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Surveillance of Hired Farm Worker Health and Occupational Safety

Appendix B:
List of Priorities for Surveillance

Priority #1: Ergonomic/Musculoskeletal Conditions

1. Back Conditions
   1. Prevalence among working farm workers
   2. Prevention
   3. Prevalence among disabled/retired farm workers
2. Upper body use problems, e.g., tendonitis among pruners
   1. Type of activity/crop - e.g., lifting overhead, twisting
   2. Extrapolate data from other non-agricultural industries
3. Effectiveness of interventions
   1. Conditioning, preventive measures to avoid early season injuries
   2. 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
   3. 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
   4. Comments (not ranked):
      • Develop ergonomic standards for agricultural work
      • Evaluation of tool ergonomics
      • Modification of tools or implements
      • Worker training in ergonomics
4. Carpal tunnel syndrome
   1. Prevalence
   2. Warehouse sorters
5. Handweeding
   1. How relates to back injury and stress
   2. Prevalence
6. Short-handled hoe and similar implements
   1. How relate to back injury and stress
   2. Prevalence of use in the U.S.
   3. Prevalence of use in California
7. Measure extent to which workers' compensation underestimates true prevalence of specific conditions
   1. Often missed or denied as not due to acute injury
   2. Child safety in fields, homes, etc.
8. Pregnancy/reproductive outcomes
   1. Surveillance of miscarriages - how to do?
   2. Premature/early delivery
   3. Compare to foreign studies
   4. Birth Defects
9. Early Season Injuries
   1. Prevalence
   2. Worker training

Priority #2: Pesticides

1. Pesticide Exposures
   1. Need for more pesticide exposure data
   2. Underreporting
   3. Drift
   4. High foliage crops
      Additional points
      • Public media campaign
      • Lack of laundry facilities
      • Take-home/at-home exposures
      • Use of pesticides for rodent/vector control
2. Poisonings
   1. Number and type
   2. 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
   3. Child poisonings from take-home & in-home contamination
   4. Clinical characteristics of over-exposure
3. Effectiveness of Interventions
   1. Worker Protection Standard
   2. Restricted entry intervals
   3. Training
   4. Personal protective equipment (PPE)
   5. Additional ideas
      • Removal of pesticides from the market
      • Availability of laundry facilities
      • Provision of rehabilitation facilities
4. Pregnancy/reproductive problems
   1. Birth defects
   2. Surveillance of miscarriages - how to do?
   3. 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
5. Heat stress and Personal Protective Equipment
   1. Equipment modification to reduce heat stress
   2. Worker training
   3. Diagnostic indicators to distinguish heat vs. poisoning
   4. Extended use of PPE for early entry
   5. Patterns of fluid consumption when temperature is greater than 85 degrees
6. Greenhouse industry hazards
   1. Extent of exposure/compare the risk with other agricultural jobs
   2. Ventilation/air quality
   3. Effectiveness of PPE
   4. Occurrence of pesticide illness
7. Untrained workers who mix/load/apply pesticides
   1. Extent of problem/acute and chronic health problems
   2. Worker knowledge/extent of training
   3. Consistency of PPE use/compare PPE footgear vs. leather boots
   4. Survey farmers re: risk/beliefs
8. Unknown problems with cholinesterase inhibitors
   1. Effect on drinking water
   2. Need for worker education on risk
   3. Central nervous system changes - "expert" post-poisoning evaluations almost always reject cause/effect relationship because no objective CNS deficits
   4. Connection to Parkinson's disease
   5. Connection to muscular dystrophy
   6. Neurologic consequences of chronic exposure
   7. Immunologic effects
   8. Post-poisoning toxic syndrome
      • Mechanism
      • Incidence
      • Treatment
9. Pesticide drift
   1. Train all farm workers
   2. Access to chemical information

Priority #3: Traumatic Injuries

1. Serious Injuries - death and disability
   1. Transportation-related/motor vehicle accidents
   2. Farm machinery-related/mangling injuries
   3. Electrocutions
   4. Ladder injuries
   5. 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
2. Workers' Compensation
   1. Compare states with farm worker coverage to states without farm worker coverage
   2. Evaluate reliability of the data
      Issues included:
      • Measure of extent to which workers' comp underestimates true prevalence of specific injuries
   3. Lack of or inadequate compensation for injury
   4. Acute vs. chronic conditions
   5. Additional points
      • Availability of treatment
      • Child labor
      • Problems leading to injury: lack of parental supervision, conditions in and around labor camps
3. Child safety in fields, homes
   1. Prevention: day care, schools to educate parents, children; public education campaign
   2. Number of injuries
   3. Other points
      • Availability of treatment
      • Child labor
      • Problems leading to injury: Lack of parental supervision, conditions in and around labor camps
4. Effectiveness of interventions
   1. Safety programs tied to lower premiums
   2. Transportation safety measures
   3. Workers' Compensation - a built in intervention?
   4. 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
5. Study of disabled workers
   1. Extent of problem
   2. Binational study
   3. Access to benefits/extent of involvement of clinics and government agencies
   4. Personal and societal costs
   5. Cross-sectional study of 50 year-old males
6. Pregnancy/reproductive problems
   1. Surveillance of miscarriage - how to do?
   2. Other Points
      • Birth Defects
      • Sterility
      • Complications/stillbirth
      • Worker training
      • Public education
7. Personal and societal costs
8. • Lost work days and wages
   • Permanent/serious disabling conditions and medical costs
   • Losses to families
   • Physical abuse/crowding
   • Estimate costs
9. 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

1. Nursery/greenhouse workers
   • Prevalence and occurrence
   • Provider training
2. Effectiveness of interventions
   1. Lung disability-change environment
   2. Lung disability-rehabilitation
   3. Prevention
3. Cotton pesticide defoliant
   • Prevalence and occurrence
   • Provider training
4. Sulfur dust used on table grapes
   • Prevalence and occurrence
   • Provider training
5. Apple thinners' exposure to pesticides (particularly residues)
   • Prevalence and occurrence
   • Provider training
   • Compare with organic orchards
   • Occurrence of allergic rhinitis/sinusitis
6. Hops asthma
   • Prevalence and occurrence
   • Provider training
7. 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

1. 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
2. Caused by plants - peaches, strawberries, poinsettias
3. • Prevalence
   • Clinic provider training
   • Work-related - should be covered by workers' compensation
4. In nursery industry
   • Prevalence
   • Clinic provider training
   • Extent of exposure and dermatitis
   • High-risk activities
   • Preventive measures
5. Urticaria (hives)
   • Prevalence
   • Provider awareness
6. Effectiveness of Interventions
   • Changing restricted entry intervals
   • Methods to decrease plant-caused dermatitis
   • How to measure?
   • Relation to availability of sanitation
7. Other
   • Insect, mosquito, bacteria & fungus control
   • Ringworm, scabies, lice, mosquitoes, fleas, chiggers
   • Systemic exposure to some degree in many cases

Priority #6: Water Quality

1. Contaminated drinking water (in housing, wells, other water sources)
   1. Fecal coliforms
   2. Pesticides
   3. Fertilizers/nitrates
   4. Other
      • Arsenic in areas with lead arsenate use
2. Field Sanitation
   • Extent of potable water
   • Access to facilities
   • Exclusions from provisions
3. Urinary tract infections
   • Prevalence
   • Link to access to sanitation
   • Water not available
   • Time not allowed to use facilities
   • Restrooms not proper for human use
4. Effectiveness of interventions
   1. Field sanitation facilities
   2. Other ideas
      • Extent of voluntary compliance/enforcement of regulations
      • Field worker feedback
      • Water system improvements

Priority #7: Infectious Diseases

1. Field sanitation-related
   1. Facilities unavailable/inaccessible for workers
      Issues included:
      • Mechanized picking - workers unable to take bathroom breaks
      • Facilities too far from workers for them to be able to use
      • Low employer compliance with field sanitation standard
   2. Heat Stress - water/fluid consumption patterns
   3. Urinary tract infections in women
2. Tuberculosis
   1. Overcrowded housing
   2. Overcrowded transportation
      • Screening by clinics or health department outreach
      • Workers with home base in Mexico
3. Housing-related
   • Living as occupational hazard
   • Lack of indoor plumbing, insufficient bathroom facilities, and insects/mosquito control
   • Prevalence
   • Management by state vs. private sector
4. Rodent and vector control/zoonoses
   • Prevalence
5. Sexually transmitted diseases (STDs)
   1. male-only labor camps
   2. Drug/alcohol abuse as contributing factor
   3. Homosexual behavior
      • Prostitution, STD patterns/prevalence HIV locally
6. Effectiveness of Interventions
   • Extent of voluntary compliance & enforcement of regulations
   • How to measure
   • Media
7. Underreporting of communicable diseases
   • Prevalence

Priority #8: Cancer

1. Breast
   • Link with estrongenic pesticide
   • Measure intervention
2. Leukemia
   • Link with pesticide exposure
   • Measure prevalence - National Cancer Institute
   • Population studies - National Cancer Institute
3. Childhood
   • Leukemia and farm worker children
   • Brain cancer and farm worker children
   • NCI data
   • Cancer cluster follow-up
4. Other
   • National descriptive cancer study
     • Prioritize epidemiological studies
     • Investigate and establish occupational linkages
   • Skin Cancer
     • Measure prevalence
     • Evaluate intervention

Priority #9: Eye Conditions

1. Chronic conjunctivitis/inflammation
   • Prevalence
   • Provider awareness
   • Prevention
2. Measure extent to which workers' compensation underestimates the prevalence of eye conditions
   • Prevalence
   • Provider awareness
   • Prevention: ultraviolet sunglasses and workers' compensation
3. Pyergyia (membranous growths on the eyes)
   • Prevalence
   • Provider awareness
4. Effectiveness of interventions
   1. Use of goggles in thinning
   2. Comment (not ranked)
      • Other preventive measures, such as hats

Priority #10: Mental Health

1. Surveys for prevalence
   • Depression and pesticide exposure
   • Measure need
   • Measure provider awareness
2. Link with occupation?
   • Association with pesticide exposure or poisoning
   • Effect on occupational stress
   • Link between mental health condition and increased occupational injury
   • Various factors contributing to severe mental stress such as lack of money, drugs/alcohol, housing, food shortages
   • Measure need
   • Provider awareness
   • Somatoform pain disorder - post injury
3. Stress and link to domestic violence
   • Measure need
   • Measure provider awareness
4. Effectiveness of interventions
   • Clinic access to services (mental health hours)

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NOTE: This document is provided for historical purposes only.

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