Research Highlights and Publications

Principal Investigator:  Thomas A. Arcury, PhD
Project Dates: 09/30/1996 - 02/29/2016

Abstract:

Farmworkers are frequently exposed to a wide variety of pesticides, including organophosphate, carbamate, and pyrethroid insecticides, all of which are neurotoxins. The doses of pesticides to which farmworkers are generally exposed, while frequent, are small.  Therefore, the full effect of these neurotoxic pesticides may go undetected for years until manifest as a diagnosis of neurodegenerative disease. Research is needed to delineate the immediate, sub-clinical neurological signs of pesticide exposure among farmworkers.  CPBR allows communities and universities to conduct research collaboratively and to address policy and regulatory changes.  This project is based on established collaborations between Wake Forest University School of Medicine, North Carolina Farmworkers Project, HOLA of Wilkes County, and Toxic Free NC.

This CBPR project will accomplish 5 specific aims: (1) delineate differences in pesticide exposure between Latino farmworkers who are exposed to agricultural pesticides and Latino manual workers who are not exposed to agricultural pesticides; (2) determine associations between pesticide exposure and neurologic function; (3) delineate the effects of pesticide exposure on changes in neurologic function among pesticide exposed Latino farmworkers and non-exposed Latino manual workers; (4) characterize the DNA methylation and gene expression patterns in pesticide exposed Latino farmworkers and non-exposed Latino manual workers, and determine if changes in neurologic function are associated with DNA methylation and gene expression patterns, and (5) address pesticide safety and health policy and regulatory changes through collaboration with members of the farmworker community, farmworker health and immigrant health advocacy groups, and policy makers and regulators.

This project is significant and innovative.  It includes a sufficiently large sample size, a long follow-up time, and appropriate neurological domains to evaluate the weight of evidence for neurological effects from pesticide exposure.  It examines dose-response relationships for a set of biomarkers of pesticide exposure in an attempt to establish quantitative estimates of neurological outcomes.  It combines multiple methods, including neurobehavioral, neurophysiological, and genomics.  It provides a unique opportunity to study several clinically salient and important public health outcomes that are potentially responsive to interventions.  It examines genetic factors involving metabolism of pesticides and genome-wide DNA methylation with etiological importance in the expression of neurological dysfunctions.  This genomics-based approach is likely to identify associations with, and potentially the underlying mechanisms of, pesticide exposure and neurological function.  This project is innovative in its attention to policy.  It will follow a large cohort of adult farmworkers with an appropriate comparison group to document pesticide exposure and outcomes over multiple years.  We have included policy change as an integral component and we will integrate policy development throughout the project.

Funder:  National Institute of Environmental Health Sciences

Key Publications:
Arcury TA, Nguyen HT, Summers P, Talton JW, Holbrook LC, Walker FO, Chen H, Howard TD, Galván L, Quandt SA. Lifetime and current pesticide exposure among Latino farmworkers in comparison to other Latino immigrants. Am J Ind Med. 2014 Apr 15. doi: 10.1002/ajim.22324. [Epub ahead of print] PubMed PMID: 24737498.  
Quick Reference
Center for Worker Health

Thomas A. Arcury, PhD
tarcury@wakehealth.edu

Principal Investigator:  Sara A. Quandt, PhD
Project Dates: 09/30/2008 - 09/29/2014

Abstract:

U.S. poultry processing workers experience a disproportionate share of occupational injuries and illness compared to workers in other industries.  Recent trends in this industry have resulted in a worker population that is poor, minority, and increasingly comprised of immigrants.  Little research documents the onset of occupational injuries among immigrants in the poultry processing industry, the progression of these occupational injuries, or the occupational and personal characteristics associated with these occupational injuries.  The overall goal of this research study is to document the nature and sources of occupational injuries among minority poultry processing workers.  It follows several years of community participatory research by this team with workers in the target communities, in which a sampling frame has been developed. 

The specific aims are: (1) to compare the prevalence of selected musculoskeletal (MSDs) and skin disorders among Latino poultry processing workers and controls (non-poultry, Latino manual laborers), and assess the mediating and moderating effects of occupational (task, shift), structural (income, education, access to healthcare), and socio-cultural (ethnicity, beliefs, values, acculturation) factors on these disorders; (2) to document the development of selected MSDs and skin disorders and assess the mediating and moderating effects of occupational, structural, and socio-cultural factors on this development; (3) to delineate the impact of selected MSDs and skin disorders on workers’ and controls’ health-related quality of life, both cross-sectionally and over time; and (4) to determine the interpretation of occupational illness and injury symptomatology, self-care behaviors, and barriers to prevention, treatment seeking, and reporting among workers. 

These specific aims will be achieved using a linked cohort and ethnographic design, combining qualitative and quantitative research methods.  276 immigrant poultry workers with experience in processing line work </= 3 yr and 276 controls will be recruited.  Data collected will include physical examination, nerve conduction, wrist ultrasound, and interview.   133 disease free new hires and 133 controls will be interviewed again at 6 months, and the complete examination at 12 months.  30 workers who have experienced progressive musculoskeletal injury or dermatological illness will be recruited for in-depth interviews based on an “explanatory models of illness” framework. 

Funder:  National Institute for Occupational Safety and Health

Key Publications:

Quandt SA, Grzywacz JG, Marín A, Carrillo L, Coates ML, Burke B, Arcury TA. Illnesses and injuries reported by Latino poultry workers in western North Carolina. American Journal of Industrial Medicine. 2006; 49:343-351.

Quandt SA, Schulz MR, Feldman SR, Vallejos Q, Marín A, Carrillo L, Arcury TA. Dermatological illnesses and injuries among immigrant poultry-processing workers in North Carolina. Archives of Environmental and Occupational Health. 2005;60:165-169.

Arcury TA, Grzywacz JG, Chen H, Mora DC, Quandt SA. Work Organization and Health Among Immigrant Women: Latina Manual Workers in North Carolina. Am J Public Health. 2014 Jan 16. [Epub ahead of print] PubMed PMID: 24432938.

Arcury TA, Cartwright MS, Chen H, Rosenbaum DA, Walker FO, Mora DC, Quandt SA. Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina. Am J Ind Med. 2014 Apr;57(4):468-75. doi: 10.1002/ajim.22298. Epub 2014 Jan 16. PubMed PMID: 24436169.

Arcury TA, Mora DC, Quandt SA. "…you earn money by suffering pain:" Beliefs About Carpal Tunnel Syndrome Among Latino Poultry Processing Workers. J Immigr Minor Health. 2013 Dec 21. [Epub ahead of print] PubMed PMID: 24363119.

Cartwright MS, Walker FO, Blocker JN, Schulz MR, Arcury TA, Grzywacz JG, Mora D, Chen H, Marín AJ, Quandt SA. Ultrasound for carpal tunnel syndrome screening in manual laborers. Muscle Nerve. 2013 Jul;48(1):127-31. doi: 10.1002/mus.23735.  Epub 2013 May 6. PubMed PMID: 23649357; PubMed Central PMCID: PMC3878605.

Cartwright MS, Walker FO, Newman JC, Schulz MR, Arcury TA, Grzywacz JG, Mora DC, Chen H, Eaton B, Quandt SA. One-year incidence of carpal tunnel syndrome in Latino poultry processing workers and other Latino manual workers. Am J Ind Med.  2014 Mar;57(3):362-9. doi: 10.1002/ajim.22250. Epub 2013 Aug 31. PubMed PMID: 23996875; PubMed Central PMCID: PMC3946621.

Cartwright MS, Walker FO, Newman JC, Arcury TA, Mora DC, Chen H, Quandt SA. Muscle Intrusion as a Potential Cause of Carpal Tunnel Syndrome. Muscle Nerve. 2014 Jan 22. doi: 10.1002/mus.24183. [Epub ahead of print] PubMed PMID: 24449488.

Mora DC, Grzywacz JG, Anderson AM, Chen H, Arcury TA, Marín AJ, Quandt SA. Social Isolation Among Latino Workers in Rural North Carolina: Exposure and Health Implications. J Immigr Minor Health. 2013 Feb 17. [Epub ahead of print] PubMed PMID: 23417706.

Pichardo-Geisinger R, Muñoz-Ali D, Arcury TA, Blocker JN, Grzywacz JG, Mora DC, Chen H, Schulz MR, Feldman SR, Quandt SA. Dermatologist-diagnosed skin diseases among immigrant Latino poultry processors and other manual workers in  North Carolina, USA. Int J Dermatol. 2013 Nov;52(11):1342-8. doi:10.1111/j.1365-4632.2012.05580.x. Epub 2013 Mar 3. PubMed PMID: 23451943.

Quandt SA, Newman JC, Pichardo-Geisinger R, Mora DC, Chen H, Feldman SR, Arcury TA. Self-reported skin symptoms and skin-related quality of life among Latino immigrant poultry processing and other manual workers. Am J Ind Med. 2014  May;57(5):605-14. doi: 10.1002/ajim.22291. Epub 2013 Dec 17. PubMed PMID: 24343776.

Rosenbaum DA, Grzywacz JG, Chen H, Arcury TA, Schulz MR, Blocker JN, Mora DC,Quandt SA. Prevalence of epicondylitis, rotator cuff syndrome, and low back pain in Latino poultry workers and manual laborers. Am J Ind Med. 2013 Feb;56(2):226-34. doi: 10.1002/ajim.22127. Epub 2012 Oct 25. PubMed PMID: 23109055.

Walker FO, Cartwright MS, Blocker JN, Arcury TA, Suk JI, Chen H, Schulz MR, Grzywacz JG, Mora DC, Quandt SA. Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of Latino poultry processors and other manual workers. Muscle Nerve. 2013 Oct;48(4):539-44. doi: 10.1002/mus.23797. Epub 2013 Aug 27. Erratum in: Muscle Nerve. 2014 Feb;49(2):297.

Schulz MR, Grzywacz JG, Chen H, Mora DC, Arcury TA, Marín AJ, Mirabelli MC, Quandt SA. Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers. Am J Ind Med. 2013 Feb;56(2):197-205. doi: 10.1002/ajim.22100. Epub 2012 Jul 27. PubMed PMID: 22847516.

Grzywacz JG, Arcury TA, Trejo G, Quandt SA. Latino Mothers in Farmworker Families' Beliefs About Preschool Children's Physical Activity and Play. J Immigr Minor Health. 2014 Feb 13. [Epub ahead of print] PubMed PMID: 24522435.

Principal Investigator:  Sara A. Quandt, PhD
Project Dates:  09/15/2009 - 08/31/2014

Abstract:  

Overweight and obesity is prevalent among farmworker children, the vast majority of whom are Latino of Mexican descent.  Unfortunately, there has been little systematic research focused on the primary determinants of childhood overweight – physical activity and diet – among farmworker children, consequently there is a limited empirical foundation for building culturally and contextually appropriate intervention strategies for preventing or treating childhood overweight and obesity in this health disparate and medically underserved population.  The physical activity and dietary patterns of Latino farmworker children is fundamentally a work-family issue.  The nature of farmwork and the farmworker lifestyle poses significant barriers to healthy lifestyle habits among children, and it manifests in elevated obesity in a group of children already at risk for poor health and developmental outcomes.  

The goal of this research project is strengthen the empirical foundation upon which to build diet and physical activity intervention programs to address overweight and obesity among young Latino farmworker children.  To achieve this goal, we build on a long-standing academic community partnership focused on farmworker family health to: 1) document the dietary and physical activity patterns of young (3 year-old) children of farmworker families; 2) determine the child, familial, community, and cultural factors that contribute to obesigenic dietary and physical activity behavior; and 3) identify culturally and contextually appropriate strategies for improving dietary and physical activity patterns of Latino farmworker children.

The proposed project’s specific aims will be accomplished using separate project components based in both qualitative and quantitative techniques.   The qualitative project component involves in-depth personal interviews with mothers of farmworker children (n=30) to develop a comprehensive understanding of the beliefs farmworker families have about children’s weight and obesity, and the factors shaping children’s diet and physical activity patterns.  Results of this project component will be useful in identifying the concrete factors that shape children’s eating and physical activity patterns, and they will inform the content of the second project component.  The second project component involves quantitative assessment of farmworker children’s dietary and physical activity patterns.  A representative sample of mother-child dyads (n=250) will be recruited using a site-based sampling strategy and assessed every three months over a two year period.  Data collection includes 24 hour dietary recalls, use of accelerometers for collecting objective assessments of children’s physical activity, and maternal interviews.  The results of this project component will provide robust descriptions of children’s dietary and physical activity behavior.  They will also be useful for intervention development by targeting particularly at-risk children, identifying specific factors that should be addressed in an effective intervention, and discerning ideal time periods for implementing interventions.

Key Publications:

Grzywacz JG, Arcury TA, Trejo G, Quandt SA. Latino Mothers in Farmworker Families' Beliefs About Preschool Children's Physical Activity and Play. J Immigr Minor Health. 2014 Feb 13.[Epub ahead of print] PubMed PMID:24522435

Principal Investigator:  Thomas A. Arcury, PhD
Project Dates:   09/01/2011 - 08/31/2014

Abstract:

Immigrant Latinos experience elevated rates of occupational fatality, injury and illness within the construction industry.  One likely source of poor occupational health outcomes in this vulnerable worker population is the absence of linguistically and culturally appropriate safety education materials.  The overall goal of the proposed research is to determine the feasibility of using a lay health advisor (LHA)-based lesson for promoting safety practices among Latino construction workers.  LHAs provide a compelling route for delivering occupational safety content to Latino construction workers because they have been successfully used to improve occupational safety knowledge among Latino workers in several industries.

The project goal will be achieved by accomplished three specific aims that will: (1) develop and implement a linguistically and culturally-appropriate LHA-based safety education curriculum targeting fall prevention for immigrant Latino construction workers employed in roofing; (2) Document preliminary evidence of effectiveness in using an LHA-based safety education program to improve safety practices among Latino roofers; and (3) identify refinements for the LHA-based safety education program to enable definitive effectiveness testing for promoting safety among Latino roofers and reducing poor occupational health outcomes.

Preliminary evaluation of the developed safety education materials will be based on randomized trial involving 100 workers, 50 who will receive the developed Falls Prevention lesson from a trained LHA and 50 who will receive an alternative lesson targeting wage theft.  Assessments of personal safety practices will be obtained using computer-assisted telephone survey (CATS) technology to support a seven-day, end-of-day daily diary protocol.  The diary protocol will be fielded one week prior to receipt of the LHA-based lessons, again 3 weeks after receiving the safety education program, and a third time 8 weeks after receiving the lesson.

Funder:  National Institute for Occupational Safety and Health

Key Publications:

Arcury TA, Summers P, Carrillo L, Grzywacz JG, Quandt SA, Mills TH 3rd. Occupational safety beliefs among Latino residential roofing workers. Am J Ind Med. 2013 Sep 4. doi: 10.1002/ajim.22248. [Epub ahead of print] PubMed PMID: 24006046.

Lane CM, Jr., Grzywacz JG, Marín AJ, Carrillo Holbrook L, Mills T, Quandt SA, Arcury TA.  2012. Get Smart Working in Roofing! / ¡Ponte Listo Trabajando en Roofing!  Educational flipchart produced by Center for Worker Health, Wake Forest School of Medicine and Occupational Safety and Health Research Center, Virginia Tech.

Quick Reference
Center for Worker Health
Thomas A. Arcury, PhD
tarcury@wakehealth.edu

Principal Investigator:  Ha T. Nguyen, PhD, MPH
Project Dates:  09/09/2011 - 09/08/2014

Abstract:

In adult farmworkers, pesticide exposure is associated with cognitive deficits.  Whether exposure to pesticide causes impairments and declines in specific cognitive domains beyond what would be expected due to normal aging alone is not known.  Normal aging is associated with declines in various complex cognitive abilities, including declines in processing speed, working memory, mental flexibility, and spatial learning, while some aspects of cognition, such as those involving verbal skills, implicit learning, and semantic memory, generally remain largely spared. Poor complex cognitive abilities are associated with greater limitations in activities of daily living, problems accessing health care systems, vulnerability to disease, injury, malnutrition, and subsequently a loss of ability to function independently in the community. That loss of independence impairs the quality of life for both the affected individuals and their caregivers, and constitutes a major financial burden to affected families and society. Previous studies suggest that exposure to pesticide is associated with the risk for cognitive impairment, but no study has examined whether low-level chronic exposure to pesticide exacerbates age-related impairments in cognitive function.  Distinguishing cognitive decrements associated with pesticide exposure from normal aging could prove to be a sensitive measure of the effects of low-level chronic exposure to pesticide.

The goals of this study are (1) to identify the domains of cognitive function that are affected by pesticide exposure; and (2) to determine whether older farmworkers are more vulnerable to the effects of pesticide exposure and have significantly poorer cognitive scores than younger farmworkers.  A secondary aim focuses on exploring the relative contributions of normal aging and pesticide exposure to change in cognitive function at 1-year follow-up.  Our goals are to provide an early understanding of the interaction of aging and pesticide exposure on cognitive function, and to achieve exploratory longitudinal study benchmarks, including quality control, recruitment, retention, measures refinement, and sample size estimates.  The information will provide the foundation for future definitive studies directed towards identifying and characterizing cognitive domains that are affected and temporal decline in cognitive function as related to pesticide exposure.

Funder:  National Institute of Environmental Health Sciences

Principal Investigator:  Thomas A. Arcury, PhD
Project Dates:  03/01/2013 - 02/28/2016

Abstract:

CBPR on Pesticide Exposure & Neurological Outcomes for Latinos: PACE4 (PACE4) is a community-based participatory research (CBPR) project that will provide prospective data to delineate the immediate, sub-clinical neurological effects of pesticide exposure among farmworkers.  This ViCTER Program application builds on the parent PACE4 project, expanding its translational and transdisciplinary nature.  Building on the results of ongoing pesticide exposure research, it is translational in addressing effects of pesticide exposure on neurological (brain) physiology and postural control, and by developing procedures for meaningful communication of research results (DNA methylation and gene expression patterns) to community members.  The original PACE4 team is transdisciplinary, including expertise in anthropology, cognition, family science, genetics, neurology, and statistics.  This ViCTER Program application expands the transdisciplinary composition of the PACE4 team with the addition of expertise in industrial and systems engineering, biomedical engineering, and neuroimaging.

Three new sets of specific aims will be addressed through this competing revision.  The brain imaging specific aims (Paul Laurienti, MD, PhD, WFHS) are to (1) compare hippocampal blood flow and functional connectivity between Latino migrant and seasonal farmworkers who are exposed to agricultural pesticides and Latino manual workers not exposed to agricultural pesticides; and (2) compare basal ganglia blood flow and functional connectivity between Latino migrant and seasonal farmworkers exposed to agricultural pesticides and Latino manual workers not exposed to agricultural pesticides.  The postural control specific aim (Maury Nussbaum, PhD, Virginia Tech) is to compare measures of postural control between Latino migrant and seasonal farmworkers who are exposed to agricultural pesticides and a control group of Latino manual workers who are not exposed to these pesticides.  The communication specific aim (parent grant) is to develop and test procedures to communicate meaningful information about gene epigenetic and expression patterns to (a) pesticide-exposed Latino farmworkers and non-exposed Latino manual worker study participants and (b) the larger Latino farmworker and Latino non-farmworker communities.

The PACE4 ViCTER Program is innovative in examining the health outcomes of pesticide exposure along a spectrum of human function.  At the most fundamental level, PACE4 will examine biochemical and cellular through analysis of DNA methylation and gene expression (parent grant).  At the next level it will investigate biological function through analysis of brain physiology (new collaborator 2).  At the third level it will consider neurological and cognitive functions through analysis of cognitive/neurobehavioral tests, neuropathy scale, and olfactory function (parent grant).  At the next level it will examine more functional or performance aspects of pesticide exposure, such as those related to postural control (new collaborator 1).  Finally, it will address translation and application issues of communicating results (new parent grant aim).

Funder:  National Institute of Environmental Health Sciences

Principal Investigator:  Thomas A. Arcury, PhD
Project Dates:   04/01/2013 - 03/31/2015

Abstract:

This research will (1) delineate factors that affect Latino participants’ use of sobadors, including predisposing characteristics, enabling resources, and need, as reported by Latinos who reside in NC, (2) delineate the health beliefs of sobadors and the strategies they use to diagnose patient health conditions, and identify strategies sobadors use to treat patients’ health conditions as recorded through sobador interviews and video recorded treatments, and (3) delineate how Latinos predisposing characteristics, enabling resources, and need affect integration, or lack thereof, of sobador and conventional care use, as reported by Latinos who reside in NC.

The Behavioral Model for Vulnerable Populations guides the research design and analysis.  Semi-structured in-depth interviews will be conducted with 24 Latino patients living in NC.  Patient participants will be restricted to individuals aged 18 and older who used a sobador during the previous two years.  Six sobadors will also be interviewed.  Sobador treatment sessions with 24 patients will be video recorded; sobadors will subsequently explain the recorded activity.  All interviews will be audio recorded, translated, and transcribed.  A computer-assisted, systematic analysis procedure will be used to delineate and compare the factors that affect Latino participants’ use of sobadors and conventional health care and to delineate the health beliefs and practices of sobadors.  A chiropractor trained in manipulation, mobilization, and massage techniques will carefully examine the videotapes and evaluate the techniques performed.  These results will provide the foundation for an R01 application in which primary data will be collected to examine frequency of use of sobadors and conventional care providers to treat specific symptoms among US Latinos, the effect of sobador-provided treatments on Latinos’ well-being, and strategies that increase Latino access to conventional providers when allopathic care is indicated.

Funder:  National Center for Complementary and Alternative Medicine

Principal Investigator:  Thomas A. Arcury, PhD
Project Dates: 01/01/2014 - 12/31/2014

Abstract:

Agricultural production in the United States (US) often requires the hand labor of agricultural workers.  Much of this agricultural labor is provided by immigrant workers, who are largely Latinos/Hispanics from Mexico and other Central American nations.  Farmworkers are among the most exploited populations in the US, and migrant and seasonal farmworkers often reside in extremely poor housing conditions. Farmworker housing is an environmental health and justice concern as farmworkers have limited access to any housing, and the housing to which they have access is often a component of their work environment that results in exposure to chemical, biological, physical and psychological toxicants.  At the same time, current research on farmworker housing and health is scattered in the literature, with a great deal of the information presented in non-peer-reviewed sources.  The peer-reviewed and non-peer-reviewed materials must be critically assessed and compiled to provide the basis for further research, improve current housing standards, develop effective policy, and provide training to farmworkers so that they can reduce their risks of health problems from poor quality housing.

The goal of this conference is to draw together experts from the variety of disciplines who contribute to research and practice focused on farmworker housing and health in order to delineate current knowledge and propose next steps.  This one day conference will achieve four specific aims, it will:  (1) consolidate current knowledge on characteristics and quality of housing provided for farmworkers, and the associations of farmworker housing characteristics with farmworker health; (2) delineate pertinent directions and areas for farmworker housing health and safety research; (3) delineate pertinent directions and areas for farmworker housing health and safety policy; and (4) facilitate the development of working groups to support the implementation of research, education, and engineering projects that can address the major directions and areas identified during the conference.

To achieve the specific aims, groups of experts will be commissioned to complete three reports on farmworker housing, and the association of farmworker housing and health.  Presentations of these reports will be the key-note addresses for the conference.  The organizers also will solicit volunteer presentations of new completed research and case studies.  The organizers will disseminate the reports produced for this conference.  This conference responds to the themes and goals of the NIEHS 2012-2017 Strategic Plan:  Theme 4 Health Disparities and Global Environmental Health, and Theme 6 Communications and Engagement; and Goals 6, 10, and 11.  The conference is being organized by the Center for Worker Health, Wake Forest School of Medicine (WFSM), California Rural Legal Assistance (CRLA) as part of its ongoing Rural Justice Forums, and Farmworker Justice.  The conference will be held in conjunction with the biennial National Farmworker Law Conference, in Arlington, Virginia, December, 2014.

Funder:  National Institute of Environmental Health Sciences