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The authors describe the growth of the Occupational Pesticide Poisoning Surveillance Program at the Texas Department of Health. The program was based on a Sentinel Event Notification System for Occupational Risks(SENSOR) model, using sentinel providers to report cases. The number of confirmed occupational cases increased from 9 workers in 1987 to 99 workers in 1996.

Matthew C. Keifer, MD, MPH; Iris Reyes, MPH; Amy K. Liebman, MA, MPA; Patricia Juarez-Carrillo, PhD, MPH.  Abstract. Audience response systems (ARS) have long been used to improve the interactivity of educational activities. Most studies of ARS have addressed education of literate trainees. How well these devices work with low-literacy subjects is not well studied. Information gathering on the training audience is an important use of ARS and helpful in improving the targeting of training information. However, obtaining demographic information from vulnerable populations with reasons to be concerned about divulging information about themselves has not been tested. In addition, a culturally competent method to effectively collect demographic and evaluation data of this growing population is essential. This project investigated the use of ARS to gather information from Hispanic immigrant workers, many of whom are socially vulnerable and have limited English proficiency (LEP) and low-literacy. Workers attended focus groups and were asked to use ARS devices or clickers to respond to questions. Questions were both catergorical (multiple choice) and open-ended numerical (text entry), and varied from simple queries to more sensitive points regarding immigration. Most workers answered the one-key response categorical questions with little difficulty. In contrast, some participants struggled when responding to numerical questions, especially when the response required pressing multiple clicker keys. An overwhelming majority of participants reported that the clickers were comfortable and easy to use despite the challenges presented by the more complex responses. The error rate increased as question complexity increased and the trend across three ordered categories of response complexity reached statistical significance. Results suggest that ARS is a viable method for gathering dichotomous or higher-order categorical information from LEP and low-literacy populations in a group setting while assuring anonymity. However, it is recommended that clickers be developed and tested with fewer, bigger, and more widely separated buttons, and less printing on the buttons for these populations. Further research is needed to determine the effectiveness of using clickers with simplified configurations in the workplace as a tool to collect data for surveys and assessments and to better engage LEP and low-literacy workers in training sessions. 

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Summary of Results from the California Pesticide Illness Surveillance Program - 2010.  

 The Department of Pesticide Regulation administers the California pesticide safety program, widely regarded as the most stringent in the nation.  Mandatory reporting of pesticide illnesses has been part of this comprehensive program since 1971.  Illness reports are collected, evaluated and analyzed by program staff.  PISP is the oldest and largest program of its kind in the nation; its scientists provide data to regulators, advocates, industry, and indivudal citizens.

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The CHAMACOS study is a longitudinal birth cohort study examining chemicals and other factors in the environment and children's health. 

In 1999-2000, CHAMACOS enrolled 601 pregnant women living in the agircultural Salinas Valley.  They are following their children through age 12 to measure their exposures to pesticides and other chemicals and to determine if this exposure impacts their growth, health, and development. 

Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to directly test the association of behavioral and environmental factors with pesticide exposure in this population.  This study seeks to identify factors potentially associated with pesticide exposure among farmworkers; grade the evidence in the peer-reviewed literature for such associations; and propose a minimum set of measures necessary to understand farmworker risk for pesticide exposure.   From: Environmental Health Perspectives

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Print, cut, and distribute this handy bookmark to providers who treat migrant and seasonal farmworker patients. The bookmark includes links and a qr code to connect you to pesticide - related clinical tools and resources. In addition, we've included some useful phone numbers in case of a pesticide emergency.

You can also use the bookmark to keep handy the Health Network phone number to be sure your patients on the move remain in care.

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A report prepared by researchers at The George Washington University School of Public Health and Health Services features a wealth of information on occupational health and safety and the migrant population, from farmworkers to fast-food chain employees to restaurant cooks and servers.

News release:
http://defendingscience.org/news/labor-day-looking-back-year-us-occupational-health-and-safety

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This webinar is the sixth in a series of seven in our Clinician Orienatation to Migration Health.

DATE RECORDED: Wednesday, July 17, 2013
PRESENTED BY: Candace Kugel, FNP, CNM, Specialist in Clinical Systems & Women's Health and Melissa Bailey, Executive Director of North Carolina Field, Inc.

To view the recorded version of this webinar, click here.

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Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,
Mark S. Crowley, Rosanna Barrett, Adolfo Correa, Sheila
Higgins, Hugo L. Leon, Jane Correia, Alan Becker,
Ruth H. Allen and Elizabeth Evans
doi:10.1289/ehp.9647 (available at http://dx.doi.org/)
Online 21 February 2007

Geoffrey M. Calvert, Walter A. Alarcon, Ann Chelminski,Mark S. Crowley, Rosanna Barrett, Adolfo Correa, SheilaHiggins, Hugo L. Leon, Jane Correia, Alan Becker,Ruth H. Allen and Elizabeth Evans

doi:10.1289/ehp.9647 (available at http://dx.doi.org/) Online 21 February 2007

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Introduction

In August of 2005, the North Carolina Division of Public Health, Occupational and Environmental Epidemiology Branch (OEEB) was notified that three women who had worked on farms in North Carolina owned by Ag-Mart had delivered infants with birth defects.  All three births took place in Florida where the women also worked on Ag-Mart farms and lived near each other.  This report summarizes the OEEB’s investigation and assessment of the pesticide exposures likely experienced by these women while in North Carolina. 

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California Poison Control System developed an online game that focuses on poison prevention through the use of "look-a-like" pills and candy. There are other resources on the site. The game is available as an app on itunes and in the android marketplace. Search for 'Choose your Poison.'

This website and training material were developed to give communities and promotores ways to help farm workers learn how to protect themselves from pesticide exposure.

The project and all materials on the website were developed by the California Poison Control System in collaboration with the the Western Center for Agricultural Health and Safety at the University of California, Davis and the California Department of Pesticide Regulation.

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Sherry L. Baron, MD, MPH, Sharon Beard, MS, Letitia K. Davis, ScD, EdM, Linda Delp, PhD, MPH, Linda Forst, MD, MPH, Andrea Kidd-Taylor, PHD, Amy K. Liebman, MPA, MA, Laura Linnan, ScD, Laura Punnett, ScD, and Laura S. Welch, MD

Background: Nearly one of every three workers in the United States is low-income. Low-income populations have a lower life expectancy and greater rates of chronic diseases compared to those with higher incomes. Low- income workers face hazards in their workplaces as well as in their communities. Developing integrated public health programs that address these combined health hazards, especially the interaction of occupational and non-occupational risk factors, can promote greater health equity.

Methods: We apply a social-ecological perspective in considering ways to improve the health of the low-income working population through integrated health protection and health promotion programs initiated in four different settings: the worksite, state and local health departments, community health centers, and community-based organizations.

Results: Examples of successful approaches to developing integrated programs are presented in each of these settings. These examples illustrate several complementary venues for public health programs that consider the complex interplay between work related and non work-related factors, that integrate health protection with health promotion and that are delivered at multiple levels to improve health for low-income workers.

Conclusions: Whether at the workplace or in the community, employers, workers, labor and community advocates, in partnership with public health practitioners, can deliver comprehensive and integrated health protection and health promotion programs. Recommendations for improved research, training, and coordination among health departments, health practitioners, worksites and community organizations are proposed.

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Carlos Eduardo Siqueira, MD, ScD, Megan Gaydos, MPH, Celeste Monforton, Dr PH, MPH, Craig Slatin, ScD, MPH, Liz Borkowski, BA, Peter Dooley, MS, CIH, CSP, Amy Liebman, MPA, MA, Erica Rosenberg, JD, Glenn Shor, PhD, MPP, and Matthew Keifer, MD, MPH

Background This article introduces some key labor, economic, and social policies that historically and currently impact occupational health disparities in the United States.

Methods We conducted a broad review of the peer-reviewed and gray literature on the effects of social, economic, and labor policies on occupational health disparities.

Results Many populations such as tipped workers, public employees, immigrant workers, and misclassified workers are not protected by current laws and policies, including worker’s compensation or Occupational Safety and Health Administration enforcement of standards. Local and state initiatives, such as living wage laws and community benefit agreements, as well as multiagency law enforcement contribute to reducing occupational health disparities.

Conclusions There is a need to build coalitions and collaborations to command the resources necessary to identify, and then reduce and eliminate occupational disparities by establishing healthy, safe, and just work for all.

Sara A. Quandt, PhD, Kristen L. Kucera, PhD, Courtney Haynes, MS, Bradley G. Klein, PhD, Ricky Langley, MD, Michael Agnew, PhD, Jeffrey L. Levin, MD, Timothy Howard, PhD, and Maury A. Nussbaum, PhD

Background Workers in the Agriculture, Forestry, and Fisheries (AgFF) sector experience exposures directly related to the work itself, as well as the physical environment in which the work occurs. Health outcomes vary from immediate to delayed, and from acute to chronic.

Methods We reviewed existing literature on the health outcomes of work in the AgFF sector and identified areas where further research is needed to understand the impact of these exposures on immigrant Latino workers in the southeastern US.

Results Outcomes related to specific body systems (e.g., musculoskeletal, respiratory) as well as particular exposure sources (e.g., pesticides, noise) were reviewed. The most extensive evidence exists for agriculture, with a particular focus on chemical exposures. Little research in the southeastern US has examined health outcomes of exposures of immigrant workers in forestry or fisheries.

Conclusion As the AgFF labor force includes a growing number of Latino immigrants, more research is needed to characterize a broad range of exposures and health outcomes experienced by this population, particularly in forestry and fisheries.

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Arthur L. Frank, MD, PhD, Amy K. Liebman, MPH, MA, Bobbi Ryder, BA, Maria Weir, MAA, MPH, and Thomas A. Arcury, PhD

 

 

Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in the
US is comprised primarily of Latino immigrants. Health care access for these workers
is limited and increases health disparities.

Background The Agriculture, Forestry, and Fishery (AgFF) Sector workforce in theUS is comprised primarily of Latino immigrants. Health care access for these workersis limited and increases health disparities.

 

Methods This article addresses health care access for immigrant workers in the AgFF Sector, and the workforce providing care to these workers.

 

Contents Immigrant workers bear a disproportionate burden of poverty and ill health and additionally face significant occupational hazards. AgFF laborers largely are uninsured, ineligible for benefits, and unable to afford health services. The new Affordable Care Act will likely not benefit such individuals. Community and Migrant Health Centers (C/MHCs) are the frontline of health care access for immigrant AgFF workers.C/MHCs offer discounted health services that are tailored to meet the special needs of their underserved clientele. C/MHCs struggle, however, with a shortage of primary care providers and staff prepared to treat occupational illness and injury among AgFF workers. A number of programs across the US aim to increase the number of primary care physicians and care givers trained in occupational health at C/MHCs. While such programs are beneficial, substantial action is needed at the national level to strengthen and expand the C/MHC system and to establish widely Medical Home models and Accountable Care Organizations. System-wide policy changes alone have the potential to reduce and eliminate the rampant health disparities experienced by the immigrant workers who sustain the vital Agricultural, Forestry, and Fishery sector in the US. Am. J. Ind. Med.

 

By Amy K. Liebman, MPA, MA, Melinda F. Wiggins, MTS, Clermont Fraser, JD, Jeffrey Levin, MD, MSPH, Jill Sidebottom, PhD, and Thomas A. Arcury, PhD

Background Immigrant workers make up an important portion of the hired workforce inthe Agricultural, Forestry and Fishing (AgFF) sector, one of the most hazardous industrysectors in the US. Despite the inherent dangers associated with this sector, workerprotection is limited.

Methods This article describes the current occupational health and safety policies andregulatory standards in theAgFF sector and underscores the regulatory exceptions and limitationsin worker protections. Immigration policies and their effects on worker health and safety arealso discussed. Emphasis is placed on policies and practices in the Southeastern US.

Results Worker protection in the AgFF sector is limited. Regulatory protections are generallyweaker than other industrial sectors and enforcement of existing regulations is woefullyinadequate. The vulnerability of the AgFF workforce is magnified by worker immigrationstatus. Agricultural workers in particular are affected by a long history of “exceptionalism”under the law as many regulatory protections specifically exclude this workforce.

Conclusions A vulnerable workforce and high-hazard industries require regulatoryprotections that, at a minimum, are provided to workers in other industries. A systematicpolicy approach to strengthen occupational safety and health in the AgFF sector mustaddress both immigration policy and worker protection regulations.

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CDC’s US-Mexico Unit (USMU) works to prevent the spread of infectious disease across borders and improve and promote the health of travelers, migrants, and other mobile border and binational populations. USMU’s main activities include collaborating on the US-Mexico Binational Technical Working Group, overseeing the operation of the Binational Border Infectious Disease Surveillance Program (BIDS), migrant health and binational tuberculosis programs, and international regulatory responsibilities. Their website on US-Mexico health provides a brief overview of the public health issues unique to the border region, our key partners, the guidelines for cooperation, and a resources page complete with health education/communication resources and publications.

To learn more, please visit http://www.cdc.gov/USMexicoHealth/index.html and check back for updates and a Spanish mirror site which should launch this summer.

The West Virginia Rural Health Research Center (WVRHRC) pursues a multi-disciplinary research effort directed to improve environmental health for rural populations. Collaborators from public health, geographic information systems, nursing, pharmacy, environmental science, health policy and other disciplines work together to conduct policy-relevant research to achieve this goal.

This study, conducted by the West Virginia Rural Health Research Center, identified the availability and characteristics of agricultural medicine training opportunities for health care professionals.  Agricultural workers and their families face numerous threats to health and safety, and yet there is limited information on health care expertise in place to recognize and prevent threats, and to diagnosis and treat agriculturally-related injury and illness.

Good article on cultural humility--basically the groundbreaking one used to propose the term

Journal of Health Care for the Poor and Underserved; May 1998; 9, 2; Research Library
Melanie Tervalon; Jann Murray-Garcia 

Objectives. We assessed implicit and explicit bias against both Latinos and

African Americans among experienced primary care providers (PCPs) and
community members (CMs) in the same geographic area.
Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizations
in the Denver, Colorado, metropolitan area completed Implicit Association
Tests and self-report measures of implicit and explicit bias, respectively.
Results. With a 60% participation rate, the PCPs demonstrated substantial
implicit bias against both Latinos and African Americans, but this was no
different from CMs. Explicit bias was largely absent in both groups. Adjustment
for background characteristics showed the PCPs had slightly weaker ethnic/racial
bias than CMs.
Conclusions. This research provided the first evidence of implicit bias against
Latinos in health care, as well as confirming previous findings of implicit bias
against African Americans. Lack of substantive differences in bias between the
experienced PCPs and CMs suggested a wider societal problem. At the same
time, the wide range of implicit bias suggested that bias in health care is neither
uniform nor inevitable, and important lessons might be learned from providers
who do not exhibit bias. (Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.
2012.300812)

This article from the American Journal of Public Health is on implicit bias.

Authors: Irene V. Blair, PhD, Edward P. Havranek, MD, David W. Price, MD, Rebecca Hanratty, MD, Diane L. Fairclough, DrPH, Tillman Farley, MD, Holen K. Hirsh, PhD, and John F. Steiner, MD, MPH

Objectives. We assessed implicit and explicit bias against both Latinos and African Americans among experienced primary care providers (PCPs) and community members (CMs) in the same geographic area.

Methods. Two hundred ten PCPs and 190 CMs from 3 health care organizationsin the Denver, Colorado, metropolitan area completed Implicit Association Tests and self-report measures of implicit and explicit bias, respectively.

Results. With a 60% participation rate, the PCPs demonstrated substantial implicit bias against both Latinos and African Americans, but this was no different from CMs. Explicit bias was largely absent in both groups. Adjustment for background characteristics showed the PCPs had slightly weaker ethnic/racial bias than CMs.

Conclusions. This research provided the first evidence of implicit bias against Latinos in health care, as well as confirming previous findings of implicit bias against African Americans. Lack of substantive differences in bias between the experienced PCPs and CMs suggested a wider societal problem. At the same time, the wide range of implicit bias suggested that bias in health care is neither uniform nor inevitable, and important lessons might be learned from providers who do not exhibit bias.

(Am J Public Health. 2013;103:92–98. doi:10.2105/AJPH.2012.300812)

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This web site houses a collection of information, contacts and resources to assist health practitioners in providing care to migrant farm workers. Although the primary intended audience is health care providers in Ontario, much of the information may be useful to other parties.

This website contains information on the 156 health centers that get federal funds to provide primary care to migrant and seasonal farmworkers regardless of immigration status. Most are part of community health centers that also receive additional federal funding to serve all low-income people. They offer services on a sliding fee scale.

A preliminary total of fatal work injuries recorded in the United States. According to results from the 
Census of Fatal Occupational Injuries (CFOI) program conducted by the U.S. Bureau of Labor
 Statistics.

At Workers' Comp Hub we provide basic information for workers with job-related injuries and illnesses. We also share resources to advance pro-worker advocacy and action.

The Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) provides for federal regulation of pesticide distribution, sale, and use. All pesticides distributed or sold in the United States must be registered (licensed) by EPA. Before EPA may register a pesticide under FIFRA, the applicant must show, among other things, that using the pesticide according to specifications "will not generally cause unreasonable adverse effects on the environment.''

Haz-Map® is an occupational health database designed for health and safety professionals and for consumers seeking information about the adverse effects of workplace exposures to chemical and biological agents. The main links in Haz-Map are between chemicals and occupational diseases. These links have been established using current scientific evidence.

Children encounter pesticides daily and have unique susceptibilities to their potential toxicity. Acute poisoning risks are clear, and understanding of chronic health implications from both acute and chronic exposure are emerging. Epidemiologic evidence demonstrates associations between early life exposure to pesticides and pediatric cancers, decreased cognitive function, and behavioral problems.
In this policy statement, the American Association of Pediatrics outlines the symptoms and suggested course of treatment for acute exposure pesticides belonging to the eight most predominant classes of pesticides. The policy statement also makes recommendations for both pediatricians and government to take measures to improve pesticide safety.
© AAP - 2012; This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors.

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The California Healthcare News regularly posts jobs around the state. Check back frequently for updated information.