Family and Community Medicine Occupational and Environment Health Research

Occupational and Environmental Health Research

The occupational and environmental health research program offered through the Department of Family and Community Medicine at Wake Forest School of Medicine leads research projects focused on farmworkers, poultry workers, and work and family issues.

Migrant and Seasonal Farmworker Health Research

The production of vegetables and fruits in the U.S. and other nations is dependent upon the hand labor provided by migrant and seasonal farmworkers. While providing this essential service to society, farmworkers are exposed to numerous occupational and environmental health risks that result in high rates of physical injury and illness.

Farmworkers suffer psychological as well as physical stressors, including discrimination, separation from family, long work hours and fear of unemployment and under-employment that increase their risks for mental illness and substance abuse. While their work is essential and their exposure to harm is high, farmworkers generally receive low wages, and they are seldom provided health benefits by their employers.

We have conducted projects that have documented the prevalence of occupational and environmental exposures of farmworkers and their families, as well as health status among members of this population. We have also developed and implemented programs to reduce the occupational and environmental exposures that farmworkers experience.

Farmworker Projects

Preventing Agricultural Chemical Exposure (PACE) among North Carolina Farmworkers

PACE was a four-year project (1997-2000) to develop, test and disseminate culturally appropriate public health interventions to reduce pesticide exposure among migrant and seasonal farmworkers in North Carolina. Working collaboratively with seasonal and migrant farmworkers communities through the North Carolina Farmworkers’ Project, PACE:

Conducted research among farmworkers, growers and service providers to identify knowledge, attitudes and behaviors associated with exposure to agricultural chemicals.
Used this research to develop or adapt multiple culturally sensitive interventions designed to increase knowledge, change behavior and reduce exposure to agricultural chemicals.
Tested the effectiveness of the interventions using an experimental trial.
Analyzed the effects of the intervention on increasing knowledge and reducing exposure to agricultural chemicals.

PACE focused on workplace pesticide safety in eight North Carolina counties in which sizable numbers of migrant and seasonal farmworkers are employed. These counties were Duplin, Harnett, Johnston, Nash, Sampson, Wake, Wayne and Wilson.

Project Team: Thomas A. Arcury, PhD, Principal Investigator; Sara A. Quandt, PhD, Co-Principal Investigator; Aaron Pell, BA (North Carolina Farmworkers’ Project) Co-Principal Investigator; Pamela Rao, PhD, Project Coordinator.

Funding Agency: National Institute of Environmental Health Sciences (R21 ES08739 and R01 ES08739)

La Familia

A five-year (2001-2005) continuation of PACE. ¡La Familia! extends collaboration between the North Carolina Farmworkers’ Project (NCFP) and researchers at Wake Forest School of Medicine to evaluate a Lay Health Advisor (LHA) model to reduce pesticide exposure among farmworker families. With ¡La Familia!, the PACE focus shifts to exposure of farmworker families, particularly children, and expands work with the North Carolina farmworker community to Latino Christmas tree workers in the western region of the state.

¡La Familia! is:

Documenting farmworker knowledge, beliefs and perceptions of pesticide exposure of all family members, particularly as they relate to exposure of children.
Identifying pathways for environmental exposure of farmworker children to pesticides.
Developing, implementing and evaluating a culturally appropriate LHA intervention to reduce pesticide exposure of children (aged 18-48 months) in farmworker homes.
Compiling and disseminating the final intervention program to other farmworker communities and farmworker service providers.

A model of community participation has been implemented throughout the five project years. Formative research (in-depth interviews; pathway exposure assessment) was completed in Years 1 and 2. Using the formative results in a “PRECEDE-PROCEED” framework, the content and format of the LHA intervention was developed in Year 2. This intervention (and a revision) was evaluated in Years 3 and 4 using a group randomized design.

End-points will include:

Change in knowledge of pesticide exposure routes for children and ways to reduce their exposure.
Change in exposure-related behaviors.
Changes in household dust levels.

In the current and final year, support continued for the LHA program as part of the process of NCFP developing its health outreach mission in western NC, while the results of the project have been disseminated to regional and national farmworker groups, to those providing health care to farmworkers and in the research literature.

Project Team: Thomas A. Arcury, PhD, Principal Investigator; Sara A. Quandt, PhD, Co-Principal Investigator; Carol Brooke, JD, MPH (North Carolina Farmworkers Project); Stephen W. Davis, MA; Jane Hoppin, ScD (National Institute of Environmental Health Sciences); David S. Jackson, Jr., MD; Pamela Rao, PhD; and Beverly M. Snively, PhD. Dana B. Barr, PhD, (Centers for Disease Control and Prevention) is a consultant.

Funding Agency: This five-year project is supported by a grant from the National Institute of Environmental Health Sciences (R01 ES08739).

Occupational Skin Disease (OSD) Among Migrant Farmworkers

A four-year project with three phases.

In-depth interviews with farmworkers, which will be used to gain an understanding of farmworker interpretations of skin disease symptoms, etiology, self-care behaviors and treatment seeking.
A prospective surveillance study in which 250 farmworkers will complete a survey about skin symptoms and occupational exposures to risk factors every two weeks throughout the work season. This phase will:
- Estimate the prevalence of OSD across the work season.
- Determine risk factors for presence and severity of OSD symptoms.
- Evaluate skin-related quality of life.
A clinic-based study that will use interviews and teledermatology to determine the predictors of occupational skin disease severity and specific diagnoses among farmworkers who present at migrant health clinics.

Project staff is working in collaboration with Carolina Family Health Center, Inc. and Greene County Health Care, Inc. in eastern North Carolina to recruit participants for each phase of the project.

Project Team: Thomas A. Arcury, PhD, Principal Investigator; Steven R. Feldman, MD, PhD; Alan B. Fleischer, MD; Sara A. Quandt, PhD; Stephen R. Rapp, PhD; Mark R. Schulz, PhD (University of North Carolina at Greensboro); and Qurinia Vallejos, MPH. John S. Preisser, Jr., PhD, (University of North Carolina at Chapel Hill) is a consultant.

Funding Agency: This four-year project is supported by a grant from the National Institute of Environmental Health Sciences (R01 ES012358).

Community Participatory Approach to Measuring Farmworker Pesticide Exposure: PACE3

A four-year (2006-2010) continuation of the PACE and ¡La Familia! projects. PACE3 builds on the ten years of community-based participatory research conducted by a partnership of the North Carolina Farmworkers Project, Student Action with Farmworkers and Wake Forest School of Medicine.

In the course of our research, the partnership has also developed, analyzed and published effective means to establish and sustain university-community collaboration. Despite efforts by our partnership and others to help farmworkers make their work environments safer and change their behaviors to reduce pesticide exposure, there are remarkably few data to document the actual routine exposure of farmworkers to pesticides in their work and home environments.

To address this problem, PACE3 is addressing four specific aims. PACE3 will:

Use community-based participatory processes to design an acceptable and effective strategy for collecting valid and reliable data on routine farmworker pesticide exposure.
Document pesticide exposure levels and variability in these levels among farmworkers in North Carolina using urinary biomarkers.
Delineate the predictors of pesticide exposure levels among farmworkers in North Carolina, including farmworker workplace and household behaviors, characteristics of the work and household environments, psychosocial stressors and health beliefs.
Develop and implement a communication and dissemination plan for disseminating risk information in culturally and educationally appropriate formats to farmworkers concerning pesticide exposure.

The PACE3 research design is based on a conceptual framework that contrasts proximal and distal determinants of pesticide exposure for farmworkers and tests hypotheses derived from this conceptual model. In the first year of the project, data collection procedures were finalized through collaborative efforts with our community partners. In the second project year, data was collected; this involved four repeated measures at monthly intervals with a sample of 260 farmworkers across the agricultural season. A minimum of three data points is necessary to answer research questions about within-person variation in pesticide exposure. Data collection included several components, a structured interview questionnaire collected information on exposure characteristics, a urine sample was used to measure the presence of pesticide metabolites and heavy metals, a blood sample was used to measure cholinesterase and a salvia sample was used to delineate genes related to pesticide metabolism. Laboratory analysis was completed in project years two and three. In project years three and four, through the collaborative efforts of the community and academic partners, the communication and dissemination plan was implemented, including returning results to participants and communicating results to the community and to policy makers.

Project Team: Thomas A. Arcury, PhD, Principal Investigator; Stephen W. Davis, MA; Mercedes Hernández-Pelletier, MPH (North Carolina Farmworkers Project); Ann Hiott, MD; Sara A. Quandt, PhD, and Melinda Wiggins, MTS (Student Action with Farmworkers). Dana B. Barr, PhD (Centers for Disease Control and Prevention) and Jane Hoppin, ScD (National Institute of Environmental Health Sciences) are consultants.

Funding Agency: This four-year project is supported by a grant from the National Institute of Occupational Safety and Health (R25 OH07611)

Casa a Campo (Pesticide Safe for Farmworker Families)

This is a project that began in October 2001 with a grant from the National Institute of Occupation Safety and Health. “Casa” builds on the community-university partnership among Wake Forest University, the North Carolina Farmworkers Project and Student Action with Farmworkers (SAF) to reduce one environmental health risk, pesticide exposure, among farmworkers and their families in North Carolina. Project activities focused on the counties surrounding the North Carolina Farmworkers Project office in Benson, North Carolina.

Casa is a community education project in which we developed programs to educate members of the farmworker community and health care providers about pesticide health risks and safety. We have documented the knowledge and beliefs about pesticide exposure and about other environmental health concerns of farmworker families. We have also developed culturally appropriate materials and programs to reduce pesticide exposure among these families, and to better prepare health care providers to recognize, treat and prevent pesticide exposure of farmworker family members.

One exciting component of Casa was the participation of two SAF interns during each project year.

Project Team: Thomas A. Arcury, Ph.D., Principal Investigator; Stephen W. Davis, MA; Mercedes Hernández-Pelletier, MPH (North Carolina Farmworkers Project); Ann Hiott, MD; Sara A. Quandt, PhD; and Melinda Wiggins, MTS (Student Action with Farmworkers). Dana B. Barr, PhD (Centers for Disease Control and Prevention) and Jane Hoppin, ScD (National Institute of Environmental Health Sciences) are consultants.

Funding Agency: This four-year project is supported by a grant from the National Institute of Occupational Safety and Health (R25 OH07611)

Poultry Workers

Poultry processing workers in the U.S. experience a disproportionate share of occupational injuries and illnesses 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. Occupational injuries among immigrant workers, including poultry processing workers, are one factor driving the health disparities experienced by minority communities.

Little research documents the onset of occupational injuries among immigrant workers in the poultry processing industry, the progression of these occupational injuries, or the occupational and personal characteristics associated with these occupational injuries. This information is vital for culturally and educationally appropriate industrial hygiene and occupational safety programs to reduce the number and severity of these occupational injuries among poultry processing workers.

We have conducted projects that have documented the prevalence of occupational injuries of poultry processing workers. We have also developed and implemented a program to reduce the occupational health risks experienced by these work.

Projects

JUSTA: Justice and Health for Latino Poultry Workers

The overall goal of JUSTA is to address the health disparities faced by immigrant Latino workers employed by the poultry production and processing industries in rural, western North Carolina, through a partnership of community advocates from Centro Latino of Caldwell County, environmental health scientists at Wake Forest School of Medicine and health care providers at Wake Forest School of Medicine. Workers in the poultry industry in the U.S. experience a disproportionate burden of occupation-attributed musculoskeletal, skin and respiratory disorders. Workers lack safety and health education aimed at their specific work and social challenges.

JUSTA is focused on bringing greater social and environmental justice for these workers. The first focus is on individual workers and their families, helping them to be more resilient to stressors. This focus recognizes that individuals need to work and that they will continue to work in industries that are detrimental to their health and well-being. The second focus is on the community, strengthening community-based organizations so that they can move toward social and regulatory change and justice. Community advocates, health care providers and environmental health researchers will work together in this project to address four specific aims:

To encourage social action by Latino community-based advocacy groups in western North Carolina to reduce the burden of occupational and environmental health disparities due to employment in the poultry industry.
To construct a foundation to design educational materials and communication strategies to prevent or reduce exposure to physical and social occupational stressors and minimize their effects among poultry worker families in North Carolina.
To develop culturally and linguistically appropriate educational materials and implement programs that will prevent or reduce exposure to physical and social occupational stressors and their effects among poultry worker families.
To develop educational materials and implement programs that will better prepare health care providers to recognize and treat with cultural competence illnesses caused by stressors related to poultry production and processing among immigrant families, and counsel families on ways to prevent or reduce exposure.

Project Team: Sara A. Quandt, PhD, Principal Investigator (Department of Public Health Sciences); Michael Coates, MD, Co-Principal Investigator; Bless Burke, MA, (Centro Latino of Caldwell County) Co-Principal Investigator; Thomas A. Arcury, PhD; Joseph Grzywacz, PhD; Tony Marin, MA; and Lourdes Carrillo, BS (Centro Latino of Caldwell County).

Funding Agency: This four-year project is supported by a grant from the National Institute for Occupational Safety and Health (R25 OH008335).

Work and Family

The interconnections between work and family and their health-related consequences are central foci in the Department of Family and Community Medicine’s research program. Work and family are connected in several ways and each contributes to family member health.

Physical interconnections between work and family such as the transfer of harmful pesticides from work to home on workers’ clothes, skin and hair affects the development of workers’ children and contributes to health problems for multiple family members. Psychological interconnections such as preoccupation with work or emotional exhaustion can undermine the health of children and adults alike through poorer attentiveness to children’s needs, stress and unhealthy lifestyle habits.

Finally, several health conditions are exacerbated by the social interconnections between work and family, such as when parents are unable to miss work to care for sick children or when employment in jobs requiring non-standard shifts interfere with sleep cycles and patterns of physical activity and diet. Our research seeks to document and quantify the ways by which the interconnections between work and family affect health, with the goal of creating health education, intervention and policy that protects the health of individuals and families.

Maternal Work Schedules

Consequences for Parenting and Child Development (NICHD – ongoing)

Despite a well-developed literature examining the effects of maternal employment on early child development, research examining how maternal work schedules affect children is scant. This omission is problematic because 15 to 25 percent of mothers of young children have jobs requiring a nonstandard schedule outside the typical 8 am to 5 pm work week, and projections suggest this trend will increase. Moreover, because a disproportionate number of mothers at or near poverty work in these jobs, research in this area has important implications for understanding the effects of poverty on child development.

The goal of this project is to understand how early maternal employment in jobs that operate outside the traditional 8 am to 5pm (Monday through Friday) schedule influence children's early cognitive, language, and socioemotional development. Guided by a bioecological model of human development and using prospective data from the NICHD Study of Early Child Care, we will achieve our goal by accomplishing four specific aims that will:

Identify whether early maternal employment in jobs with nonstandard schedules contributes to poorer developmental outcomes in children.
Determine whether differences exist in maternal behavior (for example, maternal responsiveness and cognitive stimulation) and psychological well-being between mothers in jobs with nonstandard schedules and those with standard schedules.
Identify whether differences in maternal behavior and psychological well-being explain differences in child development by maternal work schedule.
Delineate whether the effect of early maternal employment in jobs with nonstandard schedules on maternal behavior, psychological well-being and child development differ by social context (i.e., race and poverty), level of family support or infant temperament.

Project Team: Joseph G. Grzywacz, PhD, (Principal Investigator); Stephanie Daniel, PhD, (University of North Carolina, Greensboro); Esther Leerkes, PhD (University of North Carolina, Greensboro); Jenna Tucker; and Jill Walls (University of North Carolina, Greensboro).

Funding Agency: This two-year project is supported by a grant from the National Institute of Child Health and Human Development (R03 HD050204)

Weaving Work and Family:

Implications for Mother and Child (National Institute of Child Health and Human Development – ongoing)

Despite widespread agreement that the work-family "balancing act" has significant implications for women's health and the well-being of their families, the work-family literature remains fragmented. First, research has not been undertaken to understand the array of strategies used by women to balance or weave their work and family lives. Equally important, research tends to focus on either the effects of combining work and family on maternal well-being or it focuses on child outcomes.

The goal of this exploratory and developmental project is to develop a better understanding of the consequences of maternal weaving strategies, or tactics used to integrate work and family responsibilities, on both mothers' health and their infants' health and development. This goal will be achieved by accomplishing three specific aims:

Document the behavioral and psychological components of work-family weaving strategies used by working mothers of infants, and determine if specific components of these strategies (for example, allocation of household tasks to partner, modifying standards for relationship) cluster by childcare arrangement.
Delineate the effect of different components of weaving strategies on specific dimensions of women's health (for example, physical symptoms, depression), as well as their effect on infant health (for example, otitis media) and development (for example, communication).
Identify if the strategy components predictive of less maternal illness are also predictive of positive infant outcomes. These aims will be accomplished using a prospective, within-subjects design with 225 mother-infant dyads living in Forsyth County, North Carolina. Data from women and their infants will be collected by trained interviewers when infants are 4, 8, 12, and 16 months of age. Analyses, using linear mixed effects models, will be undertaken to answer three fundamental questions:
- What strategies do working mothers use to weave work and family and how stable are these strategies over time?
- What effect do mothers' weaving strategies have on their well-being and their infants' health and development?
- Are strategies that are associated with better maternal health and well-being also associated with better infant health and development?

Project Team: Joseph G. Grzywacz, PhD, (Principal Investigator); Thomas A. Arcury, PhD; and C. Randall Clinch, DO, MS

Workplace Flexibility & Employee Health

An Exploratory Study (Alfred P. Sloan Foundation – ongoing)

Substantial claims have been leveled suggesting that workplace flexibility contributes to employee health. Unfortunately, the evidence base for these claims is weak. Existing research focused on workplace flexibility and worker health is limited by diffuse conceptualizations and operationalizations of workplace flexibility, narrow and fragmented views of “health” and an almost exclusive reliance on cross-sectional study designs.

The goal of this project is to explore the potential health implications of workplace flexibility. This goal will be achieved using existing longitudinal data from a multinational pharmaceutical company to:

Determine if formalized flexible work arrangements (i.e., compressed workweeks, flextime, telework) and informal flexibility (i.e., perceived flexibility) are associated with health.
Delineate if formalized flexible work arrangements and informal flexibility are associated with differences in lifestyle behaviors.
Identify if formalized flexible work arrangements and informal flexibility contribute to changes in lifestyle behaviors or health.

Project Team: Joseph G. Grzywacz, PhD, (Principal Investigator) and Patrick Casey

Project Collaborators: Adam B. Butler, PhD (University of Northern Iowa); Susan Ettner, PhD and Bo Liu (University of California, Los Angeles); and Fiona Jones, PhD (University of Leeds).

Funding Agency: This one-year project is supported by a grant from the Alfred P. Sloan Foundation (2006-5-22 WPF).

Technology Transfer and Commercialization

Research Focus Areas

Translation to Care

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