1 of 30

Injury, Substance Use & Health among Fisheries Harvesters in Downeast Maine

Downeast Health Research Collaborative presenters

Dr. Tora Johnson, Joseph Spiller, Gray Jones

Downeast Health Research Collaborative

University of Maine IRB 2021-05-04

2 of 30

Disclosure

Downeast Health Research Collaborative

The presenters have nothing to disclose

with regard to commercial relationships.

3 of 30

About DHRC

Downeast Health Research Collaborative

  • A statewide network of partner organizations, faculty and students
  • Based on the Machias Campus of UMaine
  • Building capacity for community-engaged research toward rural health equity & systems change

​

Draft Mission

To promote the health and resilience of Washington County residents through transformative health equity research, applied projects and policy change, accomplished within cross-sector partnerships that include faculty, students, community organizations, healthcare providers, and policymakers.

4 of 30

Harvester Health Study: Our Team

Downeast Health Research Collaborative

Research Team

      • Dr. Tora Johnson. PI., University of Maine Machias
      • Gray Jones. Graduate Research Fellow. University Maine
      • Joseph Spiller. Undergraduate Research Fellow. University of Southern Maine
      • Dr. Katherine Darling. Co-PI. University of Maine Augusta
      • Dr. Linda Silka. Co-PI. University of Maine
      • Dr. Lois-Ann Kuntz. Co-PI, University of Maine Machias
      • Dr. Tara Casimir. Co-PI, University of Southern Maine
      • Dr. Bridie McGreavy. Co-PI, University of Maine
      • Lauren Sachs. Undergraduate Research Fellow. University of Maine Machias
      • Amy Dowley. Graduate Research Fellow. University of Maine Machias

Key Partners

      • Maine Center For Coastal Fisheries |coastalfisheries.org
      • The Community Caring Collaborative | cccmaine.org
      • Maine Mobile Health | mainemobile.org
      • Lobster & Shellfish Associations

5 of 30

Funders

Downeast Health Research Collaborative

UMaine System Rural Health & Wellbeing

Grand Challenge Injury Prevention Seed Grant Program

​

Maine Shellfish Restoration and Resilience Fund

​

Elmina B. Sewall Foundation

6 of 30

Background

Downeast Health Research Collaborative

  • Prior fisheries policy work pointed to health & substance use challenges (McGreavy et al., 2018; Johnson et al., 2019).
  • Shellfish & lobster harvesting: high risk of injury (Berg-Beckhoff et al., 2016).
  • Chronic pain: known driver of opioid use and misuse (Cheng et al., 2013).
  • Work-related injuries: known to precede most opioid deaths (Cheng et al., 2013).
  • Workers in fisheries: disproportionately at risk for opioid death (Hawkins, 2020).
  • Self-employed: often uninsured or underinsured

​

7 of 30

Objectives

Downeast Health Research Collaborative

This study:

​

1) Understand harvesters’ risk factors, injury and pain, substance use

​

2) Identify barriers to positive health outcomes for harvesters

​

3) Identify potential interventions for improved health outcomes

Long Term:�

To implement interventions, we need a better understanding of prevalence, risk & structural factors in injury, pain management & substance use among lobster & shellfish harvesters.

8 of 30

Methods

Downeast Health Research Collaborative

      • Literature/ policy review
      • Collaborate with community partners on survey & interview design
      • Field outreach & participant observation
      • Surveys of harvesters, healthcare providers & advocates
      • Semi-structured interviews with harvesters, healthcare providers & advocates
      • Iterative coding

9 of 30

Downeast Health Research Collaborative

Harvester Survey

  • Washington & Hancock Counties, ME
  • $10 VISA gift card incentive
  • Harvester Survey Recruitment:
    • Shellfish license holders (459)- Direct email
    • Lobster operation owners (48)- Direct email
    • Others- Outreach, posters, waterproof cards, social media posts, newspaper coverage
  • Questions: injury, health, healthcare access

Methods

10 of 30

Downeast Health Research Collaborative

Healthcare Providers & Advocate Survey

  • Downeast & Acadia Regions, ME
  • Recruitment:
    • Licensed doctors, chiropractors, PAs, FNPs, and PT/OTs
    • Local clinics from internet sites
  • Questions: injury, health, substance use among harvesters
  • Used to triangulate/ expand harvester data

Methods

11 of 30

Preliminary Results: Survey

Downeast Health Research Collaborative

I am a (Check all that apply):

Count

% of total

Professional Shellfish Harvester

51

61%

Crew/ sternman in a lobster fishing operation

26

31%

Owner of a lobster fishing operation

22

27%

Professional harvester of worms or periwinkles

13

16%

Professional harvester in other fisheries

9

11%

Total 83 Harvester Responses

12 of 30

Downeast Health Research Collaborative

​

Lobster

​

Shellfish

Injuries

Count

%

​

Count

%

Back or Neck

27

54%

​

36

69%

Shoulder, arm, elbow, hand

30

60%

​

40

77%

Leg

21

42%

​

28

54%

Head or face

8

16%

​

7

13%

Other injury

1

2%

​

5

10%

What kinds of injuries have you had while doing fisheries work in the past year?

Preliminary Results: Survey

13 of 30

Preliminary Results

Downeast Health Research Collaborative

Further Insights from Interviews:

  • Risks: Falling, repetitive injuries, cuts & abrasions, lifting, weather, sun damage
  • Backs, hands, knees, shoulders, skin
  • Mental health challenges (chicken/ egg?)

​

​

14 of 30

Harvester Quotes

Downeast Health Research Collaborative

“I have had frostbite, severe enough that now it is self-induced neuropathy. My feet are numb now. I get a burning sensation, shoots up into my legs.”

15 of 30

Downeast Health Research Collaborative

Response to injury

Count

% of total

Rested/ didn't work

36

43%

Over-the-counter medication (Tylenol, Aleve, Advil, etc)

35

42%

Visited a doctor, physician's assistant or nurse practitioner

26

31%

Exercise or stretching

24

29%

Visited a chiropractor

11

13%

Medical or recreational marijuana, CBD or THC

10

12%

Other

10

12%

Prescription medication

7

8%

Visited a massage therapist/ got massage from friend/family

6

7%

Preliminary Results: Survey

16 of 30

Harvester Quotes

Downeast Health Research Collaborative

“Unless it’s sticking out or very very bloody, we work through it.”

17 of 30

Downeast Health Research Collaborative

Pain Management

Every Day

Most days

Occasionally

Never

Tylenol / OTC

7%

19%

51%

14%

Marijuana, CBD or THC

11%

7%

11%

48%

Presciption med with Rx

4%

8%

8%

57%

Presciption med without Rx

0%

4%

8%

63%

Accupuncture

0%

4%

5%

63%

Other

1%

2%

5%

28%

In the past year, how often have you used each of the following to manage pain for injuries related to harvesting?

​

​

Preliminary Results: Survey

18 of 30

Preliminary Results

Downeast Health Research Collaborative

​

Further Insights from Interviews:

​

  • MANY ANECDOTES OF ADDICTION & OVERDOSE STEMMING FROM INJURY
  • Self-Medication: Oxy, alcohol, marijuana, heroin, meth, kratom, caffeine
  • Comorbidities, including Hep-C, HIV, organ failure

​

​

19 of 30

Harvester Quotes

Downeast Health Research Collaborative

“A lot of it was due to the injuries… being on the pain medications, and I got addicted to it. And it took off from there. It started with my back and just escalated.”

20 of 30

Downeast Health Research Collaborative

​

Count

% of Total

Yes

58

70%

No

24

29%

​

​

​

Why?

Count

% of Total

Couldn't Afford it

32

39%

Worried how I would be treated

9

11%

Didn't have time

25

30%

Other

16

19%

Have you ever avoided going to the doctor or getting other kinds of medical care?

Preliminary Results: Survey

21 of 30

Preliminary Results

Downeast Health Research Collaborative

Further Insights from Interviews:

​

Norms & Culture

  • Deferral of care/ minimizing injury & illness
  • Generational variation in self-care
  • Poor self-care, poor financial literacy among young harvesters
  • Geographic differences in community openness & support/ intervention

22 of 30

Preliminary Results

Downeast Health Research Collaborative

Further Insights from Interviews:

​

Barriers to Health

  • Travel burden for care & selling catch
  • Scheduling care around tides
  • Uninsured and underinsured

​

​

23 of 30

Harvester Quotes

Downeast Health Research Collaborative

“When he hurt his back, he had no insurance… in and out of the emergency room, and he saw a doctor a couple times, had a herniated disk and never received no PT, no surgery, nothing. And so five years later, he was divorced and broken.”

24 of 30

Harvester Quotes

Downeast Health Research Collaborative

“I've actually stitched myself up before, believe it or not.”

25 of 30

Harvester Quotes

Downeast Health Research Collaborative

“I think a lot of fishermen would actually [get insurance] if it was something affordable for them and their family.”

26 of 30

Conclusion

Downeast Health Research Collaborative

Injury combined with structural & normative barriers to care are likely a significant contributor to addiction and overdose among harvesters.

27 of 30

Conclusion

Downeast Health Research Collaborative

Emerging Potential Solutions:

​

  • Injury prevention programs
  • Insurance programs for harvesters
  • Financial literacy programs
  • Mobile health units
  • Emergency department & clinic interventions
  • Training for clinical providers

​

​

28 of 30

Discussion

Downeast Health Research Collaborative

Next Steps:

​

  • Finalizing data collection & coding
  • Member checking -> preliminary recommendations
  • Funding for further research & pilot interventions

​

29 of 30

Citations

Downeast Health Research Collaborative

Berg-Beckhoff, G., Østergaard, H., & Jepsen, J. R. (2016). Prevalence and predictors of musculoskeletal pain among Danish fishermen – results from a cross-sectional survey. Journal of Occupational Medicine and Toxicology, 11(1). https://doi.org/10.1186/s12995-016-0140-7

​

Cheng, M., Sauer, B., Johnson, E., Porucznik, C., & Hegmann, K. (2013). Comparison of opioid-related deaths by work-related injury. American Journal of Industrial Medicine, 56(3), 308–316. https://doi.org/10.1002/ajim.22138

​

Hawkins, D. M. (2020). The Contribution of Work to Deaths of Dispair [Dissertation]. University of Massachusetts Lowell. https://dx.doi.org/10.1097%2FJOM.0000000000002145

​

Johnson, T., Morgan, R., Pontbriand, K., & Roden, M. (2019). Evaluating the Effectiveness of Shellfish Legal Notices. A report to the Maine Department of Marine Resources. University of Maine Machias.

​

McGreavy, B., Randall, S., Quiring, T., Hathaway, C., & Hillyer, G. (2018). Enhancing adaptive capacities in coastal communities through engaged communication research: Insights from a statewide study of shellfish co-management. Ocean & Coastal Management, 163, 240–253. https://doi.org/10.1016/j.ocecoaman.2018.06.016

30 of 30

Injury, Substance Use & Health among Fisheries Harvesters in Downeast Maine

Downeast Health Research Collaborative presenters

Dr. Tora Johnson, Joseph Spiller, Gray Jones

Downeast Health Research Collaborative

University of Maine IRB 2021-05-04