Surveillance of Hired Farm Worker Health and Occupational
Safety
Appendix B:
List of Priorities for Surveillance
Priority #1: Ergonomic/Musculoskeletal Conditions
Back Conditions
Prevalence among working farm workers
Prevention
Prevalence among disabled/retired farm workers
Upper body use problems, e.g., tendonitis among pruners
Type of activity/crop - e.g., lifting overhead, twisting
Extrapolate data from other non-agricultural industries
Effectiveness of interventions
Conditioning, preventive measures to avoid early season
injuries
Payment of workers' compensation claims
Issues included:
Cumulative trauma syndrome (CTS) as a concrete category
Better definition of outcomes
Biological plausibility - published sources for clinicians'
use
Education of Claims reviewers to understand all exposure is not
just dermal
Time lag of payments
Impact of Proposition 187 - regressive work practices have
resurfaced; as undocumented workers find it harder to get work and
are more desperate, those who hire them have an easier time
exploiting them
Comments (not ranked):
Develop ergonomic standards for agricultural work
Evaluation of tool ergonomics
Modification of tools or implements
Worker training in ergonomics
Carpal tunnel syndrome
Prevalence
Warehouse sorters
Handweeding
How relates to back injury and stress
Prevalence
Short-handled hoe and similar implements
How relate to back injury and stress
Prevalence of use in the U.S.
Prevalence of use in California
Measure extent to which workers' compensation underestimates true
prevalence of specific conditions
Often missed or denied as not due to acute injury
Child safety in fields, homes, etc.
Pregnancy/reproductive outcomes
Surveillance of miscarriages - how to do?
Premature/early delivery
Compare to foreign studies
Birth Defects
Early Season Injuries
Prevalence
Worker training
Priority #2: Pesticides
Pesticide Exposures
Need for more pesticide exposure data
Underreporting
Drift
High foliage crops
Additional points
Public media campaign
Lack of laundry facilities
Take-home/at-home exposures
Use of pesticides for rodent/vector control
Poisonings
Number and type
Underreporting
Issues include:
Nonspecific symptoms
Measuring cholinesterase often not helpful (pesticide to which
worker was exposed may not be a cholinesterase inhibitor)
Need for follow-up
Child poisonings from take-home & in-home contamination
Clinical characteristics of over-exposure
Effectiveness of Interventions
Worker Protection Standard
Restricted entry intervals
Training
Personal protective equipment (PPE)
Additional ideas
Removal of pesticides from the market
Availability of laundry facilities
Provision of rehabilitation facilities
Pregnancy/reproductive problems
Birth defects
Surveillance of miscarriages - how to do?
Other ideas
Infertility
Cohort identified for birth defect study
Worker training for miscarriages
Measure urinary metabolites in first trimester workers and in
workers in labor-intensive crops
Heat stress and Personal Protective Equipment
Equipment modification to reduce heat stress
Worker training
Diagnostic indicators to distinguish heat vs. poisoning
Extended use of PPE for early entry
Patterns of fluid consumption when temperature is greater than 85
degrees
Greenhouse industry hazards
Extent of exposure/compare the risk with other agricultural
jobs
Ventilation/air quality
Effectiveness of PPE
Occurrence of pesticide illness
Untrained workers who mix/load/apply pesticides
Extent of problem/acute and chronic health problems
Worker knowledge/extent of training
Consistency of PPE use/compare PPE footgear vs. leather
boots
Survey farmers re: risk/beliefs
Unknown problems with cholinesterase inhibitors
Effect on drinking water
Need for worker education on risk
Central nervous system changes - "expert" post-poisoning
evaluations almost always reject cause/effect relationship because no
objective CNS deficits
Connection to Parkinson's disease
Connection to muscular dystrophy
Neurologic consequences of chronic exposure
Immunologic effects
Post-poisoning toxic syndrome
Mechanism
Incidence
Treatment
Pesticide drift
Train all farm workers
Access to chemical information
Priority #3: Traumatic Injuries
Serious Injuries - death and disability
Transportation-related/motor vehicle accidents
Farm machinery-related/mangling injuries
Electrocutions
Ladder injuries
Additional points
Farm labor contractor/grower-provided vehicles
Hazards in the field - run over by tractors, snake bites,
lightning strikes
Incidence on small farms with 10 or fewer workers
Workers' Compensation
Compare states with farm worker coverage to states without farm
worker coverage
Evaluate reliability of the data
Issues included:
Measure of extent to which workers' comp underestimates true
prevalence of specific injuries
Lack of or inadequate compensation for injury
Acute vs. chronic conditions
Additional points
Availability of treatment
Child labor
Problems leading to injury: lack of parental supervision,
conditions in and around labor camps
Child safety in fields, homes
Prevention: day care, schools to educate parents, children;
public education campaign
Number of injuries
Other points
Availability of treatment
Child labor
Problems leading to injury: Lack of parental supervision,
conditions in and around labor camps
Effectiveness of interventions
Safety programs tied to lower premiums
Transportation safety measures
Workers' Compensation - a built in intervention?
Other points
Rehabilitation services for disabled farm workers
Effect of passage of California's Proposition 187: decrease in
reporting of motor vehicle accidents
Availability of workers' comp. Affects worker
rehabilitation
Fear of employer retribution: lower filing of claims
Study of disabled workers
Extent of problem
Binational study
Access to benefits/extent of involvement of clinics and
government agencies
Personal and societal costs
Cross-sectional study of 50 year-old males
Pregnancy/reproductive problems
Surveillance of miscarriage - how to do?
Other Points
Birth Defects
Sterility
Complications/stillbirth
Worker training
Public education
Personal and societal costs
Lost work days and wages
Permanent/serious disabling conditions and medical costs
Losses to families
Physical abuse/crowding
Estimate costs
Lack of rehabilitation facilities for disabling injuries
Extent of problem
Lack of job alternatives
Lack of long-term medical coverage
Back problems not treated (25-50 year olds)
Lack of medical professionals in rural communities
Lack of cultural sensitivity among providers
Priority #4: Pulmonary or Respiratory
Nursery/greenhouse workers
Prevalence and occurrence
Provider training
Effectiveness of interventions
Lung disability-change environment
Lung disability-rehabilitation
Prevention
Cotton pesticide defoliant
Prevalence and occurrence
Provider training
Sulfur dust used on table grapes
Prevalence and occurrence
Provider training
Apple thinners' exposure to pesticides (particularly residues)
Prevalence and occurrence
Provider training
Compare with organic orchards
Occurrence of allergic rhinitis/sinusitis
Hops asthma
Prevalence and occurrence
Provider training
Other
Descriptive evaluation
National survey
Upper respiratory conditions
Rhinitis/conjunctivitis symptoms by crops; compare organic vs.
non-organic operations
Differentiate allergic vs. irritative etiology
Chronic lung disease beyond asthma
Priority #5: Dermatitis
Caused by pesticides like sulfur dust used on table grapes
Prevalence
Clinic provider training
Incidence of pigmentation/depigmentation
Listing of inert ingredients which can cause problems
Post-exposure sensitivity
Caused by plants - peaches, strawberries, poinsettias
Prevalence
Clinic provider training
Work-related - should be covered by workers' compensation