Farmworkers' paradox: Stanford study shows field laborers not eating what they growIn the middle of John Steinbeck country, the "salad bowl of America," most of the Mexican farmworkers who harvest the fruits and vegetables that feed the nation aren't eating enough of it themselves, according to a new study from the Stanford University School of Medicine.
Underpaid and overworked, Salinas farmworkers are eating at fast-food restaurants where the food is high-fat but low-cost. As a result, despite long hours working in the fields, the Latino farmworkers - particularly those single, young men living in the agricultural labor camps - are facing a very American problem: obesity.
"They often eat someplace that's cheap and fast with high fat content," said Marilyn Winkleby, PhD, associate professor of medicine at the Stanford Prevention Research Center, who has spent years visiting farm laborers in the Salinas Valley in an ongoing partnership with the Monterey County Health Department. "Their jobs are becoming increasingly mechanized and less active."
Winkleby is the senior author of a study published in the February issue of the journal Ethnicity and Health that examines the changes in cancer-related health behaviors within the Salinas Latino population, most of whom are of Mexican origin, over the 10-year period between 1900 and 2000. The study surveyed almost 2,000 Latino women and men from both the community at large and the Latino population within 29 agricultural labor camps.
The goal was to detect changes in diet, physical activity, smoking and alcohol use as well as cancer health screenings in order to help design future public health interventions. Latinos, the country's fastest-growing minority group, suffer disproportionately from poor health exacerbated by poverty, poor education and a lack of health insurance and medical care, according to the study. Furthermore, they suffer disproportionately from some types of cancer and are 20 percent more likely to die from a malignancy than non-Latino whites.
Not all the news was bad. Among the positive behavior changes noted in the survey were continued low rates of smoking among both women and men and a substantial drop in alcohol consumption among men. But most striking among the results were the increasing obesity rates, particularly within the labor camps. All populations, both men and women, had reached 60 percent rates of being overweight or obese by the year 2000. There was an increase in obesity of 90 percent within the labor camps.
The majority of the Mexican-American population in Salinas has now been living in the United States for at least 10 years, long enough to have been exposed to the "high-fat, low-exercise American environment," the study states.
On the positive side, there were some changes in diet that showed marked improvements: a shift away from the use of whole-fat to lower-fat milk among both labor camp men and women from the community; and a decrease in the use of lard or meat fat for cooking among men and women within the community. Fried food remained high on the menu.
Also on the positive side, the surveys showed significant increases in screenings for both breast and cervical cancer with a significant increase in the rates of pap screenings and mammograms. Mammography screenings showed especially large gains, from 15 percent in 1990 to 53 percent in 2000. But researchers were concerned that annual blood stool testing for colon cancer remained infrequent and unchanged at 0-17 percent across the groups, about half the percentage of the non-Latino white population.
Winkleby said public health policy-makers have been working to enhance health behaviors among the Latino population in Salinas by working with community partners to make policy and organizational changes. She pointed to a $5 million grant awarded to the Monterey County Health Department called "Steps to a Healthier U.S.," which she helped author and is evaluating. The five-year program funded from 2003-08 has resulted in extensive partnerships between the health department and the community. The health department has partnered with agricultural employers, fast-food restaurants, churches, schools, senior centers, small stores and even shopping malls proposing changes that will help encourage healthier behaviors, such as asking taquerias and corner stores to offer low-fat milk and to increase their fruit and vegetable supplies.
"For example, the health department negotiated with the main agricultural employers to provide healthy lunches and paid time off for workers to attend a wellness program," Winkleby said. Senior centers have received healthier government foods from food banks that supply much of their menu.
"If you want to effect change it's not enough to educate people," Winkleby said. "Individual behavior is influenced by the environments in which you live. Men living in the labor camps are primarily single, poor; they live in housing without cooking facilities."
Dropping off leaflets about the health effects of a poor diet, isn't enough to affect change - policy and health professionals must work toward enhancing the environments in which people live and work.
Stanford University Medical Center integrates research, medical education and patient care at its three institutions - Stanford University School of Medicine, Stanford Hospital & Clinics and Lucile Packard Children's Hospital at Stanford. For more information, please visit the Web site of the medical center's Office of Communication & Public Affairs at http://mednews.stanford.edu.
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