Prevalence and Risk Indicators of Visual Impairment and Eye Exams among Latino Migrant Farmworkers Public

Abstract

Purpose: Little is known about vision loss and eye health in migrant farmworkers in the United States. The purpose of this study was to assess the prevalence and independent risk indicators of visual impairment and access to eye care among migrant farmworkers.

Methods: A cross-sectional study was performed using nationally-validated survey questions. Participants (n=162) were migrant farmworkers 18+ years working in agricultural camps throughout Lowndes County, Georgia, recruited from a primary care clinic. Primary measures included prevalence of self-reported moderate-to-severe visual impairment and history of eye exam within the last year. Predictors of visual impairment and eye exam within the last year were identified through bivariate analysis and stepwise multivariate logistic regression (all p-values <0.05).

Results: Prevalence of moderate-to-severe visual impairment was 12.3% overall, with 6.7% reported by those <40 years and 32.4% reported by those ≥40 years. Of those ≥ 65 years, with moderate-to-severe visual impairment, or diabetes, 33.3%, 15.8% and 33.3% had an eye exam in the last year. Predictors (odds ratio [95% confidence interval]) of moderate-to-severe visual impairment were eye pain (12.6 [2.6-68.5]); age 40-64 years (12.1 [2.7-54.7]) or ≥65 years (41.6 [1.9-914.5]); and current smoking status (7.6 [1.6-36.8]). Predictors of eye exam within the last year include ≥ high school education (4.7 [1.6-13.2]) and moderate-to-severe far vision impairment (0.2 [0.04-0.9]).

Conclusions: Migrant farmworkers have high rates of visual impairment, but have limited access to care. Concerted efforts are needed to improve prevention education, increase detection, and facilitate treatment of eye disease and injuries in migrant farmworkers.

Table of Contents

Chapter 1: Introduction..............................................................................9

Problem and Significance...........................................................................11

Purpose statement.....................................................................................12

Definition of Terms....................................................................................12

Hired Farmworker......................................................................................12

Seasonal Farmworker.................................................................................12

Migrant Farmworker..................................................................................13

Eye Health................................................................................................13

Visual Impairment....................................................................................13

Access to Eye Care.....................................................................................14

Unauthorized Migrant Farmworker.............................................................14

Chapter 2: Literature Review......................................................................15

Overview of the US Agriculture Industry and Hired Farmworkers..................15

Figure 1: Distribution of Hired Farmworkers to Family Farmworkers in the US (1950-2006) ¹.....16

History of Immigrant Farmworkers.............................................................17

Geography and Migration Patterns of Migrant Farmworkers in the United States.........18

Figure 2: Crop Worker Estimated Geographic Distribution¹⁷.........................19

Sociodemographic Characteristics of Migrant Farmworkers..........................20

Legal Authorization Status.........................................................................21

Employment and Economic Status..............................................................22

Migrant Farmworkers in Georgia................................................................24

Health of Migrant Farmworkers..................................................................25

Health of Migrant Farmworkers in Georgia..................................................27

Healthcare Access among Migrant Farmworkers..........................................28

Eye Health and Safety Among Migrant Farmworkers....................................29

Access to Eye Care Among Migrant Farmworkers.........................................31

Gaps in Research.......................................................................................31

Chapter 3: Manuscript...............................................................................33

Introduction.............................................................................................33

Materials and Methods..............................................................................35

Study Population.......................................................................................35

Data Collection.........................................................................................36

Demographic Indicators.............................................................................36

Ocular Health Risk Indicators.....................................................................37

Access to Eye Care Indicators......................................................................37

Primary Outcomes.....................................................................................38

Statistical Analysis....................................................................................38

Results.....................................................................................................39

Study cohort.............................................................................................39

Ocular health and safety............................................................................39

Prevalence of Visual Difficulty Stratified by Age-Group................................40

Stratification of Risk Factors by Level of Visual Impairment.........................40

Access to Eye Care.....................................................................................41

Stratification of Risk Factors by History of Eye Exam within the Last Year......41

Discussion................................................................................................42

Visual Impairment among Migrant Farmworkers.........................................42

Access to Eye Care among Migrant Farmworkers.........................................44

Eye Safety.................................................................................................46

Limitations of our Study............................................................................47

Implications and Future Directions for Research.........................................48

Tables and Figures....................................................................................49

Table 1. Distribution of Demographic, Ocular Health, and Access to Care Risk Factors by Visual Impairment in Migrant Farmworkers49

Table 2. Prevalence of Visual Impairment by Age Group..............................50

Table 3. Independent Predictors of Moderate-to-Severe Visual Impairment among Migrant Farmworkers Based on Stepwise Logistic Regression Analysis (n=131)*.....................................................................50

Table 4. Prevalence of Last Eye Exam History by Age Group, Visual Impairment, and Diabetes Status.......50

Table 5. Distribution of Demographic, Ocular Health, and Access to Care Risk Factors Stratified by Eye Exam within the Last Year in Migrant Farmworkers...........................................................................................51

Table 6. Independent Predictors of Eye Exam in the Last Year among Migrant Farmworkers Based on Stepwise Logistic Regression Analysis (n=131)*.................................................................................................52

References.............................................................................................52

Chapter 4: Conclusions and Recommendations.........................................56

The Impact of Visual Impairment among Migrant Farmworkers and Recommendations........56

The Impact of Access to Care among Migrant Farmworkers.......................58

Final Words...........................................................................................60

Appendices............................................................................................61

Appendix 1:...........................................................................................61

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Ophthalmology Health Sciences, Epidemiology
Mot-clé	Occupational Health Access to Care Eye Health Agricultural Health Eye Safety Latino Migrant Farmworker Ophthalmology Hispanic
Committee Chair / Thesis Advisor	Haddad, Danny, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs Community-based non-profit organization (e.g., AID Atlanta) CDC

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