Joseph G. Grzywacz

Work organization, job insecurity, and occupational health disparities

BACKGROUND Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status. METHODS A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards. RESULTS There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective. CONCLUSIONS Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

Cognitive function is a risk for health literacy in older adults with diabetes

AIMS Cognitive impairment is common in older adults with diabetes, yet it is unclear to what extent cognitive function is associated with health literacy. We hypothesized that cognitive function, independent of education, is associated with health literacy. METHODS The sample included 537 African American, American Indian, and White men and women 60 years or older. Measures of cognitive function included the Mini-Mental State Examination (MMSE), Verbal Fluency, Brief Attention, and Digit Span Backward tests. Health literacy was assessed using the S-TOFHLA. RESULTS Cognitive function was associated with health literacy, independent of education and other important confounders. Every unit increase in the MMSE, Digit Span Backward, Verbal Fluency or Brief Attention was associated with a 20% (p<.001), 34% (p<.001), 5% (p<.01), and 16% (p<.01) increase in the odds of having adequate health literacy, respectively. CONCLUSIONS These results suggest that cognitive function is associated with health literacy in older adults with diabetes. Because poor cognitive function may undermine health literacy, efforts to target older adults on improving health literacy should consider cognitive function as a risk factor.

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.

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.

Depression, Social Factors, and Farmworker Health Care Utilization

PURPOSE Farmworkers frequently live in rural areas and experience high rates of depressive symptoms. This study examines the association between elevated depressive symptoms and health care utilization among Latino farmworkers. METHODS Data were obtained from 2,905 Latino farmworkers interviewed for the National Agricultural Workers Survey. Elevated depressive symptoms were measured using the Center for Epidemiologic Studies Depression short-form. A dichotomous health care utilization variable was constructed from self-reported use of health care services in the United States. A categorical measure of provider type was constructed for those reporting use of health care. RESULTS Over 50% of farmworkers reported at least 1 health care visit in the United States during the past 2 years; most visits occurred in a private practice. The odds of reporting health care utilization in the United States were 45% higher among farmworkers with elevated depressive symptoms. Type of provider was not associated with depressive symptoms. Women were more likely to seek health care; education and family relationships were associated with health care utilization. CONCLUSIONS Latino farmworkers who live and work in rural areas seek care from private practices or migrant/Community Health Clinics. Farmworkers with elevated depressive symptoms are more likely to access health care. Rural health care providers need to be prepared to recognize, screen, and treat mental health problems among Latino farmworkers. Outreach focused on protecting farmworker mental health may be useful in reducing health care utilization while improving farmworker quality of life.

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.

A Qualitative Analysis of How Elders Seek and Disseminate Health Information

This study documents older adults’ sources of health information, describes the purposes for health information seeking, and delineates gender and ethnic variation in health information seeking. Sixty-two African American and White adults aged 65 and older completed qualitative interviews describing their use of complementary therapies. Interviews identified how individuals obtained and shared health information. Friends, not family, were the dominant source of health information. Participants ranged from active seekers to passive consumers of health information. Information seeking was common for benign symptoms. More women than men discuss health information with others. Friends are the primary source of health information for rural older adults. There is substantial passivity in the pursuit of health information. Identifying health information sources of rural older adults can support the dissemination of information to those who share it with others.

Intensive Mothering Beliefs Among Full-Time Employed Mothers of Infants

This study examined the degree to which 205 full-time employed mothers of infants endorsed intensive mothering beliefs (IMB), the stability of IMB, and contextual correlates of IMB. Results suggested that full-time employed mothers in this study did not endorse IMB, on average, but that endorsement varied for specific domains of IMB for the total sample and by mothers’ education. Global IMB scores did not change from 4 to 16 months postpartum, with the exception of single mothers whose scores declined over time. Endorsement of IMB was associated with multiple socioeconomic and demographic characteristics, and endorsement of IMB also varied based on unique intersections of race, education, and marital status.

Use of Complementary Therapies for Health Promotion Among Older Adults

This article describes the types of complementary therapies used by older adults for health promotion, and delineates the predisposing, enabling, and need factors associated with their use. One-hundred ninety-five African American and White participants (age 65+) completed a baseline interview and up to six sets of three daily follow-up interviews at monthly intervals. Complementary therapies for health promotion included home remedies, specific foods or beverages, herbs, supplements, vitamins, over-the-counter (OTC) medicine, prayer, exercise, and being active. Although gender, ethnicity, education, and trust in doctors were associated with the use of complementary therapies for health promotion, health information seeking was the predisposing factor most often associated. The enabling factors were also associated with their use. Health information seeking, which reflects a wellness lifestyle, had the most consistent associations with complementary therapy use for health promotion. This health self-management for health promotion may have positive effects on future medical expenditures.

Psychosocial factors associated with depressive symptoms among Latina immigrants living in a new arrival community.

Few studies have examined the mental health of foreign-born Latinas living in new immigrant destinations. We examined levels of depressive symptoms and depression caseness (i.e., clinically significant levels of depressive symptoms) and psychosocial correlates among foreign-born Latinas living in a new immigrant destination. One hundred fourteen Latinas participated: 93% Mexican-born (Mage = 37.3 years, SD = 5.7, age range = 25–53 years). Most of the women (86%) had been in the United States 10 years or longer but did not have legal documents (80.7%). Depressive symptoms were measured with a short version of the Center for Epidemiological Studies Depression Scale (CES-D). Depression caseness was defined as a score of 10 or higher on the short CES-D. Age, education, family income, time living in the United States, family cohesion, social support, undocumented status, and undocumented stress were examined as correlates of depressive symptoms and depression caseness. The mean level of depressive symptoms was 5.5, and 17.5% of participants met the criteria for depression caseness. Regression analysis showed that both lower family cohesion and lower social support were associated with greater depressive symptoms but that only lower social support was associated with depression caseness. Undocumented women experienced higher levels of undocumented stress than did documented women; however, they neither reported more depressive symptoms nor were they more likely to meet the criterion for depression caseness. Helping foreign-born Latinas strengthen their family cohesion and social support, as well as fostering support services for immigrant women and their families, could contribute to fewer depressive symptoms and better mental health among this vulnerable population. Pocos estudios han examinado la salud mental de Latinas nacidas en el extranjero viviendo en nuevos destinos para inmigrantes. Nosotros examinamos los niveles de síntomas depresivos en general y casos de depresión clínica así como ciertas variables psicosocialesen un grupo de Latinas extranjeras viviendo en un nuevo destino para inmigrantes. Las participantes fueron 114 Latinas; 93% nacidas en México; edad promedio 37.3 años, desviación estándar 5.7; rango de edad 25–53 años. Síntomas depresivos se midieron con una versión corta de la escala CES-D. Síntomas clínicos fueron definidos como un puntaje de 10 o más en dicha escala. Las variables psicosociales examinadas fueron edad, educación, ingreso familiar, número de años viviendo en los Estados Unidos, cohesión familiar, apoyo social, estatus migratorio y estrés asociado con el estatus migratorio. El promedio de síntomas depresivos fue 5.5 y 17.5% de las participantes clasificaron en el nivel de síntomas clínicos. Análisis de regresión mostraron que bajos niveles de cohesión familiar y apoyo social estuvieron relacionados con un alto nivel de síntomas depresivos en general, aunque sólo un bajo nivel de apoyo social estuvo asociado con síntomas clínicos. Mujeres indocumentadas reportaron un nivel más alto de estrés relacionado con estatus migratorio de indocumentada que mujeres con documentos; sin embargo, mujeres indocumentadas no reportaron un nivel de síntomas depresivos más alto ni tampoco clasificaron en la categoría de síntomas clínicos más a menudo que mujeres con documentos. Ayudar a las Latinas extranjeras a fortalecer la cohesión familiar e incrementar el nivel de apoyo social, así como promover servicios de apoyo para las mujeres inmigrantes y sus familias podría contribuir a una reducción en síntomas depresivos y una mejor salud mental en ésta población vulnerable.