Knowledge, Attitudes, Behaviors and Environmental Health Needs of Latinas in Cleaning Occupations

Background: Population health, including research and educational outreach, are quickly becoming mainstays at large tertiary care medical centers around the U.S. In fulfilling this mission, it is essential to understand underserved and underrepresented communities, including any unique health challenges faced. In New Jersey, the Latino population ranks seventh largest in the country with 1,730,000 Hispanics, or 19 percent of the population throughout the state. Yet there may be underrepresentation in health research and a lack of understanding of key health needs faced by this population. This underrepresentation is impacted by several factors, including lack of health insurance and poverty. In the United States, 90.1 percent of 1,512,000 maids and housekeeping cleaners are female, and of those 49.3 percent are Latino or Hispanic. Therefore, an estimated 671, 619 Latina women work as maids or housekeepers nationally. Purpose: The purpose of this study is twofold: first to explore the knowledge, attitudes, and behaviors (cleaning routines and product uses) of a bicultural population of Latina women from different countries of origin and acculturation levels. The second is to understand the environmental health needs (such as increased training, use of personal protective equipment, health services, etc.) within a bicultural population of Latina women from different countries of origin and acculturation levels. Methods: This was a cross-sectional, general qualitative study that was exploratory in nature. The study consisted of three focus groups with a survey. The focus groups explored the knowledge, attitudes, and behaviors regarding cleaning practices within a bicultural population of Latina women from different countries of origin and acculturation levels. Demographics and information related to cleaning practices at work and at home was collected via a 43-question survey. Data Collection and Analysis: Data was collected from three focus groups, for a total enrollment of 15 participants. Participants were recruited from English as a Second Language (ESL) classes offered at a high school in Hackensack, New Jersey. Students in the class were mothers of high school students. Focus group audio recordings were translated from Spanish to English and transcribed for analysis. The PI employed descriptive and in vivo coding, and further coded inductively to explore thematic analysis. Statistical analysis of the survey evaluated means and frequency and percentage for each of the responses. This quantitative data helped further describe study participants and included country of origin, household income, health issues, and cleaning products used. Together with the focus group transcripts, both the quantitative and qualitative data helped to form a comprehensive picture of the knowledge, attitudes, behaviors, and environmental health needs of the Latinas participating in the study. Results: The study results, both qualitative (focus group responses) and quantitative (survey responses) are organized by research question (RQ). For RQ1, the qualitative and quantitative data show that training for cleaning typically began at a very young age. Participants learned how to clean by observation at home. Over half the participants have been cleaning ten years or more. Several participants spoke to a lack of job training. For RQ2, the qualitative data shows a variety of attitudes towards chemicals in cleaning products including wanting things to “smell nice.” This is a health concern since scented products often contain phthalates and other chemicals linked to cancer and endocrine disruption. Many participants felt it is important to use products that will get the job done effectively. For RQ3, the qualitative and quantitative data show that participants have organized work groups where tasks are rotated and/or shared. Most participants are the primary person cleaning at home, suggesting increased exposure to cleaning chemicals. Gloves and masks were the most frequently used PPE, but use is not consistent, and barriers exist. For RQ4, the qualitative and quantitative data show that the environmental health needs of this population are complex and varied. Respiratory and dermal issues were reported, as well as other concerns such as sore muscles and back problems. Cancer was discussed by participants several times. The roles of genetics, food, and chemical exposures in cancer etiology were of great interest and a variety of opinions on the topic were discussed. For RQ5, the qualitative and quantitative data show a range of behaviors regarding product use. For participants who purchase their own products, price is a driving factor while others use products per the employer. Conclusions: Latinas in cleaning occupations in northern NJ face a range of social and health barriers including lack of training, inadequate PPE, low literacy and health issues ranging from short term (skin rashes) to long-term (cancer). The barriers found in this population are compounded by daily environmental exposures from occupational and home cleaning practices. To address these issues, the development of an intervention is warranted to provide training and resources for this critical population of essential workers