Back pain in migrant farmworker families and farmworker high school students from Starr County, Texas

Back symptoms are a major global public health problem with the lifetime prevalence ranging between 50-80%. Research suggests that work-related factors contribute to the occurrence of back pain in various industries. Despite the hazardous nature, strenuous tasks, and awkward postures associated with farm work, little is known about back injury and symptoms in farmworker adults and children. Research in the United States is particularly limited. This is a concern given the large proportion of migrant farmworkers in the United States without adequate access to healthcare as well as a substantial number of youth working in agriculture. The present study describes back symptoms and identifies work-related factors associated with back pain in migrant farmworker families and farmworker high school students from Starr County, TX. Two separate datasets were used from two cohort studies "Injury and Illness Surveillance in Migrant Farmworkers (MANOS)" (study A: n=267 families) and "South Texas Adolescent Rural Research Study (STARRS)" (study B: n=345). Descriptive and inferential statistics including multivariable logistic regression were used to identify work-related factors associated with back pain in each study. In migrant farmworker families, the prevalence of chronic back pain during the last migration season ranged from 9.5% among youngest children to 33.3% among mothers. Chronic back pain was significantly associated with increasing age; fairly bad/very bad quality of sleep while migrating; fewer than eight hours of sleep at home in Starr County, TX; depressive symptoms while migrating; self-provided water for washing hands/drinking; weeding at work; and exposure to pesticide drift/direct spray. Among farmworker adolescents, the prevalence of severe back symptoms was 15.7%. Severe back symptoms were significantly associated with being female; history of a prior accident/back injury; feeling tense, stressed, or anxious sometimes/often; lifting/carrying heavy objects not at work; current tobacco use; increasing lifetime number of migrant farmworker years; working with/around knives; and working on corn crops. Overall, results support that associations between work-related exposures and chronic back pain and severe back symptoms remain after controlling for the effect of non-work exposures in farmworker populations. ^

The Skip To Breakfast project: Development, implementation, and feasibility evaluation of an intervention to increase healthful breakfast consumption among fifth grade students and their families

Children and adults frequently skip breakfast and rates are currently increasing. In addition, the food choices made for breakfast are not always healthy ones. Breakfast skipping, in conjunction with unhealthy breakfast choices, leads to impaired cognitive functioning, poor nutrient intake, and overweight. In response to these public health issues, Skip To Breakfast, a behaviorally based school and family program, was created to increase consistent and healthful breakfast consumption among ethnically diverse fifth grade students and their families, using Intervention Mapping™. Four classroom lessons and four parent newsletters were used to deliver the intervention. For this project, a healthy, "3 Star Breakfast" was promoted, and included a serving each of dairy product, whole grain, and fruit, each with an emphasis on being low in fat and sugar. The goal of this project was to evaluate the feasibility and acceptability of the intervention. A pilot-test of the intervention was conducted in one classroom, in a school in Houston, during the Fall 2007 semester. A qualitative evaluation of the intervention was conducted, which included focus groups with students, phone interviews of parents, process evaluation data from the classroom teacher, and direct observation. Sixteen students and six parents participated in the study. Data were recorded and themes were identified. Initial results showed there is a need for such programs. Based on the initial feedback, edits were made to the intervention and program. Results showed high acceptability among the teacher, students, and parents. It became apparent that students were not reliably getting the parent newsletters to their parents to read, so a change to the protocol was made, in which students will receive incentives for having parents read newsletters and return signed forms, to increase parent participation. Other changes included small modifications to the curriculum, such as, clarifying instructions, changing in-class assignments to homework assignments, and including background reading materials for the teacher. The main trial is planned to be carried out in Spring 2008, in two elementary schools, utilizing four, fifth grade classes from each, with one school acting as the control and one as the intervention school. Results from this study can be used as an adjunct to the Coordinated Approach To Child Health (CATCH) program. ^

The socioeconomic status of families of hyperglycemic versus non-hyperglycemic children: A descriptive analysis

The proportion of children and adolescents living with type 2 diabetes mellitus (DM) is rising at an alarming rate. Studies have shown that poor dietary choices and sedentary behaviors account for progression of some of the most prevalent diseases in America, including obesity, heart disease and diabetes. Other studies have shown that genetics plays a role in the diabetic determination of an individual, although not very common. What are some of the differentiating factors between elevated and non-elevated fasting capillary glucose (FCG) levels in children of similar ages, knowing they spend a majority of their lives at home or at school? Why are some children acquiring diabetes while others are not? This study utilized an IRB-approved Family Demographic Survey to determine gender, family income, parent education levels, sedentary practices, and household size. Only those families who gave consent to take part in the study received a questionnaire. The statistical results were used to test the hypothesis that children living with elevated FCG levels are more likely to descend from families with lower incomes, and lower levels of education.^ With regard to household income and FCG status of non-hyperglycemic and hyperglycemic children (Table 4b), there are 10.4% more hyperglycemic children in the lower income bracket than non-hyperglycemic children in the same income bracket.^ With regard to maternal education and FCG status (Table 5b), there are 7.0% more hyperglycemic children in the high school or less maternal educational attainment level than non-hyperglycemic children in the same maternal educational level. The Pearson correlation of maternal education and FCG status showed a negative correlation value of -.035 (Table 5d). The higher the occurrence of hyperglycemia in a child, the lower the maternal educational status is. Household size ranges and averages are nearly identical in families of both hyperglycemic and non-hyperglycemic children. ^

Lessons for emerging state Children's Health Insurance Premium Assistance programs: Case study of the Massachusetts Masshealth Family Assistance Program (MHFAP)

Providing health insurance coverage for vulnerable populations such as low-income high-risk children with limited access to health care is a challenge for many states. Over the past decade, higher private insurance premiums and unpredictable labor markets have increased the number of uninsured and underinsured children nationwide. Due to recent economic downfalls, many states such as Texas, have expressed interest in using premium assistance programs to increase enrollment of low income children and families in private coverage through employer sponsored health insurance. Massachusetts has been especially successful in reducing the number of uninsured children through the implementation of MassHealth Family Assistance Program (MHFAP), an employer based premium assistance program. The purpose of this study is to identify key implementation factors of a fully established premium assistance program which may provide lessons and facilitate implementation of emerging premium assistance programs. ^ The case study of the fully established MassHealth Family Assistance Program (MHFAP) has illustrated the ability of states to expand their Medicaid and SCHIP programs in order to provide affordable health coverage to uninsured and underinsured low income children and their families. As demonstrated by MHFAP, the success of a premium assistance program depends on four key factors: (1) determination of participant and employer eligibility; (2) determination of employer benefits meeting benchmark equivalency (Medicaid or State Children's Health Insurance Program); (3) the use of appropriate marketing and outreach strategies; and (4) establishment of adequate monitoring and reporting techniques. Successful implementation strategies, revealed by the case study of the Massachusetts MassHealth Family Assistance Program, may be used by emerging premium assistance programs, such as Texas Children's Health Insurance Premium Assistance Program (CHIP-PA) toward establishment of an effective, efficient, and equitable employer sponsored health program.^

Rules to limit snacking in front of the TV and childhood BMI status: Findings from the "Fun Families Study"

Childhood obesity is increasing at epidemic rates, and thus there is a need to target appropriate childhood behaviors that contribute to obesity. Many factors contribute to childhood weight status. The aim of this study was to look at relationships between parental rules to limit snacking while watching television and childhood weight status. The study looked at the presence of the behavior of snacking while watching television yesterday, congruence between child- and parent-reported perception of the presence of rules to limit snacking while watching television, and parent-reported frequency of children following rules to limit snacking while watching television. The outcomes were examined in a multi-ethnic population of children ages 6 to 9 years in Southeast Texas.^ This study was a cross-sectional secondary data analysis of the pilot program, Fun Families. This study examined baseline data from 202 parent-child dyads, which included both the control ( N= 101) and intervention groups (N= 101). Data were gathered using validated questions that were administered to 6-9 year old children and their primary caregiver (referred to as parent in the rest of the discussion) in Southeast Texas, between 2006 and 2008. The main study outcome was childhood weight status based on CDC BMI-for-age categories. The independent variables are (1) the presence of parental rules to limit snacking while watching television, (2) the congruence between child and parent about the presence of rules to limit snacking while watching television, and (3) the parent-reported frequency of the child following the rules to limit snacking while watching television. Chi-Square analyses were used to determine if weight status was different for (1) children who reported rules to limit snacking yesterday, (2) children who reported snacking, (3) children whose parents reported rules were present, and (4) those who had rule congruence with the parents not. Chi-Square analyses also examined if there was a difference in the presence of snacking behavior for children who reported rules, for children whose parents reported rules, and for those children who had congruence about rules. Linear regressions were used to determine if any of the studied variables predicted increased weight status or reported snacking while watching television yesterday.^ This study found that child-reported snacking yesterday was significantly different for children who reported rules (4.12, p= 0.04). Child-reported rules was significantly associated with (p= -0.14, α= 0.04) and predicted child-reported snacking yesterday (R 2 0.021, p= 0.04, t= -2.04, 95% CI -0.31, -0.01). There was statistical significant incongruence between child and parent perception about the presence of rules to limit snacking yesterday (15.06, p= 0.00). For this population, parent education level was significantly associated with child-reported rules (r= -0.16, p= 0.02), child-reported snacking yesterday (r= -0.15, p= 0.04), and parent-reported frequency of child following rules to limit snacking (r= 0.29, p= -0.01). Parent-reported speaking another language besides English at home was significantly associated with parent-reported rules (r= 0.17, p= 0.02).^ Although the studied variables did not show any significant associations or predictors for childhood weight status, the significant discord between parent and child perception about the presence of rules provides valuable information to future interventions that aim to reduce childhood weight status. Including the creation and enforcement of parental rules in interventions to reduce childhood weight status will be beneficial for future studies.^

Psychosocial factors and musculoskeletal symptoms in a vulnerable working population in Nicaragua

This research is a secondary data analysis of the CUPID-INCA Nicaragua study, a cross-sectional study comparing psychosocial and physical factors on musculoskeletal symptoms among nurses, office workers and maquiladoras in Nicaragua. There were three objectives for this thesis. (1) To describe the study population according to their socio-demographic, psychosocial (i.e. work organization and health beliefs) and physical factors. (2) To estimate the prevalence of musculoskeletal disorders (MSDs) in the study population (nurses, office workers and maquilas). (3) To analyze and compare the trends of association between psychosocial factors and MSDs to that of physical factors and MSDs in the study population. Trends of association between MSDs and psychosocial factors were also compared between nurses, office workers and maquilas. ^ Majority of the total study population were females, middle aged, non smokers and had been on the job for more than five years. Prevalence rates of low back pain and upper extremity pain were 28% and 37% respectively in nurses, 17% and 34% in office workers and 18% and 31% in maquilas. Workers' health belief was significantly associated with MSDs in all three occupational groups. Psychosocial factors were not consistently associated more with MSDs than physical factors. Maquilas had more psychosocial factors statistically significantly associated with musculoskeletal symptoms than nurses and office workers. ^ The findings of this research suggest that both psychosocial and physical risk factors play a role on the prevalence of musculoskeletal symptoms in the three working populations in Nicaragua. Future research in this area should explore further, the risk of developing MSDs from workers' exposure to psychosocial factors as well as physical factors.^

Child Welfare Waivers: The Stakes for Families

Congress has restored the authority of the U.S. Department of Health and Human Services to issue “waivers” from rules restricting the use of some funds under Title IV-E of the Social Security Act. The waivers allow funds now restricted to foster care to be used for prevention, family preservation and other services as well. This paper discusses the benefits of waivers and estimates the amount of money that a waiver would cover in each state.

A descriptive study of the sociodemographic, health and developmental factors associated with slow learning in children from upper to middle social class families in Texas

"Slow Learners" is a term used to describe children with an IQ range of 70-89 on a standardized individual intelligence test (i.e. with a standard deviation of either 15 or 16). They have above retarded, but below average intelligence and potential to learn. If the factors associated with the etiology of slow learning in children can be identified, it may be possible to hypothesize causal relationships which can be tested by intervention studies specifically designed to prevent slow learning. If effective, these may ultimately reduce the incidence of school dropouts and their cost to society. To date, there is little information about variables which may be etiologically significant. In an attempt to identify such etiologic factors this study examines the sociodemographic characteristics, prenatal history (hypertension, smoking, infections, medication, vaginal bleeding, etc.), natal history (length of delivery, Apgar score, birth trauma, resuscitation, etc.), neonatal history (infections, seizures, head trauma, etc.), developmental history (health problems, developmental milestones and growth during infancy and early childhood), and family history (educational level of the parents, occupation, history of similar condition in the family, etc.) of a series of children defined as slow learners. The study is limited to children from middle to high socioeconomic families in order to exclude the possible confounding variable of low socioeconomic status, and because a descriptive study of this group has not been previously reported. ^

AN INVESTIGATION OF THE IMPACT OF CHILDREN WITH BIRTH DEFECTS ON STRESS IN THEIR FAMILIES

A child with a birth defect places physical, financial and emotional stress upon the family. The purpose of this study was to assess the impact of a mildly handicapped child on the family's coping abilities.^ Two groups, 101 mothers of children with birth defects and 107 mothers of intact children, completed the Holroyd Questionnaire on Resources and Stress and the Luborsky Social Assets Scale. From these groups, 86 pairs were matched on four factors: the age (two to eight years) and sex of the study child and the mother's education and marital status.^ The children with birth defects had completed the diagnostic evaluation at the Meyer Center for Developmental Pediatrics, Texas Children's Hospital. Children with severe defects were excluded. The mean I.Q of the group was 88, s.d. 17; 17 children were mildly retarded and 35 had an I.Q. of 100 or above; areas of dysfunction included motor abnormalities, behavior disturbance, speech problems, and sensory impairments.^ The expected direction and statistically significant differences were obtained from the data for the matched pairs on the Q.R.S. scales. The mothers of children with a birth defect reported poor health, a negative attitude toward the child, being over-protective, financial problems and feeling a lack of social support and family integration. They perceived the child as socially obtrusive, limited as to occupational opportunities, and as having a difficult personality.^ The functioning levels of the handicapped children contributed to the respondent's problems. The child with behavior and speech problems but adequate intelligence was a situation which resulted in a poor health/mood of the mother. The mother's pessimism was related to the child's low intelligence.^ The social assets of the respondents with intact children were significantly higher than those of respondents of handicapped children. There was no relationship between the total social assets score and the scores on the Q.R.S. for mothers of handicapped children. These mothers did report poorer physical conditions, more smoking, and quarreling of their parents as they grew up. ^

Intellectual disability: A quandary for immigration

Current immigration options for individuals with intellectual disabilities do not adequately address their special needs and under existing immigration laws, intellectually disabled adult dependents of United States citizens suffer an excessive burden. This problem causes undue hardship of persons whose families lawfully reside in the United States or have the opportunity to immigrate to the United States. The aim of this review is to examine materials relevant to the issue and answer the question: What are the barriers and pathways for adults with intellectual disability within the family-based preference system under United States immigration law? ^ Adults with intellectual disability are a vulnerable population that often relies upon family members to be their principle caregiver and provide financial support. Under the family-based preference system, the United States has maintained that the reunion of family members with their close relatives promotes the health and welfare of the United States, but a review of the number of findings of inadmissibility due to a mental/physical disorder with associated harmful behavior and the number of waivers granted show otherwise. The lack of reviewability of the decisions made by the Board of Immigration Appeals in addition to the lack of transparency surrounding the immigration process only serve to compound this problem. ^

Commentary on "Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families"

Invited commentary on "Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families".

Child Welfare Workers’ Perceptions of the Influence of the Organizational Environment on Permanency Decisions for Families

The findings of this study suggest that while child welfare workers are consistently distracted by competing priorities from unexpected events, most are committed, and to understand perspectives is more inclusive and may improve retention rates. Notably, while it is recognized that permanency decisions are not made in an intellectual, legal or clinical vacuum and certain traditional aspects of the bureaucratic structure do not impact decision making, this study advances the body of knowledge on child welfare decision making. Examined in this study are child welfare case workers’ perceptions of the extent to which the organizational environment influences the permanency decisions they make to reunify or terminate parental rights of children placed out-of-home. This study includes a sample of 95 child welfare social workers employed in three public child welfare agencies in the Baltimore and Washington, DC metropolitan area. It used a cross-sectional research design, employing a survey instrument to examine bureaucratic distraction, role conflict, and supervisory adequacy as contextual factors in the organizational environment's influence on permanency outcome decisions. Implications are made for child welfare policy, practice, and research.

Risk and resiliency: The untold story of youth in military families

Background: Risky sexual behaviors have been shown to increase the risk of unintended pregnancy and sexually transmitted infections (STIs) among youth. Youth in military families may be especially at risk for engaging in risky sexual behaviors because they are exposed to factors that are unique to the military culture, such as multiple relocations and parental deployment. However, data on sexual behaviors among military-dependent youth are limited and few studies have examined how these factors influence the sexual behaviors among youth. Purpose: The purpose of this dissertation was to estimate the prevalence of risky sexual behaviors among military-dependent youth and to describe how military factors may influence their sexual behaviors. Methods: Youth, aged 15–19 years, who attended a military health facility in the southern United States between June 2011 and September 2011 were recruited to complete a short, paper-based survey (N= 208, males and females) and to participate in an in-depth interview (N = 25, females). For quantitative data, prevalence estimates were computed and chi-square analyses were conducted. Logistic regression analyses were also conducted, adjusting for age, gender, and parents' duty status. For qualitative data, thematic coding of transcribed interviews was performed. Common and unique themes were examined across participants' experiences. Results: Over half of the youth was sexually experienced (53.7%). Parental deployment and number of relocations were significantly associated with having had sex in the past 3 months; however no significant associations were found between these military factors and other sexual behaviors. Although some youth felt that being a military-dependent had negatively impacted their sexual decisions, most believed the military experience had little influence on their sexual decisions. Most youth in military families also perceived having higher parental expectations to avoid risky behaviors, in general, than youth in civilian families. Conclusions: The majority of military-dependent youth are sexually experienced; however, individual and parental factors may have a greater role in sexual initiation among youth than military stressors do. The findings highlight the need for implementation of evidence-based strategies to prevent teen pregnancy and STIs at military installations. Future studies with larger sample sizes are needed to further explore how youth may cope with these military factors and the impact of parental factors on the sexual behaviors of youth.^

Assessment of executive function before and after vitamin D replacement in vulnerable adults who self-neglect

Purpose: Self-neglect (SN) is the inability to maintain self-care needs. It is thought that older adults who have impaired executive function (EF) develop the inability to do self-care and to protect themselves. The specific aims were to (1) determine the feasibility of using multiple EF measures with community-dwelling elders with SN, (2) identify changes in EF between baseline and 5-months in community-dwelling elders with SN who receive 50,000 IU or 400 IU of oral vitamin D monthly and (2) explore changes in specific dimensions of EF between the groups. ^ Methods: Fifty adults, 65 years of age and older, were recruited from Adult Protective Services with confirmed SN. A research nurse administered the following tests at baseline and five-months: Delis-Kaplan Card Sort Test (D-KEFS), Executive Interview (EXIT 25), CLOX Drawing Test (CLOX I, II), Trails Making Test A and B (TMT A & B) and the Mini-Mental State Examination (MMSE). Demographic data was collected at baseline and serum 25-OHD levels were collected at baseline and five-months. ^ Results: Older adults with SN were more likely to fail the CLOX1 and D-KEFS, while passing the MMSE, CLOX II, TMT A & B and the EXIT 25. At five-months, the only statistically significant difference between groups was in the TMT A & B test scores; the control group did better than the treatment group. There was a non-significant increase in serum vitamin D levels for both groups and no difference between groups. ^ Conclusions: Results from this study provide support that individuals who SN will complete a battery of EF tests and that they exhibit the following impairments consistent with executive dysfunction: 'concept generation', 'planning', 'inhibition', and 'spatial working memory'. Utilizing only one EF measure in individuals with intact cognition may result in unidentification of individuals with executive dysfunction, thus delaying necessary treatment. Future studies should attempt to determine different etiologies of executive dysfunction and determine if early treatment can prevent or reverse SN. ^ Key Words: Self-neglect, Executive Dysfunction, Executive Function, Adult Protective Services, Community-dwelling, Vitamin D ^

Learning What Works: Demonstrating Practice Effectiveness with Children and Families Through Retrospective Investigation

Intensive family preservation services (IFPS), designed to stabilize at-risk families and avert out-of-home care, have been the focus of many randomized, experimental studies. Employing a retrospective “clinical data-mining” (CDM) methodology (Epstein, 2001), this study makes use of available information extracted from client records in one IFPS agency over the course of two years. The primary goal of this descriptive and associational study was to gain a clearer understanding of IFPS service delivery and effectiveness. Interventions provided to families are delineated and assessed for their impact on improved family functioning, their impact on the reduction of family violence, as well as placement prevention. Findings confirm the use of a wide range of services consistent with IFPS program theory. Because the study employs a quasi-experimental, retrospective use of available information, clinical outcomes described cannot be causally attributed to interventions employed as with randomized controlled trials. With regard to service outcomes, findings suggest that family education, empowerment services and advocacy are most influential in placement prevention and in ameliorating unmanageable behaviors in children as well as the incidence of family violence.