Latina pregnancy outcome study (SHARE) A prevention agenda

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Health Status of California Farm Workers

• Marc Schenker M.D., M.P.H.

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Outline

• General considerations
• General health status of farmworkers
• Agricultural worker study (CAHWS)
• Occupational health issues
• Acculturation and health
• Latina pregnancy outcome study (SHARE)
• A prevention agenda

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General Consideration

• Agriculture is an entry level job for Hispanic
  immigrants
• Health status of immigrant Hispanics reflects
  poverty of the population
• Preventive care is most deficient (and most
  cost-efficient)
• Acculturation-related behavioral changes
  independently affects health status

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California Agriculture is
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Diverse
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Labor Intensive
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California Agriculture

• 80,000 farms
• 50 have primary farm operator
• 750,000 - 1,000,000 hired farmworkers
• 181 farmworkersfarmers
• 80 of farmwork done by hired farmworkers
• Leading agricultural state in the country
• First in production of 60 commodities
• 30 billion per year
• 50 fruits, nuts, berries
• 40 vegetables, melons

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General Health Status of California Farmworkers
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The California Agricultural Workers Health Study
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? CAWHS sites
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High Blood Pressure, Males
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Body Mass Index, Males
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Body Mass Index, Females
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Anemia, Males
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Anemia, Females
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Dental Outcomes, Male Female
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Most Recent Dental Care Visit, Male Female
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Most Recent Eye Care visit, Male Female
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Occupational Health Statusof California
Farmworkers
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The Hazards of Farming

• The hazards of industry, transportation, mining
  and construction have been recognized.For
  agriculture there has been no such recognition
  and farming, though the oldest occupation in the
  world, remains the most hazardous.

John Powers M.D. JAMA 1131375, 1939
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NIOSH Agricultural Centers
Western Center for Agricultural Health Safety
Est 1990 Director Marc Schenker
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Age-Adjusted Prevalences for Chronic Conditions
NHIS, 1986-90
Brackbill, AJE, 1994
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Immigration, Acculturation and Health Statusof
California Farmworkers
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The Effect of Acculturation on Reproductive Risk
Factors and Birth Outcomes among Hispanic Women
The SHARE Study
Schenker MB, MD MPH1, Walsh J., MD, DTPH2,
Elvine-Kreis B1, MA, Beckett L, PhD
1Department of Epidemiology and Preventive
Medicine, School of Medicine, UC Davis
2Maternal and Child Health, School of Public
Health, UC Berkeley
(Supported by NIEHS, ES09867)
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The Hispanic Paradox

• Latinas have a higher risk profile, yet fewer
  pre-term, low birthweight births (PTLBW ) in
  Mexico
• Birth outcomes worsen the longer immigrants
  reside in the US, despite access to better
  medical care and social services
• US born Latinas are at higher risk than Mexican
  born Latinas for PTLBW

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Possible Risk Factors (Acculturation related)

• Smoking
• Alcohol and drug use
• Dietary changes
• Occupational exposures
• Stress/changes in social support
• Sexual activity
• Vaginal infection

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Study Goal

• To identify acculturation-related risk factors
  for pre-term and low birthweight (PTLBW)
  deliveries among Hispanic women residing in the
  US for varying lengths of time, and to assess
  independent associations with PTLBW.

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Methods

• Study Design
• Prospective Cohort
• Study Population
• 1000 Hispanic women receiving prenatal care
  through an OB/GYN group at San Joaquin General
  Hospital in Stockton, CA
• Study population included recent immigrants,
  acculturated immigrants, U.S. born Latinas

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Study Measures

• Interview (CAPI)
• Background/Demographics
• Acculturation
• Reproductive History
• Smoking, Alcohol Drug Use
• Nutritional Intake
• Occupational Health
• Stress and Social Support
• Sexual Activity

• Biological Specimens
• FEMs (Bacterial Vaginosis)
• Urine Samples (Pesticide Metabolites)
• Blood Samples
• Medical Record Abstraction
• Birth weight
• Gestational Age
• Fetal anomalies and deaths
• Pregnancy Complications

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Behavioral Risk Factors for U.S. vs. Mexico-Born
P lt 0.05 for all comparisons
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Active and Passive Smoking by Years in U.S.
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Alcohol Drinking by Years in U.S.
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Sex Behaviors and STDs between US and
Mexico-born Latinas
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Stress Among US and Mexican-born Latinas
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Occupation in Past Year by Place of Birth
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Longest Occupation by Years in US
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Conclusions, SHARE Study

• U.S.-born Latinas in prenatal care have higher
  rates of adverse health risk factors than
  Mexico-born Latinas
• Adverse risk factor prevalence increases with
  time in the U.S. (acculturation)
• Further research is needed to determine the role
  each of these factors play in birth outcomes and
  whether they explain the Hispanic paradox

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Summary

• Hispanic immigrants to California have higher
  rates of acute and chronic diseases.
• Preventive health care is particularly deficient.
• Many problems derive from poverty.
• Occupational health hazards cause or exacerbate
  adverse health status.
• Acculturation results in worsening of health
  profiles from Mexico

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The End