Shedra Amy Snipes

Why do farmworkers delay treatment after debilitating injuries? Thematic analysis explains if, when, and why farmworkers were treated for injuries

BACKGROUND Farmworkers who delay treatment after workplace injuries may increase injury severity and experience longer recovery times. To understand why farmworkers delay treatment we employed a mixed-methods analysis of 393 farmworker injury narratives from the National Agricultural Workers Survey (NAWS). METHODS First, open-ended injury narratives were coded for attitudes related to injury timing and delay. Next, narratives were compared against demographic survey attributes to assess contextual information and patterns linked to treatment timing. RESULTS Four treatment timings were identified: immediate medical treatment (57.9%), delayed medical treatment (18.2%) self- administered treatment (14.9%), and no treatment at all (8.9%). Delay was primarily attributed to attitudes prioritizing work over pain, and when workers were able to work despite injury. However, immediate treatment was sought when workers were completely debilitated and unable to work, when a supervisor was notified, or when exposed to pesticides during injury. Timing choices varied by education, gender and migrant status. CONCLUSIONS Training on timely treatment, including notification of supervisors, may help reduce treatment delay for farmworkers.

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.

Provision Increases Reported PPE Use for Mexican Immigrant Farmworkers: An mHealth Pilot Study.

Objective: Personal protective equipment (PPE) reduces pesticide exposures, but many farmworkers complain that it is difficult to obtain. We examined if PPE provision increased usage. We also delivered motivational messaging aimed to promote PPE use. Methods: First, we delivered a daily survey through a mobile phone app to assess PPE use. Farmworkers subsequently received a daily, individualized motivational message based on their PPE use and reported difficulties. PPE use was evaluated at baseline and at the close of the study. Results: PPE behaviors improved for gloves (P ⩽ 0.01) and safety glasses (P ⩽ 0.001). Use of long-sleeved shirts, hats, and long pants were already consistently used at baseline and did not exhibit significant change. Conclusions: Our findings demonstrate that PPE provision and delivery of motivational messaging through mobile phones may increase PPE usage for farmworkers.

Lateralized Basal Ganglia Vulnerability to Pesticide Exposure in Asymptomatic Agricultural Workers

Pesticide exposure is linked to Parkinsons disease, a neurodegenerative disorder marked by dopamine cell loss in the substantia nigra of the basal ganglia (BG) that often presents asymmetrically. We previously reported that pesticide-exposed agricultural workers (AW) have nigral diffusion tensor imaging (DTI) changes. The current study sought to confirm this finding, and explore its hemisphere and regional specificity within BG structures using an independent sample population. Pesticide exposure history, standard neurological exam, high-resolution magnetic resonance imaging (T1/T2-weighted and DTI), and [123I]ioflupane SPECT images (to quantify striatal dopamine transporters) were obtained from 20 AW with chronic pesticide exposure and 11 controls. Based on median cumulative days of pesticide exposure, AW were subdivided into high (AWHi, n = 10) and low (AWLo, n = 10) exposure groups. BG (nigra, putamen, caudate, and globus pallidus [GP]) fractional anisotropy (FA), mean diffusivity (MD), and striatal [123I]ioflupane binding in each hemisphere were quantified, and compared across exposure groups using analysis of variance. Left, but not right, nigral and GP FA were significantly lower in AW compared with controls (ps < .029). None of the striatal (putamen and caudate) DTI or [123I]ioflupane binding measurements differed between AW and controls. Subgroup analyses indicated that significant left nigral and GP DTI changes were present only in the AWHi (p ≤ .037) but not the AWLo subgroup. AW, especially those with higher pesticide exposure history, demonstrate lateralized microstructural changes in the nigra and GP, whereas striatal areas appear relatively unaffected. Future studies should elucidate how environmental toxicants cause differential lateralized- and regionally specific brain vulnerability.

Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults

BACKGROUND Gendered perspectives may be particularly important in shaping norms and values around HPV and HPV vaccination, as previous research suggests that sexuality taboos (e.g. promiscuity) may contribute to low perceived risk among adolescent and young adult Hispanic females. However, research to date focuses primarily on Hispanic mothers, adolescent females, and women of HPV vaccine-eligible age. Hispanic fathers perspectives are relatively unknown despite fathers important role in shaping norms for their female children. OBJECTIVE To close this gap, this study examines gendered perspectives in knowledge, beliefs, and attitudes about HPV and HPV vaccination from Hispanic parents (mothers and fathers), women of vaccine-eligible age (18-26 years old), and women eligible for Pap Test screening (>26 years old) living in two counties along the Texas-Mexico border. DESIGN We conducted eight focus groups. Research staff transcribed audio recordings verbatim and uploaded them into Atlas(ti) 5.0 for analysis. The research team analyzed the data for content, meaning, patterns and themes using the constant comparison approach. RESULTS Perspectives were highly gendered. Womens (all groups combined) beliefs focused on misconceptions around how the HPV virus is contracted (e.g. toilet surfaces). Women also linked HPV-related sexual risk to adultery and indiscretion of male partners. Fathers (men) were more likely to link risk to female promiscuity. Fathers also worried that HPV vaccination might increase promiscuity. All groups believe that HPV vaccination is a way to protect Hispanic females in the face of beliefs around sexual behavior and risk of contracting HPV. CONCLUSION Results suggest gendered differences in risk beliefs concerning HPV among Hispanics living along the Texas-Mexico border. Researchers can use these findings to address barriers to HPV vaccination, as well as to create culturally appropriate prevention messages that may help reduce disparities in HPV among Hispanic women.

Educated and At-Risk: How the Shortage of Available Partners Influences HIV Risk for College-Educated African-American Women

BACKGROUND African-Americans have the greatest gender-ratio imbalance compared to other racial groups in the United States. This has been associated with higher rates of concurrent sexual partnerships, increasing risk of HIV infection. College-educated African-American women are of particular interest as they are not often represented in studies on HIV prevention, while their dating and sexual negotiation patterns may differ from those of their lower-educated and lower-income counterparts more often the subject of study in HIV research among African-Americans. METHOD In this qualitative study, we investigate: a) how the gender-ratio imbalance is perceived by college-educated African-American women, b) how they feel limited partner availability impacts heterosexual relationships in the African-American community, and c) the influence this has on their sexual decision making and HIV protective behaviors. RESULTS Four major themes emerged- Limited pool of available male partners, Pressure to get married, Feelings of competition among women for male partners, and Mens negotiating power in relationships. CONCLUSIONS Using the PEN-3 Cultural Model, we discuss how this information may be used to develop interventions for this group of women designed to address their more specific barriers to HIV risk reduction.

Abstract C53: Human papillomavirus (HPV) and cervical cancer: Exploring knowledge, attitudes, and cultural taboos among Mexican American families along the Texas-Mexico border

Background: Hispanic women living along the Texas-Mexico border have higher cervical cancer mortality and incidence rates compared to other Hispanic women in the U.S. The human papillomavirus (HPV) causes the majority of cervical cancers. Although cervical cancer can be prevented through HPV vaccination and prevented or detected early through Pap test screening and follow-up treatment, they are all underutilized by Hispanic females. Research indicates that beliefs, misconceptions, and taboos regarding sexuality may contribute to the low perceived risk for HPV and cervical cancer, thus contributing to the underutilization of vaccination and Pap test screening. Since beliefs are often transmitted through parents, it is critical to elucidate parents9 and young women9s (aged 18-26 years) beliefs about HPV and cervical cancer. In this study, we explored knowledge, attitudes, and perceptions about HPV and cervical cancer among Hispanic parents and young women living along the Texas-Mexico border. Methods: We conducted eight focus groups in two counties along the Texas-Mexico border. Research staff recruited family members - fathers, mothers, and young women (aged 18-26 years) who were eligible for HPV catch-up vaccination - from local community centers, health centers, and colleges. Research staff audio-recorded focus groups for accuracy, transcribed recordings word-for-word, and uploaded transcripts into Atlas(ti) 5.0 for analysis. After open and axial coding, the research team analyzed the data for content, meaning, patterns, frequency, and themes by applying the constant comparison method to guide analysis and generation of themes. Results: Although misconceptions existed across all participant groups, the type of misconception varied. Mothers, fathers, and young women held different beliefs. Misconceptions among parents centered heavily on sexual risk with fathers linking HPV risk to promiscuity. On the other hand, mothers linked HPV risk to adultery and indiscretion of male partners. Young women9s beliefs were about transmission of the virus via unclean surfaces and beliefs that medications can cure HPV. Conclusions: Results uncovered important differences in knowledge and risk beliefs concerning HPV and cervical cancer among Hispanic parents and young women living along the Texas Mexico border. Our findings highlight critical knowledge areas that can be addressed through interventions to overcome barriers to HPV prevention in Hispanic women, as well as to create culturally appropriate prevention messages that may ultimately help reduce disparities in HPV and cervical cancer among Hispanic women along the Texas-Mexico border. Citation Format: Daisy Y. Morales-Campos, Shedra Amy Snipes, Maria E. Fernandez. Human papillomavirus (HPV) and cervical cancer: Exploring knowledge, attitudes, and cultural taboos among Mexican American families along the Texas-Mexico border. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C53.