Household food security among migrant and seasonal latino farmworkers in North Carolina

OBJECTIVE: Food insecurity is defined as lack of access at all times, due to economic barriers, to enough food for an active and healthy lifestyle. The objective of this study was threefold: to characterize levels of food security, food insecurity, and hunger among migrant and seasonal Latino farmworkers; to assess predictors of food insecurity for this group; and to describe the strategies farmworkers use to cope with food insecurity. METHODS: Adults from 102 farmworker households in North Carolina responded to a survey that used a Spanish-language adaptation of the U.S. Household Food Security Survey Module and questions about sociodemographic characteristics and food behaviors. Twenty-five farmworkers participated in in-depth interviews in which they described their households' food security situation and coping strategies. RESULTS: Forty-eight of the 102 sample households (47.1%) were classified as food insecure, including 10 (9.8%) with moderate hunger and five (4.9%) with severe hunger. Households with children had a significantly higher prevalence of food insecurity than those without children (56.4% vs. 36.2%). Households with children accessed food programs such as the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) that were unavailable to those without children, while those without children were more likely to access food pantries and to consume wild game or fish. Coping strategies included borrowing money, reducing food variety, and adults consuming less food to protect children from hunger. Food insecurity was more than four times as prevalent among farmworker households as among the general U.S. population. CONCLUSION: Policy changes to increase economic resources and access to federal programs are needed to decrease this food insecurity.     

Proportionate mortality among US migrant and seasonal farmworkers in twenty-four states.

BACKGROUND: US migrant and seasonal farmworkers may be exposed to potentially carcinogenic pesticides and other agents. Little epidemiologic research has been conducted on this population. METHODS: We examined the proportionate mortality of 26,148 subjects (14,631 white men (WM), 7,299 nonwhite men (NM), 1,081 white women (WW), and 3,137 nonwhite women (NW)) who were identified as farmworkers on death certificates from 24 US states during 1984-1993. RESULTS: Farmworkers had significantly elevated proportionate mortality from injuries, tuberculosis, mental disorders, cerebrovascular disease, respiratory diseases, ulcers, hypertension (NW), and cirrhosis (NW). There was significantly reduced mortality from infectious diseases (other than tuberculosis), endocrine disorders, nervous system diseases, pneumoconioses, arteriosclerotic heart disease (WM), and all cancers combined. Proportionate cancer mortality analyses found excess cancers of the buccal cavity, larynx, esophagus, stomach, skin (NW), and cervix, and deficits for cancers of the colon, breast, kidney, pancreas (NW), and lymphohematopoietic system. CONCLUSIONS: The excess deaths from injuries, respiratory disease, and stomach cancer, and the deficits of colon cancer and arteriosclerotic heart disease among farmworkers, are consistent with typical mortality patterns previously observed among farm owner/operators. The excess buccal, laryngeal, esophageal, and cervical cancers, and the deficits of breast cancer and lymphohematopoietic cancers have not generally been observed in studies of farm owner/operators.     

Occupational health among migrant and seasonal farmworkers: the specific case of dermatitis

Occupational health studies of agricultural workers have generally excluded migrant and seasonal farmworkers, and this population experiences a high degree of health risk from agricultural exposures. A survey of dermatologic disorders among migrant and seasonal farmworkers will be used to illustrate this point. Data from a recent field study are presented to illustrate epidemiologic approaches to studying dermatologic disorders in farmworkers and risk factors for dermatitis. This study suggests there is generally a high health risk to agricultural workers and this study also suggests methods to investigate other acute and chronic diseases among agricultural workers.     

Prenatal exposure to pesticides: a feasibility study among migrant and seasonal farmworkers.

BACKGROUND: Migrant and seasonal farmworkers have a high potential for pesticide exposures, yet are rarely included in epidemiologic studies. This study examined the feasibility of assessing prenatal exposures to pesticides and other compounds in pregnant Hispanic farmworkers. METHODS: Nine women completed a survey about work experiences during pregnancy. Maternal urine, cord blood, and placenta samples were obtained at delivery for analysis of 51 analytes, including 6 phenoxy acid or triazine herbicides, 21 organochlorine insecticides, 10 PCBs, and 14 volatile organic compounds. RESULTS: Seven of 51 analytes were found in the biological samples. DDE, DDT, dichlorbenzene, toluene, trimethylbenzene, and endosulfan sulfate were detected in cord blood samples, and 2,4-D in urine from one or more women. CONCLUSIONS: We documented the feasibility of following farmworkers to assess in utero exposure to pesticides and other contaminants, and demonstrated exposure to these compounds. Difficulties in measuring pesticides with short half lives were noted.     

Health status of migrant farmworkers: a literature review and commentary.

I made a computerized search of MEDLINE files from 1966 through October 1989 followed by a review of this literature. Four hundred eighty-five articles were scanned; 152 were found specifically related to migrant families, while another 51 articles addressed the health of agricultural workers or farmers in general. Solid data exist on dental health, nutrition and, to a lesser extent, childhood health. Data also were prominent in several disease categories including certain infectious diseases, pesticide exposures, occupational dermatoses, and lead levels in children. Estimates of the size of the migrant and seasonal farmworker population vary widely. Basic health status indicators such as age-related death rates are unknown. Prevalence rates of the most common cause of death in the United States have yet to be studied. More research is needed into the health problems and health status of migrant and seasonal farmworker families.     

Occupational eye injuries experienced by migrant farmworkers

Migrant farmworkers in North Carolina (n?=?300) reported eye injuries, circumstances of injuries, and outcomes during lifetime U.S. agriculture work. Seventeen injuries were reported by 15 farmworkers; five resulted in lost work time. Most reported injuries were penetrating or open wounds, often caused by branches or other foreign objects. Injuries were seldom reported to employers; and treatment at clinics, when received, was often delayed. The incidence rate of lost work-time injuries of 23.8/10,000 worker years (95% confidence interval 7.5, 55.9), exceeds the 2009 national incidence rate (6.9/10,000). Migrant farmworkers constitute a vulnerable population; better occupational safety protections should be considered.     

Estimating the occupational morbidity for migrant and seasonal farmworkers in New York state: a comparison of two methods

PURPOSE: Compare occupational morbidity estimates for migrant and seasonal farmworkers obtained from survey methods versus chart review methods and estimate the proportion of morbidity treated at federally recognized migrant health centers (MHCs) in a highly agricultural region of New York. METHODS: We simultaneously conducted 1) an occupational injury and illness survey among agricultural workers, 2) MHC chart reviews, and 3) hospital emergency room (ER) chart reviews. RESULTS: Of the 24 injuries reported by 550 survey subjects, 54.2% received treatment at MHCs, 16.7% at ERs, 16.7% at some other facility, and 12.5% were untreated. For injuries treated at MHCs or ERs, the incidence density based on survey methods was 29.3 injuries per 10,000 worker-weeks versus 27.4 by chart review. The standardized morbidity ratio for this comparison was 1.07 (95% confidence intervals = 0.65-1.77). CONCLUSIONS: Survey data indicated that 71% of agricultural injury and illness can be captured with MHC and ER chart review. MHC and ER incidence density estimates show strong correspondence between the two methods. A chart review-based surveillance system, in conjunction with a correction factor based on periodic worker surveys, would provide a cost-effective estimate of the occupational illness and injury rate in this population.     

Pterygium among Latino migrant farmworkers in North Carolina

The authors describe the prevalence and severity of pterygium among Latino migrant farmworkers in North Carolina and delineate its risk factors. They selected a sample of 304 farmworkers working in eastern North Carolina in 2005. Digital photographs were taken of each farmworker, including a facial view showing the eyes. Two physicians independently rated each farmworker for the presence and severity of pterygia, with an initial intercoder agreement of 91%. Sixty-eight (23.3%) participants had a pterygium in at least 1 eye; 28 (9.5%) had bilateral pterygia. Age was significantly associated with pterygia (odds ratio = 1.07; 95% confidence interval = 1.03-1.11). Research on the causes of pterygium among farmworkers is needed. In the interim, improvements in farmworkers' preventive behaviors, such as wearing ultraviolet protective lenses and brimmed hats, are reasonable and inexpensive measures.     

Occupational injuries among North Carolina migrant farmworkers.

A population-based cross-sectional study of occupational injuries among a random sample of 287 migrant farmworkers demonstrated frequent obstacles to health care; 65% (11/17) of the more seriously injured subjects did not receive prompt care or never received care. Subjects not receiving prompt care were twice as likely to have incomplete recovery. Employers covered medical expenses for only 5/13 (38%) of the injured workers, and only 3/15 were compensated for lost work. This study indicates that comprehensive Workers' Compensation coverage is urgently needed in North Carolina.     

Intestinal parasites among North Carolina migrant farmworkers.

OBJECTIVES. The public health significance of intestinal parasitism among migrant farmworkers has been poorly defined. We report a three-part study in which we attempted to provide population-based estimates and identify risk factors for infection. METHODS. Parasite prevalence and incidence were estimated from two cross-sectional studies and a longitudinal study. We used questionnaires and clinical measurements such as hematocrits to examine risk factors and health effects. RESULTS. In the 1987 convenience sample (n = 265), parasite prevalence ranged from 28% among the US born to 86% among the Central American born, with no significant difference between the prevalence of pathogens among US-born (14%) and Mexican-born (24%) subjects (P = .12, chi 2 test). High prevalences were also found in the 1988 random sample. An annual incidence of 9.5% (n = 74) was demonstrated in 1988. Symptoms such as abdominal pain were associated with infection, and lower hematocrits were associated with hookworm infection (P = .02, t test). CONCLUSIONS. Infection with intestinal parasites appears to be an occupational hazard of farmwork, necessitating improved working and living conditions and greater clinical awareness.     

Medical utilization patterns of Hispanic migrant farmworkers in Wisconsin

In a survey conducted in 1978 of a 10 percent stratified random sample of Wisconsin migrant agricultural workers, the self-perceived health status and the medical utilization patterns of the Hispanic workers in the sample (92 percent of the total group) were examined.Based on prior research with national populations, it was hypothesized that older, female, better educated, and English-speaking workers would have higher utilization levels. Utilization was measured by four variables: a physician or clinic visit in the preceding year and ever having had a general physical examination, a dental visit, or a vision checkup.The survey results, based on unverified self-reported data, indicated that in general the use by migrant workers of health services, especially preventive care, was low compared with other populations. Some of the hypotheses that were tested were confirmed by the survey data: older workers were more likely to have visited a physician in the preceding year and to have had a routine physical examination; women were more likely to have seen a physician in the preceding year and to have had a dental visit; workers who spoke English as well as Spanish (usually the younger workers) were more likely to have been to a dentist and to have had a vision checkup. Educational attainment was not related to any of the utilization measures.Besides the demographic factors related to medical utilization, the survey revealed barriers to care related to time, distance, language, and money. Access to a migrant health clinic and the availability of Medicaid were related to dentist visits and vision checkups. Thirty-eight percent of the migrants had used migrant health clinics; only 14 percent had used Medicaid to pay medical bills; about one in five had no means of payment except his or her own funds.