The purpose of the descriptive cross-sectional study is to examine the factors that enable or impede cervical cancer screening among Latinas in California. This study applied a well-known theoretical framework for health service usage, the Behavioral Model for Vulnerable Populations, to examine correlates of Pap testing practices among Latinas who were native-born, recently immigrated or established immigrants.

Data from the combined 2001, 2003, and 2005 California Health Interview Survey (CHIS) for self-identified Latinas was explored to determine Pap testing practices and rates. Weighted data for 13,889 Latinas were analyzed using multivariate logistic regression models to assess factors that facilitated or presented barriers to Pap testing.

This study determined there was an overall decline of 3% by Latinas reporting a Pap test in their lifetime. Latinas who had health insurance, food insecurity, and/or quit smoking were more likely to have received a Pap test in their lifetime. Time since immigration, age, education, marital status, family type, and time since the last physician visit were variables that contributed the least to ever having a Pap test for Latinas in California.

The theoretical model used for this study, with its emphasis on economic as well as social and psychological factors, appears to fit the data well and addresses the relevant explanatory factors. This study found that among the three groups: U.S.-born, recent immigrants, and established immigrants, lifetime use of Pap testing was lowest among the recently immigrated Latinas, controlling for other known factors associated with screening. This finding demonstrates the importance of targeting recent Latina immigrants to increase the use of cervical cancer screening. However, the declining trend for both native Latinas and established immigrants in Pap testing rates suggests a need for health professionals to target all Latinas, regardless of immigration status, to increase the rate of Pap testing among this vulnerable group.

PSYCHOSOCIAL WORK FACTORS AND SHOULDER PAIN

IN HOTEL ROOM CLEANERS

Barbara J. Burgel

Aims: To measure, among hotel room cleaners, the relationship between psychosocial work factors (job strain, iso-strain, and effort-reward imbalance [ERI]) and severe shoulder pain, controlling for selected socio-demographic, behavioral, anthropometric, biomechanical, and hotel factors.

Background: Hotel room cleaners have physically demanding jobs that place them at high risk for work-related shoulder pain (WRSP). Biomechanical factors have been associated with WRSP. Psychosocial work factors, including job strain (high psychological demand with low decision latitude), iso-strain (job strain with low coworker and supervisor support), and ERI (high effort with low rewards), may also play a role in WRSP, but this is not well studied.

Methods: 941 of 1,276 (74%) hotel room cleaners from 5 hotels in Las Vegas completed a survey in 2002. Of them, 493 with complete data for the shoulder pain outcome, the 3 key psychosocial independent variables, and 17 covariates were included in logistic analyses using Stata, Version 9.2.

Results: Fifty-six percent (n=274) reported WRSP in the prior 4-weeks. The sample was female (98%), Latina (78%), married/partnered (69%), born outside the USA (85%), and age 41 (SD 9.67). On average, participants had worked as a room cleaner 7.74 (SD 5.41) years, 40.26 hours (SD 11.00) per week, and made 19.35 beds/day (SD 6.72). In fully adjusted models, job strain and iso-strain were not associated with WRSP. However, ERI was significantly associated with WRSP: those with an ERI score greater than 1.0 had 3 times the odds of reporting severe shoulder pain, after adjusting for age, years of education, caregiving at home, current smoking and alcohol, height, number of years worked as a room cleaner, number of hours worked/week, number of beds made/day, and physical workload, work intensification and ergonomic indices (AOR 2.98, 95% CI 1.93-4.59, p=0.000).

Implications for nursing: These findings will aid occupational health professionals in developing "healthy work" policies to prevent WRSP. Creative job design and an enhanced reward system for hotel room cleaners may help to achieve a better balance between effort and rewards of work.

DISSERTATION ABSTRACT

Cohort Study of Persons with Human T-cell Lymphotropic Virus

Deborah A. DeVita

Background: The HTLV Outcomes Study (HOST) is a longitudinal prospective study of 155 HTLV-I, 387 HTLV-II and 799 HTLV seronegative persons enrolled in 1990-92 following attempted blood donation at five blood centers in the United States. The study has completed eight subject visits over 18 years and has data from health questionnaires, neurologic and lymph node examinations, and phlebotomy.

Objectives: To familiarize healthcare workers with the literature pertaining to the biological properties and the epidemiology of the HTLV viruses and present clinical and statistical information about persons in a study of HTLV.

Methods: An existing data set from HOST is used for this study. The original aims of HOST were to better define the disease outcomes and the risk factors associated with HTLV-I and -II infection, and to assess the prevalence and incidence of adult T-cell leukemia (ATL) and HTLV-associated myelopathy (HAM). The current study has three chapters. The first chapter reviews the HTLV literature to present the public health relevance and counseling recommendations for HTLV to healthcare providers. The second chapter calculates odds ratios with generalized estimated equations to analyze fixed and time-varying predictors of HOST participation. The third chapter provides some insights about the concerns and fears of persons living with HTLV.

Results: With millions of people estimated to be infected by HTLV worldwide and a lack of effective therapy, health care provider knowledge of the natural history of the virus is vital to secondary and tertiary prevention efforts.

The main findings of chapter three were that persons with higher incomes and more education were more likely to participate in study visits and men and persons of Black and other race/ethnicity were less likely to participate. In the third chapter, a majority of subjects reported specific concerns such as fear of future progression to HTLV-related disease and fear of transmitting HTLV to others.

Discussion: The clinical importance of HTLV-I and HTLV-II has been overlooked by nurses and other health care workers because it is fairly obscure, and due to confusion between HTLV and human immunodeficiency virus (HIV). While studies have shown that blood donors as a group have higher socioeconomic status, the persistent and independent influence of race/ethnicity, education and income demonstrates the continued and urgent need to develop and test strategies to encourage participation by under-represented groups. HTLV health care providers need to inquire about the fears and concerns of their patients.