The Association of Visa Status and Health Outcomes in SouthGeorgia's Migrant Farmworker Population Open Access

Wheeler, Kathleen Susan (2013)

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Background: Although Latino immigrants to the US have been frequently noted to have better health than the general US population (the "Latino health paradox"), there is little research on the health of one specific group of US Latinos--migrant farmworkers. Due to their marginalized status and the dangerous nature of farmwork, they may be at risk for poor health outcomes.

Objective: This study examines the prevalence of several health outcomes (specifically anemia, elevated blood pressure, high blood glucose, and overweight/obesity) among a population of migrant farmworkers. These health outcomes are compared across H2A visa status to determine whether there are significant health differences in documented and undocumented workers; they are also examined in the context of the general US population.

Methods: A temporary summer clinic has provided health services to this population since 1993. For this study, data was extracted from the past ten years (2003-2012) of clinic records (n=2599) and health outcome prevalences calculated. These prevalences were compared across H2A visa status using chi-square tests of association. Logistic regression was used to calculate age-adjusted odds ratios for each health outcome, based on visa status. Results from the National Health and Nutrition Examination Survey (NHANES) were used for comparisons with the general US population.

Results: Overall, the prevalence of overweight/obesity was lower among farmworkers than in the general US population (57% vs. 73%), as was the prevalence of hypertension (24% vs. 34%). However, the prevalence of high or elevated blood glucose was much higher (74% vs. 46%). H2A visa-holders had significantly worse body mass index and blood glucose measurements than undocumented farmworkers (p<.0001). The prevalence of anemia was equal in both groups, although quite high at 33%.

Discussion: In light of rising rates of obesity and diabetes in Mexico, it is possible H2A workers are predisposed to these conditions--they return home after each growing season, while undocumented workers cannot. It is also possible that the pay differential between the two groups impacts food choices, and therefore health. There is a need for additional research examining the causal pathways between visa status, food insecurity, and poor cardiovascular health outcomes in this population.

Table of Contents

Chapter One: Introduction    1

Purpose          1

Background    2

The problem  3

Broad Public Health Implications      3

Knowledge Gap          5

Significance of this study       6

Definitions of terms   7

Chapter Two: Review of the Literature         10

Latino Migration and Health 10

The H2A program      13

Farmworker demographics   14

How are migrant and seasonal farmworkers counted?        14

A demographic portrait         16

The dangers of farming         17

Barriers to care          19

Farmworkers and Cardiovascular Risk Factors          20

Knowledge gaps         22

Chapter Three: Methodology and Results    23

Methodology 23

Introduction   23

Population and sample          23

Procedures     24

Ethics 25

Data Analysis 26

Cleaning and recoding           26

Statistical analysis      28

Limitations     29

Results 31

Descriptive Overview 31

Key Findings   32

Other Findings 36

Comparisons to Other Populations   37

Abnormal Body Mass Index   37

Hypertension 38

Abnormal Blood Glucose       38

Anemia           39

Summary        39

Chapter Four: Discussion, Conclusions, and Recommendations      41

Summary of Findings 41

Cardiovascular Health 41

Anemia           43

Strengths and Weaknesses   44

Recommendations    46

Research        46

Public Health Practice 47

Policy 48

References     49

Appendices    53

Appendix A: Tables    53

Appendix B: List of Acronyms 56

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