Marla B. Hall

Estimating the Prevalence of Heat-Related Symptoms and Sun Safety–Related Behavior among Latino Farmworkers in Eastern North Carolina

ABSTRACT In hot weather, thermal heat generated by the body, combined with environmental heat from the sun, can lead outdoor workers to experience heat-related stress, severe illness, or even death. The aims of this study were to estimate the prevalence of heat-related symptoms and potential risk factors associated with sun safety–related behavior among Latino farmworkers. Data from interviewer-administered questionnaires were collected from a cross-sectional survey among farmworkers (N = 158) from August to September 2013. Data analysis assessed associations between work activities, sun safety behavior, and the prevalence of heat-related illness (HRI) symptoms among workers. Nearly two thirds (72%) of farmworkers experienced at least one HRI symptom and lacked proper cooling methods when working outdoors. Most workers reported wearing long-sleeved shirts (85%), long pants (98%), and baseball caps (93%). The prevalence of having one HRI symptom was 72% and 27% among workers having three or more HRI symptoms. The majority of farmworkers experience symptoms of HRI and are not provided with proper shade protection when working outdoors. Increased emphasis on administrative controls, particularly educating field supervisors and workers on how to avoid and recognize HRI, should be a priority.

Residential Segregation and Racial Cancer Disparities: A Systematic Review

BackgroundThis paper provides the first review of empirical studies of segregation and black-white cancer disparities.MethodsWe searched all years of PubMed (through May 2016) using these terms: racial segregation, residential segregation, neighborhood racial composition (first terms) and (second terms) cancer incidence, mortality, survival, stage at diagnosis, screening. The 17 (of 668) articles that measured both segregation and a cancer outcome were retained.ResultsSegregation contributed significantly to cancer and to racial cancer disparities in 70% of analyses, even after controlling for socioeconomic status and health insurance. Residing in segregated African-American areas was associated with higher odds of later-stage diagnosis of breast and lung cancers, higher mortality rates and lower survival rates from breast and lung cancers, and higher cumulative cancer risks associated with exposure to ambient air toxics. There were no studies of many types of cancer (e.g., cervical). Studies differed in their measure of segregation, and 40% used an invalid measure. Possible mediators of the segregation effect usually were not tested.ConclusionsEmpirical analysis of segregation and racial cancer disparities is a recent area of research. The literature is limited to 17 studies that focused primarily on breast cancer. Studies differed in their measure of segregation, yet segregation nonetheless contributed to cancer and to racial cancer disparities in 70% of analyses. This suggests the need for further research that uses valid measures of segregation, examines a variety of types of cancers, and explores the variables that may mediate the segregation effect.

Self-rated health, objective health, and racial discrimination among African-Americans: Explaining inconsistent findings and testing health pessimism

African-Americans sometimes rate their health as Poor/Fair in the absence of chronic diseases. Theoretically, this lack of correspondence between self-rated health and objective health is due to racial discrimination that results in rating one’s health negatively and in terms of social rather than health variables. We tested this Health Pessimism model with 2118 African-Americans. Results revealed that Poor/Fair self-rated health was predicted mostly by objective health for the Low Discrimination group but mostly by demographic variables for the High Discrimination group, in a manner consistent with Health Pessimism. Inconsistencies among prior studies might reflect differences in the prevalence of high discrimination among their samples.

Residential Segregation and Overweight/Obesity Among African-American Adults: A Critical Review

The relationship between residential segregation and overweight/obesity among African-American adults remains unclear. Elucidating that relationship is relevant to efforts to prevent and to reduce racial disparities in obesity. This article provides a critical review of the 11 empirical studies of segregation and overweight/obesity among African-American adults. Results revealed that most studies did not use a valid measure of segregation, many did not use a valid measure of overweight/obesity, and many did not control for neighborhood poverty. Only four (36% of the) studies used valid measures of both segregation and overweight/obesity and also controlled for area-poverty. Those four studies suggest that segregation contributes to overweight and obesity among African-American adults, but that conclusion cannot be drawn with certainty in light of the considerable methodologic problems in this area of research. Suggestions for improving research on this topic are provided.

Bias Within: Examining the Role of Cultural Competence Perceptions in Mammography Adherence

Breast cancer mortality has affected African American women at a disproportionate rate. The purpose of this research was to assess how health professionals’ cultural competence contributes to African American women’s barriers to and receipt of mammograms. Sixty-one African American women residing in Harris County, Texas, shared their views within a series of focus groups. Theoretical propositions from the PEN-3 model were used to understand mammography adherence at the interpersonal level. Participants noted various perceived factors associated with mammography incompliance. Lack of professionalism of clinicians and clerical staff contributed to a decrease in health care services utilization. In addition, cultural insensitivity and discriminatory behavior enabled an attitude of medical mistrust. Improving patient–provider communication, through culturally appropriate centered educational efforts, is a beneficial strategy for breast health programs among underserved populations.

Organizational-Level Recruitment of Barbershops as Health Promotion Intervention Study Sites: Addressing Health Disparities Among Black Men

This article describes the process and results associated with the organizational-level recruitment of Black barbershops into Fitness in the Shop (FITShop), a 6-month barbershop-based intervention study designed to promote physical activity among Black men. Organizational-level recruitment activities included (1) a telephone call to prospective barbershop owners to assess their interest and eligibility for participation, (2) an organizational eligibility letter sent to all interested and eligible barbershops, (3) a visit to interested and eligible barbershops, where a culturally sensitive informational video was shown to barbershop owners to describe the study activities and share testimonies from trusted community stakeholders, and (4) a signed agreement with barbershop owners and barbers, which formalized the organizational partnership. Structured interviews were conducted with owners of a total of 14 enrolled barbershops, representing 30% of those determined to be eligible and interested. Most enrolled shops were located in urban settings and strip malls. Barbershop owners were motivated to enroll in the study based on commitment to their community, perceived client benefits, personal interest in physical activity, and a perception that the study had potential to make a positive impact on the barbershop and on reducing health disparities. Results offer important insights about recruiting barbershops into intervention trials.