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As mentioned, one of the objectives of public health surveillance is to identify new problems and research needs. With respect to hired farm workers, previous surveillance projects have uncovered a wide-range of health concerns in need of further research. For example, in the area of pesticides, more research on neuropsychiatric outcomes is necessary before undertaking surveillance activities for such conditions. The seven categories selected by the work group are, in their view, the most important priorities in area of hired farm worker occupational safety and health.
Like the priorities for surveillance, those for research were chosen through a polling process of the entire work group. These priorities as well as their topics and sub-topics were ranked in order according to the participant's responses. For a complete listing of the seven research priorities, refer to Appendix C.
Under pesticides, the three most important research priorities are exposure studies, poisonings, and reproductive outcomes. For exposure studies, research needs to examine exposure versus health effects, "safe" levels of exposure, and biomarkers such as metabolites. In addition, cumulative effects of long-term, repeated exposures, antibody tests to determine cholinesterase inhibition and recognition of systemic exposure with dermal exposure require further study.
For poisonings, research needs to define diagnostic criteria, establish functional case definitions, and find a method for classifying cases by agricultural sector such as with the SIC code. As for reproduction, birth defects such as heart malformations, neural tube defects such as spina bifida, and sterility are the three priorities for research.
The remaining areas which research must address include: neurologic outcomes, multiple chemical sensitivity, genotoxicity, longitudinal health studies, immunological effects, and the difficulty of obtaining a control population. With respect to neurologic effects, research needs to be done on neuropsyciatric outcomes such as depression, physiological outcomes such as muscle weakness, and diseases such as Alzheimer's and Parkinson's.
For topics pertaining to multiple chemical sensitivity outcomes, research should look at allergies and other conditions such as flashback symptoms and eye reactions that develop as a result of continuous exposure to chemicals and pesticides. Similarly, an investigation into immunological effects should include an analysis of the relationship between pesticide exposure and various allergies. Other kinds of immunological concerns should pertain to the body's natural defense mechanisms and whether repetitive contact with pesticide renders a person more susceptible to infectious diseases.
As with surveillance, workplace ergonomics and musculoskeletal conditions are a top research priority. In this instance, case definition and diagnostic criteria are the greatest research needs. Under case definition, this pertains to the mechanism of injury, cervical and shoulder-related injuries, the impact of migration, and chronic back problems in individuals who have experienced at least one major injury during their life.
For diagnostic criteria, research needs to look at a broad spectrum of topics. First, it must consider those studies done when a patient has been inactive for a period of time and compare them with those that have been done when a patient has been working. Next, research needs to examine the criteria behind clinical judgments and how such health problems as overuse injuries are classified. Finally, it needs to look at Workers' Compensation Insurance and determine the criteria it uses for defining and classifying musculoskeletal injuries.
For traumatic injuries, the primary research concern pertains to Workers' Compensation Insurance. Here, research needs to investigate the prevalence of conditions, reporting and recognition of claims and acceptance and payment of claims, and barriers that block access to the system such as California's Proposition 187.
Another research need is rehabilitation. Specifically, research needs to assess its effectiveness in helping hired farm workers return to their jobs and the availability of services. With respect to the latter, it is important to consider issues such as Proposition 187 that can prevent some farm workers from using rehabilitation services.
The remaining research needs pertain to incidence of traumatic injuries, effectiveness of intervention strategies, transportation, and disability. With incidence and prevention strategies, it is essential that research focuses on the work environments, the living situations, and the modes of transportation of hired farm workers and makes comparisons between the three areas. For disability, research must consider both permanent and temporary disabilities as well as examine their long-term effects on specific populations such as older farm workers and retired farm workers.
The two protective measures in need of additional study involve Restricted Entry Intervals (REIs) and Personal Protective Equipment (PPE). In both cases, research needs to look at their effectiveness in lowering injury and illness rates among hired farm workers. In addition, it should examine whether the methods prescribed by the government agencies that created the regulations are sufficient. This should include an analysis of the data that the EPA used to establish the REIs and an evaluation of the design of worker protective gear.
Beyond REIs and PPE, employer compliance with protective regulations, drift exposure, and hired farm worker training are the other topics in need of further study. Research should look at the extent of voluntary compliance among employers and the kinds of methods that employers rely on to train workers about pesticide safety. Likewise, research must consider the mediums through which hired farm workers receive their training and whether mediums such as videos serve as effective learning tools.
Among the many cancers, the work group targeted breast cancer as the most important research priority. In this particular category, research needs to look at hired farm worker access to services and assess the impact of interventions. The other types that must be given high priority are cancers that affect children and leukemia. In each case, the research needs are the same: compare farmers and hired farm workers, compare hired farm workers and non-farm workers, and examine the availability of tumor registry information. In addition, research needs to look at prostate cancer, Hodgkin's and non-Hodgkin's lymphomas, and skin cancer and determine their prevalence among hired farm workers.
One of the difficulties in conducting hired farm worker research is finding or, rather, defining a control population with which to compare results. Consequently, it is necessary for research to examine different populations and assess their effectiveness as a control group. One consideration involves looking at non-agricultural populations. In this manner, research could consider Hispanics and their respective health characteristics as a possibility, or it could compare hired farm workers with other residents from their community.
Other considerations for research could include farm worker versus non-farm worker populations with similar ethnicity, migrant versus permanently settled farm workers, or U.S. born farm workers versus Mexican-born workers. For all three approaches, it is essential that research determine whether the control group would be of sufficient size to create an accurate cross-sectional representation of the entire population.
In the area of mental health, stress needs to be the top research priority. Research should focus on factors such as long work hours, low wages, injuries and illnesses, job instability, and living conditions.
Similarly, pesticides require special attention under this category. Here, research must examine the relationship between pesticide exposure and mental illness. In doing so, it should consider diagnoses and conditions, which have been previously linked to pesticide exposures. It should also examine how the mental health status of those directly involved with pesticides, sprayers and mixers, fluctuates between the season and the off-season such as elevated levels of anxiety, depression, and insomnia.
Lastly, research needs to consider substance abuse, suicide, domestic violence, and differences between men and women with respect to mental health. In looking at these areas, it is important to pay special attention to the unique aspects of the hired farm worker community such as unfamiliar isolation, cultural settings, and undocumented immigration status. Added significance also needs to be given to political measures such as California 187 and their impact on the reporting of domestic violence.
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NOTE: This document is provided for historical purposes only.
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