This document summarizes a study that utilized the Behavioral Risk Factor Surveillance System (BRFSS) to identify health disparities among manufacturing workers in South Texas compared to state and county populations. The study found disparities among the manufacturing workers in health care coverage, utilization of preventive health services, rates of chronic diseases, health behaviors, obesity rates, and self-reported health status. The results indicate a need for interventions to promote healthy behaviors for these workers and suggest that low health care coverage contributes to lower use of screening and prevention services.

1. Utilization of the BRFSS to Explore
Local Health Disparities
Doménica Niño, BA, UTPA
Suad Ghaddar, PhD, UTPA
Xiaohui Wang, PhD, UTPA
Liza Talavera-Garza, PhD, UTPA
Melissa Valerio, PhD, University of Michigan
Pooja Chopra, MA, UTPA
The University of Texas-Pan American (UTPA)
South Texas Border Health Disparities Center

2. 28th Annual BRFSS Conference Atlanta, GA 2011
 Our mission is to promote research
related to health disparities along
the Texas-Mexico border.
 Health disparities are “differences in
the incidence, prevalence,
mortality, and burden of diseases
and other adverse health conditions
that exist among specific population
groups in the United States.”
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SOUTH TEXAS BORDER HEALTH DISPARITIES CENTER

3. 28th Annual BRFSS Conference Atlanta, GA 2011
OUTLINE
 Objective
 Background
 Methods
 Results
 Conclusion
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 To identify areas of health disparities among
manufacturing workers in South Texas compared to state
and county populations using questions from the BRFSS.
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OBJECTIVE

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BACKGROUND
CAMERON
STARR
HIDALGO
Willacy

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 Mainly Hispanic population
 Lower educational attainment
 Higher poverty rates
 Higher rates of uninsured
 Inadequate number of health providers
 High rates of diabetes and obesity
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BACKGROUND

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 The data is part of a larger study on
 Health Literacy in the Manufacturing Workplace (HLW)
 Sample: 228 employees from 8 manufacturing companies in
Hidalgo County
 Survey, blood work, and anthropometric measures
 Incentive: $25 gift card per employee
 Survey dates: July and August 2010
 Survey language: English and Spanish
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METHODS SAMPLE

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 Survey:
 Socio-demographics
 Health status
 Health care coverage
 Prevention services
 Health information
 Health literacy
 Health behaviors
 Clinical and anthropometric measures:
 Blood tests (HbA1c and cholesterol)
 Blood pressure
 Height and weight measurements
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METHODS SURVEY INSTRUMENT

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 Fisher’s Exact test
 Two-sample z-test for proportions
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METHODS STATISTICAL ANALYSIS

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Socio-Demographic Comparison Texas Hidalgo County HLW Sample
Age (years) 33 27 39
Female (%) 50 51 29
Hispanic (%) 36 89 96
Uninsured (%) 27 32 54
Spanish speaking (%) 29 82 95*
Individuals Below Poverty Level (%) 17 36 34
*Percent who answered that they speak some level of Spanish in response to the question “In general,
what language do you read and speak?”
Source: U.S. Census Bureau: 2005-2009 American Community Survey 5-Year Estimates , 2007 Small Area
Health Insurance Estimates (SAHIE)
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SOCIO-DEMOGRAPHIC COMPARISON BY AREA

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Health Behaviors Texas Hidalgo County HLW sample
N 11K-12K 500-540 228
Fruit and Vegetable Consumption 5+ a Day¹ (%) 23.8 19.7 5.3**††
Participation in Any Physical Activity² (%) 72.7 59.8 55.2**
Current Smoker (%) 17.9 14.7 25.4**††
*p<.05 for comparison between rates for Texas and study sample
**p<.01 for comparison between rates for Texas and study sample
†p<.05 for comparison between rates for Hidalgo County and study sample
††p<.01 for comparison between rates for Hidalgo County and study sample
¹Adults who have consumed fruits and vegetables five or more times per day
²During the past month, did you participate in any physical activities?
Source: CDC: BRFSS Prevalence and Trends Data, 2009 and SMART: BRFSS City and County Data, 2009
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RESULTS HEALTH BEHAVIORS

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Screening and Prevention Texas Hidalgo County HLW sample
N 3K-6K n/a§ 228
Mammogram¹ (%) 72.6 n/a§ 48.6**
Pap Smear² (%) 81.5 n/a§ 63.0**
Prostate Cancer Screening³ (%) 52.8 n/a§ 23.6**
Colorectal Cancer Screening⁴ (%) 56.2 n/a§ 22.0**
*p<.05 for comparison between rates for Texas and study sample, Source CDC Smart county and state
data: 2008 BRFSS
**p<.01 for comparison between rates for Texas and study sample
§data not available
¹Women aged 40+ who have had a mammogram within the past two years
²Women aged 18+ who have had a pap test within the past three years
³Men aged 40+ who have had a PSA test within the past two years
⁴Adults aged 50+ who have ever had a colonoscopy
Source: CDC: BRFSS Prevalence and Trends Data Texas, 2008
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RESULTS SCREENING AND PREVENTION

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Health Measurements Texas Hidalgo County HLW sample
N 9K-11K 400-500 228
Hypertension Awareness¹ (%) 29.1 25.3 21.0**
Cholesterol Awareness² (%) 40.9 37.7 33.0*
Diabetes³ (%) 9.3 9.8 7.0
Obesity (Body Mass Index ≥30) (%) 29.5 35.5 46.0**††
Disability⁴ (%) 17.1 14.9 8.0**††
*p<.05 for comparison between rates for Texas and for study sample
**p<.01 for comparison between rates for Texas and study sample
†p<.05 for comparison between rates for Hidalgo County and for study sample
††p<.01 for comparison between rates for Hidalgo County and for study sample
¹Adults who have been told they have high blood pressure
²Adults who have had their blood cholesterol checked and have been told it was high
³Have you ever been told by a doctor that you have diabetes?
⁴Adults who are limited in any activities because of physical, mental or emotional problems
Source: CDC: BRFSS Prevalence and Trends Data, 2009 and SMART: BRFSS City and County Data, 2009
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RESULTS HEALTH MEASUREMENTS

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Self-Reported Health Status Texas Hidalgo County HWL Sample
N 11558 534 228
Excellent (%) 20 19 5
Very Good (%) 30 19 19
Good (%) 34 39 50
Fair (%) 12 18 24
Poor (%) 4 6 2
Fisher’s Exact Test
p <0.002
Source: CDC: BRFSS Prevalence and Trends Data, 2009 and SMART: BRFSS City and County Data, 2009
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RESULTS SELF-REPORTED HEALTH STATUS

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 Health disparities among manufacturing workers in
South Texas are evident in the following areas:
 —Health care coverage
 Utilization of health screening services
 Chronic disease awareness
 —Smoking rates
 —Physical activity levels
 Fruit and vegetable consumption
 Obesity rates
 Self-reported health status
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RESULTS SUMMARY

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 State and local surveillance accompanied by local research
can highlight areas of health disparities for sectors of local
communities.
 Interventions promoting healthy behaviors are needed for
manufacturing workers.
 Low rates of health care coverage can account for low
utilization of screening and prevention services.
 Findings will inform the design of a health literacy and
health promotion intervention within the workplace.
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CONCLUSION

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This research was funded by a grant from the Centers for
Disease Control and Prevention (Grant H75DP001812). The
contents of this presentation are solely the responsibility
of the authors and do not necessarily represent the official
views of the Centers for Disease Control and Prevention or
the South Texas Border Health Disparities Center.
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FUNDING ACKNOWLEDGEMENT

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ADDITIONAL INFORMATION
For additional information please contact
Doménica Niño
domenica.nino@gmail.com
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