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Surveillance of Hired Farm Worker Health and Occupational Safety

Appendix D: Project Designs and Methods

Priority #1: Regional/Local Studies

1. Community-wide, "house-to-house" surveys
   1. Get occupational information
   2. Include "unconventional" settings and baseline data
   3. Get cases not seeking medical care
2. Migrant health center/clinic-based
   1. Computerized
   2. Appropriate case-reporting mechanism - linked to action and appropriate follow-up
   3. Link local survey efforts with clinics for medical exam component
   4. Compare diagnoses to population baseline (e.g., thyroid disease)
3. Health outcomes - associations with exposures
   1. Causation
   2. Acute vs. chronic conditions
      • Longitudinal studies
      • Multi-site studies
   3. Need for control group
4. Use NIOSH Agricultural Safety and Health Centers to collect data
   • Collaborate with migrant health centers and community-based farm worker organizations
5. Use lay health advisors/community members who have trust of farm workers to gather data
6. Reach farm workers at health fairs that give free health services, disease screening
7. Observe geographic/temporal differences
8. Measure extent to which workers' compensation data underestimates true prevalence of specific conditions (e.g., eye problems)
   • Non-existent workers' compensation in states - publicize differences for farm workers vs. other workers
   • Compare regional differences in workers' compensation services
   • Explore effects of occupational medicine education courses (CMEs) on worker participation in workers' compensation systems

Priority#2: National / International Studies

1. National baseline data needed
   1. Create a National Agricultural Exposure Survey like the National Occupational Health Survey (NOHS)
   2. Assure representativeness of surveys
      • Observe geographic/temporal differences
      • Address unique living conditions (e.g., surveys done at state-run labor camps only capture one portion of the farm worker population)
   3. Correlate exposure surveillance with illness data
      • Link exposure to outcome. At individual level (may be later step)
   4. Use standard instrument like Farm Family Health Hazard Survey (FFHHS), National Health Information Survey (NHIS), and Hispanic Health and Nutrition Examination Survey (HHANES)
   5. Augment with information from lay health advisors/farm worker interviews
2. Clinic-based research for all categories of hazardous exposures
   1. Migrant health centers
   2. Appropriate case-reporting mechanism - linked to action and appropriate follow-up
   3. Occupational clinics
3. Health outcomes - associations with exposures
   1. Causation
   2. Acute vs. chronic conditions
      • Longitudinal studies
      • Multi-site studies
4. Build on Department of Labor's National Agricultural Workers Survey (NAWS)
   1. Do occupational health supplement
   2. Use to validate clinic-based surveillance, link with local surveys
   3. Get medical data on subsample of NAWS
   4. Add questions regarding farm labor contractors
   5. Investigate representativeness of NAWS
5. Household Surveys
   1. Get occupational information
   2. Include "unconventional" settings
   3. Baseline data
   4. Get cases not seeking medical care
6. Cross-border surveillance (i.e., US-Mexico/Central America)
   1. Link back to sending villages in Mexico to capture older population
   2. Collaboration among physicians in Mexico and the US
   3. Migrant Clinicians' Network binational tracking efforts
7. Use NIOSH Agricultural Safety and Health Centers to collect data
   1. Collaborate with migrant health centers and community-based farm worker organizations.
8. Measure extent to which workers' compensation data underestimate true prevalence of specific conditions (e.g., eye problems)
   • Prevalence of complaint at camps vs. clinic prevalence
9. Health surveillance on workers exposed to newly introduced agricultural products and new applications
   • Clinic surveillance and case descriptions
   • Symptom incidence and prevalence
   • Preventive studies directed at new agents

Priority #3: Special Populations

Two items received an equal rank.

1. Pregnant Women Hired Farm Workers
   1. Pesticide exposures
   2. Comments
      • Vulnerability to injuries especially in 2^nd and 3^rd trimesters of pregnancy
      • Border issues/pesticides used in each country
      • Effect of work on miscarriages
      • Effect of chemicals on pregnancy
1. Women of childbearing age
   • Recovery from injuries vs. men
   • Effect of work on miscarriages
   • Effect of chemicals on pregnancy
   • Access to contraception
2. Children
   1. Injuries
   2. Cancer
   3. Day care availability
3. Greenhouse workers
4. Disabled workers
   • Prevalence
   • "Job" when no longer able to do agricultural work
5. Tobacco workers - green tobacco sickness
   • Exposure to pesticides
   • Green tobacco illness
   • Accidents in the fields
6. Crab workers
7. Effectiveness of interventions
8. Orchard workers
   • Injuries with ladders
   • Exposure from foliage

Appropriate Data Sources for Farm Worker Surveillance and Research Projects

• NIOSH SENSOR (Sentinel Event Notification System for Occupational Risks) data from California, Oregon, Texas, and New York regarding pesticide poisonings
• NIOSH Agricultural Safety and Health Centers
• Bureau of Labor Statistics Survey
• Workers' Compensation Insurance national compilation of data
• Agricultural Census of 1992
  • Data for US and by state
  • Reports analyzing data from one or more years
• National Agricultural Workers Survey (NAWS) - US Dept of Labor
  • New quarterly fact sheets
  • Reports analyzing data from one or more years
• OSHA data on migrant housing and field sanitation inspections and enforcement actions
• Hospital discharge data
• Death Certificates
• Newsletters
  • RCAP/MESA newsletter
  • Migrant Health Newsline
  • Migrant Clinicians Network Streamline
  • University of California at Davis Agricultural Health and Safety Center
• Cancer registries
• Birth defect registries
• EPA Pesticide Farm Safety Center Final Report (1988)
• Lay health worker/promotores
• US Department of Agriculture/Easter Seal Society Agribility data
• Clinic-based surveillance - migrant health centers, occupational clinics
• Household surveys, including "unconventional" settings
• Emergency rooms
• EPA data (reports)
• Poison control centers
• State-based programs
  1. California pesticide use reports
  2. Department of Agriculture
  3. Health Department
     1. Field sanitation inspections
     2. Housing inspections
  4. Workers' Compensation Insurance
  5. Rehabilitation Services
• Compendium of national and state farm worker laws by Motivation, Education, and Training (MET) in Texas - published 1988
• Berkeley Planning Associates study of farm worker rehabilitation

Limitations of These Data Sources

• Do not provide adequate information on farm workers
  1. Prevalence of exposure and/or illness in migrant population
  2. Distribution of/by work tasks
  3. Need for data in special populations, e.g., pregnant women
  4. Incomplete or poor data may be worse than none (e.g., may look as though no problem exists)
• Do not address problems related to agriculture
• Exclude small farms
• Need to address the way exposed: skin, seasonal
• Need NIOSH Recommended Exposure Levels (RELs) for pesticides
• Sampling methods miss people
• NAWS done only three times per season and misses geographic areas
• 1992 Census of Agriculture is self-reported data, excludes crew leaders, etc.

This document is in the public domain and may be freely copied or reprinted.

NOTE: This document is provided for historical purposes only.

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