|
Article Excerpt
The document Healthy People 2010 establishes the national agenda for health promotion and disease prevention in the United States, and its two overarching goals are to reduce health disparities and improve quality of life for all Americans. (U.S. Department of Health and Human Services, 2002). There are currently an estimated 3 to 5 million migrant farm workers in the U.S.; 90% are Latino, and 61% of that population live with their spouses and children while working in the U.S. (Carroll, Samardick, Bernard, Gabbard, & Hernandez, 2005; U.S. Department of Labor, 2005). Identified as a vulnerable population, migrant workers have a reported compromised health status due to language, insurance status, environmental access to care, and cultural expectations of patient-provider interactions. The latest report from the Pew Hispanic Center (Livingston, Minushkin, & Cohn, 2008) states that more than 25% of Hispanic adults lack a usual health care provider, and migrant farm worker families have increased frequency of diabetes, hypertension, mental health problems, dental disease, substance abuse, anemia, tuberculosis, and parasitic infections. Their children are at risk for pesticide exposure, injury from farm operations, exposure to viral and bacterial infections, dental caries, gastritis, poor nutrition, delayed development, and anemia (DuPlessis, Cora-Bramble, & American Academy of Pediatrics Committee on Community Health Services, 2005).
The life of outdoor amusement (carnival) employees is similar to the itinerant lifestyle of migrant farm workers. However, no information on carnival children is available to make an accurate number count, and their health indicators are not in any published research. Following a migratory pattern, these seasonal workers also travel for employment, taking them away from their permanent residence and medical home, and it can be speculated that they share similar health care concerns.
Children of carnival and migrant farm workers are a population at high risk for health problems due to their mobility and limited access to care while traveling, fragmented education, financial constraints, literacy issues, and lack of knowledge of available services (Early et al., 2006; Flaskerud et al., 2002; Hahn & Cella, 2003; Weathers, Minkovitz, O'Campo, & Diener-West, 2004; Wilson, Wold, Spencer, & Pittman, 2000). Although research has examined chronic and acute illnesses of children and their effects on health-related quality of life (HRQOL), no literature has examined this construct in children of itinerant families. Quality of life in children is a construct with application across medical conditions into the realm of everyday life and can assist in the allocation and distribution of public resources (Wallander, Schmitt, & Koot, 2001). For vulnerable children of itinerant families marginalized by their socioeconomic, cultural, and demographic status, the assessment of HRQOL can awaken society and health care providers to their unique needs.
The purpose of this descriptive study was to determine whether disparities in HRQOL exist between these two groups of itinerant children, and between the itinerant children and children with more stable residences, aged 2 to 12 years. The hypotheses were an expected lower HRQOL in itinerant children compared to children from more stable residences, and carnival worker children to have even lower HRQOL than children of migrant farm workers.
Method
Design and Sample
A descriptive cross-sectional design examined HRQOL in these children. The evaluation of HRQOL was part of a larger study conducted in 2004 and 2005 of the health status of children of carnival and migrant farm workers (Kilanowski & Ryan-Wenger, 2007). The study sample used cluster sampling at migrant farms and outdoor amusement companies whose owners agreed for the researcher to enter their premises and speak with their workers. Inclusion criteria were 1) children ages 2 to 12 years, 2) parent or legal guardian able to sign a consent form and complete questionnaires in either Spanish or English, and 3) child present and oral assent received. A preliminary pilot study (n = 41) was conducted to test the feasibility of the research design, data collection protocols, recruitment processes, and instrumentation with these groups (Kilanowski, 2006).
The Ohio State University Internal Review Board for the Protection of Human Subjects approved the study. Recruited were 150 participants at 3 Ohio vegetable farms and 7 outdoor amusement companies. Sixty-five carnival children and 85 migrant farm...
|
