, government programs). Environmental isolation and limited access to resources decrease the amount and diversity of household food supplies. Parental actions (parental sacrifices, reduced dietary variety) attempt to buffer children. Use of government food sources is valuable for eligible families. Leverage points are suggested that would change nutritional strategy components and lower the risk of overweight and obesity. Further prospective research is needed to verify the nutritional strategy identified and to test the ability of leverage points to prevent childhood obesity in this vulnerable population.

Physical activity of preschool-aged Latino children in farmworker families.

OBJECTIVE To describe time spent in sedentary and moderate-to-vigorous physical activity (MVPA) by children in Latino farmworker families and delineate sources of variation in sedentary and MVPA. METHOD Data were from mother-child dyads (N = 248) in Latino farmworker households in North Carolina. Physical activity was assessed using accelerometers; mothers described their childrens characteristics and their physical and social environments. RESULTS Children spent 6.2 hours/day sedentary (Median=369 minutes), and 6.0 minutes/day in MVPA. Children in Head Start spent more time sedentary, whereas children living where dogs roam freely were less sedentary. Children whose mothers limited screen time spent 2 more minutes in MVPA. CONCLUSIONS Preschool-aged Latino children in farmworker families are sedentary, engaging in little MVPA.

Barriers and Facilitators for Promotoras’ Success in Delivering Pesticide Safety Education to Latino Farmworker Families: La Familia Sana

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

Interpersonal and social correlates of depressive symptoms among Latinas in farmworker families living in North Carolina.

ABSTRACT Little research is available about the mental health of Latina women in farmworker families living in the southern United States, where Latino immigrants are relatively recent arrivals. This study examined interpersonal correlates (family conflict, family’s outward orientation, and perceived discrimination) and social correlates (residential mobility and economic insecurity) of depressive symptoms and of meeting a threshold of depressive symptoms that could be clinically significant (a cut-point of 10 or higher in a short Center for Epidemiologic Studies-Depression Scale) among Latinas in farmworker families living in North Carolina. Data were collected from April 19, 2011 to April 20, 2012 as part of Niños Sanos, a prospective study of Latino women and children (N = 248). Regression models showed that exposure to family conflict, perceived discrimination, and economic insecurity were associated with more depressive symptoms. Likewise, perceived discrimination and economic insecurity were associated with a threshold of depressive symptoms that could be clinically significant, above and beyond family conflict. The findings suggested that policies that lessen the discrimination of farmworkers and their families and reduce economic insecurity, as well as interventions that support positive family functioning, might be beneficial for the mental health of Latinas in farmworker families living in new immigrant destinations.

Profiles of Food Security for US Farmworker Households and Factors Related to Dynamic of Change

OBJECTIVES We recruited 248 farmworker families with preschool-aged children in North Carolina and examined food security indicators over 24 months to identify food security patterns and examine the dynamic of change over time. METHODS Participants in the Niños Sanos study, conducted 2011 to 2014, completed quarterly food security assessments. Based on responses to items in the US Household Food Security Survey Module, we identified different states of food security by using hidden Markov model analysis, and examined factors associated with different states. We delineated factors associated with changes in state by using mixed-effect ordinal logistic regression. RESULTS About half of the households (51%) consistently stayed in the most food-secure state. The least food-secure state was transient, with only 29% probability of this state for 2 consecutive quarters. Seasonal (vs migrant) work status, having immigration documents (vs not documented), and season predicted higher levels of food security. CONCLUSIONS Heterogeneity in food security among farmworker households calls for tailoring intervention strategies. The transiency and unpredictability of low food security suggest that access to safety-net programs could reduce low food security risk in this population.

Physical Activity States of Preschool-Aged Latino Children in Farmworker Families: Predictive Factors and Relationship With BMI Percentile

BACKGROUND Obesity disproportionately affects children of Latino farmworkers. Further research is needed to identify patterns of physical activity (PA) in this group and understand how PA affects Body Mass Index (BMI) percentile. METHODS Two hundred and forty-four participants ages 2.5 to 3.5 in the Niños Sanos longitudinal study wore accelerometers that measured daily PA. Several PA-related parameters formed a profile for conducting hidden Markov modeling (HMM), which identified different states of PA. RESULTS Latino farmworker children were generally sedentary. Two different states were selected using HMM-less active and more active. In the more active state; members spent more minutes in moderate-vigorous physical activity (MVPA). Most children were in the less active state at any given time; however, switching between states occurred commonly. One variable-mothers concern regarding lack of PA-was a marginally significant predictor of membership in the more active state. State did not predict BMI or weight percentile after adjusting for caloric intake. CONCLUSION Most children demonstrated high amounts of sedentary behavior, and rates of MVPA fell far below recommended levels for both states. The lack of statistically significant results for risk factors and PA state on weight-related outcomes is likely due to the homogeneous behaviors of the children.

Latina Workers in North Carolina: Work Organization, Domestic Responsibilities, Health, and Family Life

This analysis describes the work organization and domestic work experienced by migrant Latinas, and explores the linkage between work and health. Twenty Latina workers in North Carolina with at least one child under age 12 completed in-depth interviews focused on their work organization, domestic responsibilities, work-family conflict, health, and family health. Using a systematic qualitative analysis, these women described a demanding work organization that is contingent and exploitative, with little control or support. They also described demanding domestic roles, with gendered and unequal division of household work. The resulting work-family conflict affects their mental and physical health, and has negative effects on the care and health of their families. The findings from this study highlight that work stressors from an unfavorable work organization create work-family conflict, and that work-family conflict in this population has a negative influence on workers’ health and health behaviors.

Work and health among Latina mothers in farmworker families.

Background: Work organization is important for the health of vulnerable workers, particularly women. This analysis describes work organization for Latinas in farmworker families and delineates the associations of work organization with health indicators. Methods: Up to 220 Latina women in farmworker families completed interviews from October 2012 to July 2013. Interviews addressed job structure, job demand, job control, and job support. Health measures included stress, depressive symptoms, physical activity, family conflict, and family economic security. Results: Three fifths of the women were employed. Several work organization dimensions, including shift, psychological demand, work safety climate, and benefits, were associated with participant health as expected, on the basis of the work organization and job demands-control-support models. Conclusions: Research should address womens health and specific work responsibilities. Occupational safety policy must consider the importance of work organization in the health of vulnerable workers.

Anticipatory Guidance about Child Diet and Physical Activity for Latino Farmworker Mothers

Background. This analysis describes farmworker child health care utilization, anticipatory guidance for child weight, and the association of anticipatory guidance with personal characteristics, practice characteristics, and child’s health care utilization. Methods. Data are from interviews conducted with 221 North Carolina Latino farmworker mothers with a child aged 4–5 years. Results. Half of the children were healthy weight, 19.0% were overweight, and 28.5% were obese. Most (56.4%) had been with the usual practice for two years or longer; most had well-child visits less frequently than once per year (71.5%). Fewer children with well-child visits than without were obese (14.8% vs. 35.5%; p=.01). More children with obesity than with healthy weight or overweight received guidance messages; more children without a well-child care visit in the past 12 months received guidance messages. Conclusions. Health care providers are addressing anticipatory guidance when the opportunity arises. Creative approaches to address disparate primary care for farmworker families are important.