Health Symposium Recap: Texas Agricultural Workers Cardiovascular Disease Perceptions, Risk, and Health Seeking Behavior with Kimberly Prado, PhD, MPH
The 2nd Annual Southwest Centers Occupational Health Research Symposium was held on June 10, 2022. The virtual event, a collaboration between the Southwest Center for Occupational and Environmental Health (SWCOEH) and the Southwest Center for Agricultural Health, Injury Prevention and Education (SW Ag Center). This series will highlight presentations made by Pilot Projects Research Training Awardees who were selected and awarded by the SWCOEH.
In Part IV of our series, we discuss “Texas Agricultural Workers Cardiovascular Disease Perceptions, risk, and Health Seeking Behavior” The study was led by with Kimberly Prado, PhD, MPH, The University of Texas at Austin.
“The group of agricultural workers is one of the most vulnerable and research-demanding groups in the field of occupational health,” said Jenil Patel, PhD, the Director of the Pilot Projects Research Training Program at the SWCOEH. “Projects such as Dr. Prado’s, that focus on perception and risk behavior, have a highly indicated need to explore and address the overall barriers from the social ecological model, that may have a direct or indirect impact on the existing challenges in this workgroup. Dr. Prado’s findings on the importance of addressing food insecurity and occupational hazards among agricultural workers set important implications in terms of bringing health awareness and attention to employers as to what external policies and procedures can further improve working conditions in this vulnerable group.”
SWCOEH.org: What are your main takeaways so far from your study on CVD Perception, Risk and Health Seeking Behavior?
Kimberly Prado: The main takeaways included agricultural workers facing barriers to improving their heart health such as food insecurity, climate injustice, and occupational hazards. Solutions need to include family-centered nutrition interventions, sustainable community programs, worksite health checks, and medical-practitioner training to assist them in understanding hazards that agricultural workers face.
SWCOEH.org: Which gaps in CVD research and disparities in health awareness and treatment did you target?
Kimberly Prado: We looked at disparities by gender and how the heart healthy habits of agricultural workers are impacted by the job, community, and environment. We also looked at how parents’ circumstances and the environment they live in impacts the heart-healthy habits of their children.
SWCOEH.org: Which social determinants of occupational health did you discover within this study?
Kimberly Prado: Our focus group guide allowed us to evaluate social determinants of health including economic stability, social and community context, neighborhood and built environment, and health care quality. Participants were suffering severe economic challenges and faced food insecurity because they could not afford kitchen needs such as stoves, water, and gas, or because they did not have the means to pay for nutrient-rich foods that are expensive and perishable. The community setting was very important because it either reinforced healthy habits by providing places for physical activity or posed barriers with easy access to intake of foods high in sugar, salt, and fat. The low income, rural, and isolated neighborhoods made it difficult for families to engage in healthy habits because of dangers including speeding cars, stray dogs, and inebriated groups of adults loitering. Lastly, participants disclosed that they faced discrimination and a lack of respect from medical professionals because of their insurance status or their race. These experiences left participants traumatized and less likely to return to clinics for health checks.
SWCOEH.org: Which underlying mechanisms for CVD did you discover?
Kimberly Prado: Participants shared personal, community, and workplace exposures that contributed to CVD. Personally, men shared that they have little agency over what they ate because it was family that served them. They did not spend time in the kitchen or “on food”, or because they had little money, time, or healthy options in their area. Men also described not actively searching for heart-healthy content and resources. Women shared that they struggled to juggle various roles, including: being an income earner, rearing children, and keeping up the home. Women often reported they would rather take a rest than eat, had little time to feed themselves full meals, and were severely exhausted from the physical labor of the job. All workers shared accounts of both men and women drinking and smoking. Other personal exposures that increased CVD risk included lack of rest, increased stress, and comorbidities such as diabetes and being overweight. Community exposures included isolation from grocery stores with fresh foods and close proximity to fast foods or convenience stores with foods high in sugar, salt, and fat. Community harmony was so important that refusing social food and drinks that were not heart healthy was not preferred because it would come off as an afront to friends and family. The environment contained barriers to healthy habits as well, such as flooding when it rains, structural damages from storms, dangerous heat in the summers, low walkability areas, speeding cars, inebriated adults that loiter, and stray dogs. Workplace or occupational exposures included extreme heat, fatigue from repetitive motions, fumes and air particle inhalation on the job.
SWCOEH.org: What are some practical workplace interventions for CVD that you think could help?
Kimberly Prado: Practical workplace interventions that workers requested were quick and free services on the job so as to not disrupt work and be convenient and accessible. This might be possible if employers or advocates partner with local health departments. Workers also requested these events be scattered throughout the year so that migrant workers could also be offered these services. Workers were also open to community events that included planting fruit and vegetable trees for sustainable options and recipe demonstrations to increase skills and knowledge. Workers were also open to promotora visits in the home as long as they visitors were culturally competent in foods and culture, and a trusted member of the community.
SWCOEH.org: Tell us me more about the “Los 5 Pasos Saludables” curriculum?
Kimberly Prado: The Pasos Saludables curriculum is a heart-healthy intervention designed to increase agricultural workers healthy habits and prevent diabetes and other CVD comorbidities. This was a culturally tailored workplace program. A previous pilot of this work revealed participants increased intake of water, fruits, vegetables, and recorded reduced BMI and waist circumference.
SWCOEH.org: Is there anything else you would like to add?
Kimberly Prado: More work is needed to address the needs of indigenous workers and the creation of materials, research instruments, and activities for indigenous-language speakers. These workers are present in great numbers across Texas and are increasing annually as a source of agricultural labor nationally.
The SWCOEH provides a variety of graduate-level training opportunities for occupational and environmental health professionals through our industrial hygiene, occupational and environmental medicine, occupational epidemiology, and Total Worker Health®.
The Southwest Center for Occupational and Environmental Health is part of the UTHealth Houston School of Public Health