Linda McCauley

Hispanic adolescent farmworkers' perceptions associated with pesticide exposure

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

The risk of acquiring hepatitis B or C among public safety workers

CONTEXTnDetermination of the occupational risk of hepatitis B and C to public safety workers is important in identifying prevention opportunities and has significant legal and policy implications.nnnOBJECTIVESnCharacterize the risk of occupationally acquired infection: (1) risk of exposure to blood and body fluids, (2) seroprevalence of hepatitis B and C in the source population, and (3) risk of infection after exposure.nnnDATA SOURCESnElectronic search of MEDLINE (1991-1999), HealthStar (1982-1999), and CINAHL (1975-1999) supplemented by selected reference citations and correspondence with authors of relevant articles.nnnSTUDY SELECTIONnPeer-reviewed journal articles (N=702) that addressed the transmission of hepatitis B and C in law enforcement, correctional, fire, emergency medical services, and healthcare personnel were identified. One hundred five (15.0%) articles were selected for full-text retrieval; 72 (68.6%) were selected for inclusion.nnnDATA ABSTRACTIONnArticles selected for inclusion were abstracted by two reviewers and checked by a third reviewer, using a standard reporting form.nnnDATA SYNTHESISnEvidence tables were constructed, using the standardized abstracts. The tables were designed to summarize data for the key elements of the risk analysis.nnnCONCLUSIONSnData suggest that emergency medical service (EMS) providers are at increased risk of contracting hepatitis B, but data have failed to show an increased prevalence of hepatitis C. EMS providers have exposure risks similar to those of hospital-based healthcare workers. Other public safety workers appear to have lower rates of exposure. Urban areas have much higher prevalence of disease, and public safety workers in those areas are likely to experience a higher incidence of exposure events.

Pesticide Knowledge and Risk Perception Among Adolescent Latino Farmworkers

A substantial proportion of the agricultural production in the U.S. is dependent on the labor of Latino farmworkers. While exact figures are not known, it is estimated that adolescents make up 7% of this valuable workforce. These young workers may be at increased risk for the toxic effects of environmental exposures encountered during their work. Furthermore, language barriers and health beliefs may influence the risk perceptions of this population. We conducted a cross-sectional survey of migrant adolescent farmworkers in 1998 to investigate their work practices, health beliefs, and pesticide knowledge. The large majority of the adolescents in our sample were from Mexico, and 36.3% spoke primarily indigenous languages. Many of the adolescents (64.7%) were traveling and working in the U.S. independent of their parents. Few of the adolescents reported having received pesticide training; however, 21.6% of the sample reported that their current work involved mixing and/or applying agricultural chemicals. The scores on the pesticide knowledge questionnaire were found to significantly predict self-reported use of protection for adolescent farmworkers. The results of this study point to a need for improved pesticide training in youth agricultural workers and specialized education efforts directed toward minorities who speak indigenous dialects. Special attention is merited toward adolescent farmworkers who report that their work includes mixing or applying agricultural chemicals. As the number of adolescent farmworkers increases in the U.S. and the characteristics of the migrant stream continue to change, culturally and developmentally appropriate instruments are needed to adequately assess the health beliefs and protective practices of this population.

Symptoms of Gulf War Veterans Possibly Exposed to Organophosphate Chemical Warfare Agents at Khamisiyah, Iraq

Abstract During the 1991 Gulf War, some Allied troops were potentially exposed to satin/cyclosarin as the result the destruction of the destruction of Iraqi munitions at Khamisiyah. To evaluate the prevalence of past and current symptoms known to be associated with exposure to these chemical warfare agents; the authors conducted a computer-assisted telephone survey of 2,918 U.S, Gulf War veterans, Veterans who had participated in or witnessed the demolition in 1991 were more likely to report historical or extant symptoms than were veterans from other military units. These results should be viewed cautiously because they are based on symptoms recalled nine years after the event without precise characterization of exposure. Nonetheless, the findings suggest that symptoms consistent with low-level sarin exposure may have initially occurred, and health effects may have per-sisted in the veterans who were nearest to the demolition activity. Further research is warranted.

Psychological differences between veterans with and without Gulf War unexplained symptoms

Objective The objective of this study was to assess measures of psychological and neurobehavioral functioning to determine their association with unexplained symptoms in Gulf War veterans. Methods An epidemiological survey focusing on exposures and symptoms was mailed to a random sample of Gulf War veterans from Oregon and southwestern Washington. Volunteers were recruited from survey respondents who agreed to undergo a thorough medical examination and psychological and neurobehavioral assessment. Persistent symptoms with no medical explanation associated with service in the Persian Gulf (eg, fatigue, muscle pain, and memory deficits) that began during or after the war qualified respondents as cases. The 241 veterans with unexplained symptoms were classified as case subjects, and the 113 veterans without symptoms were classified as control subjects. All veterans completed a battery of computerized assessment tests consisting of 12 psychosocial and 6 neurobehavioral tests. Differences between case and control subjects on neurobehavioral and psychological variables were assessed with univariate and multivariate statistical comparisons. Results Case subjects differed substantially and consistently from control subjects on diverse psychological tests in the direction of increased distress and psychiatric symptoms. Case subjects had small but statistically significant deficits relative to control subjects on some neurobehavioral tests of memory, attention, and response speed. A logistic regression model consisting of four psychological variables but no neurobehavioral variables classified case and control subjects with 86% accuracy. Conclusions Our results revealed that Gulf War veterans who report symptoms associated with that conflict differed on multiple psychological measures in the direction of increased distress and performed more poorly on neurobehavioral measures when compared with control subjects who did not report symptoms. This suggests that psychological differences have a prominent role in investigation of possible explanations of Gulf War symptoms.

Chronic fatigue in a population-based study of Gulf War veterans

Abstract Fatigue has been associated with illness in veterans of the Gulf War; however, few studies have confirmed self-reported fatigue by using clinical evaluation, and symptomatic veterans have not been evaluated with established criteria for Chronic Fatigue Syndrome (CFS). The authors describe the frequency and clinical characteristics of CFS in a sample of veterans residing in the northwestern United States. The sample was selected randomly from U.S. Department of Defense databases of troops deployed to southwest Asia during the Gulf War. The selected individuals were invited to participate in a clinical case-control study of unexplained illness. Of 799 survey respondents eligible for clinical evaluation, 178 had fatigue symptoms. Of the 130 veterans who were evaluated clinically, 103 had unexplained fatigue, and 44 veterans met the 1994 U.S. Centers for Disease Control criteria for CFS. In this population, the authors estimated a minimum prevalence of any unexplained fatigue to be 5.1%, and of CFS to be 2.2%. The estimated prevalence was greater among females than among males. Cases were similar to healthy controls, as determined by laboratory tests and physical findings. In comparison to several clinical studies of CFS patients, the authors of this study found a lower proportion of veterans who reported a sudden onset of symptoms (19%) vs. a gradual onset (50%). Although it has previously been suggested that veterans of the Gulf War suffer from higher rates of chronic fatigue than the general population, the study results described herein–on the basis of clinical examination of a population-based sample of veterans–actually indicate that an increased rate may indeed exist. Gulf War veterans with unexplained fatigue should be encouraged to seek treatment so that the impact of these symptoms on overall quality of life can be reduced.

Illness experience of Gulf War veterans possibly exposed to chemical warfare agents.

BACKGROUNDnDuring the 1991 Gulf War, some Allied troops were potentially exposed to chemical warfare agents as the result of the detonation of Iraqi munitions at Khamisiyah.nnnMETHODSnIn 1999, we conducted a computer-assisted telephone survey of 2918 Gulf War veterans from Oregon, Washington, California, North Carolina, and Georgia to evaluate the prevalence of self-reported medical diagnoses and hospitalizations among this potentially exposed population and among comparison groups of veterans deployed and nondeployed to the Southwest Asia theater of operations.nnnRESULTSnTroops reported to be within 50 kilometers of the Khamisiyah site did not differ from other deployed troops on reports of any medical conditions or hospitalizations in the 9 years following the Gulf War. Hospitalization rates among deployed and nondeployed troops did not differ. Deployed troops were significantly more likely to report diagnoses of high blood pressure (odds ratio [OR]=1.7); heart disease (OR=2.5); slipped disk or pinched nerve (OR=1.5); post-traumatic stress disorder (OR=14.9); hospitalization for depression (OR=5.1); and periodontal disease (OR=1.8) when compared to nondeployed troops. There was a trend for deployed veterans to report more diagnoses of any cancer (OR=3.0).nnnCONCLUSIONSnThese findings do not provide evidence of any long-term health effect associated with exposure to the detonation of chemical warfare agents, but support findings from other investigations of increased morbidity among deployed troops. The prevalence of cancer among this population of deployed troops merits ongoing attention.

Neurobehavioral deficits in Persian Gulf veterans: Evidence from a population-based study

Reports of low-concentration nerve gas exposures during the Persian Gulf War have spurred concern about possible health consequences and refocused interest on the symptoms reported by many returning military veterans. The Portland Environmental Hazards Research Center is studying veterans from the Northwest USA who report persistent, unexplained Persian Gulf symptoms (cases) or who do not report those symptoms (controls). Of the first 101 veterans studied, cases differed substantially from controls on a broad range of psychological tests indicative of increased distress. A subgroup of cases was identified with objective deficits on neurobehavioral tests of memory, attention, and response speed.

Development of a Neurobehavioral Battery for Children Exposed to Neurotoxic Chemicals

In recent years there has been heightened concern over the potential impact of environmental exposures on neurological function in children. Children are thought to be especially vulnerable to neurotoxic effects due to a number offactors including play behavior, differences in metabolism, and the development state of the brain. Performance tests from the computerized Behavioral Assessment and Research System (BARS) and other non-computerized tests have been combined to develop a brief battery that assesses multiple neurobehavioral functions in preschool children aged 4-6. Tests were selected to assess a variety of cognitive functions including attention, memory, motor speed and coordination and other executive functions. The battery has also been translated into Spanish and developed for use with Latino populations. Four to six-year-old children are particularly challenging because of the shorter attention span and lower motivation to complete an extended test session. When testing this group it is important to maintain the motivation of the child throughout the entire session in order to obtain accurate performance measures. A series of sequential pilot studies were used to select and develop appropriate methods and parameters for the tests in the battery. Although English-speaking children were able to complete the initial battery with minimal difficulties, several difficulties were encountered when the tests were administered to a Latino population. Cultural differences made some material inappropriate for testing due to unfamiliarity with the material, and in some cases items in a test had more than one correct translation which made administration difficult.

U.S. Gulf War Veterans: Service periods in theater, differential exposures, and persistent unexplained illness

Approximately 80,000 of the 697,000 American men and women who were stationed in SW Asia during the Gulf War (GW) report unexplained illness consisting of symptoms of persistent fatigue, cognitive difficulties, such as mild memory loss, diffuse muscle and joint pain, gastrointestinal symptoms, skin lesions, and respiratory problems, among others. Associations between major symptom groups and periods of deployment in the theater of operations have been sought in a population-based, clinical case-control study of GW veterans resident in the north-western region of the United States. No statistically significant differences were evident in the proportion of cases with unexplained fatigue, cognitive/psychological or musculoskeletal symptoms among veterans present in SW Asia in 3 specific time periods: (a) 8/1/1990-12/31/1990 (which includes Desert Shield), (b) the period surrounding Desert Storm (1/1/1991-3/31/1991), and (c) the (post-combat) period immediately following hostilities (4/1/1991-7/31/1991). There was a trend for all 3 case symptoms to be more common among GW veterans who served in the post-combat period. As numbers in these deployment groups were small, and power to detect differences low, the apparent absence of significant differences in the frequency of major symptom groups among these veterans requires confirmation in a larger study. Deployment for discrete periods in SW Asia is a method to separate distinct constellations of environmental factors; these are useful for analyses of associations among symptoms and exposures given the near-total absence of objective data on chemical and other possible exposures in the theater of operations.