The Association of Visa Status and Health Outcomes in SouthGeorgia's Migrant Farmworker Population Open Access
Wheeler, Kathleen Susan (2013)
Abstract
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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