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This report captures important happenings in occupational health and safety from August 2013 through July 2014. Authoured by researchers from the George Washington University Milken Institute School Of Public Health, this resource focuses on workplace injury and illness statistics each spring and documents successes, challenges, and areas ripe for improvement in occupational health and safety.  

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Limited data document the multiple and repeated pesticide absorption experienced by farmworkers in an agricultural season or their risk factors.

Laboratory studies and case reports of accidental exposure to large amounts of chemicals indicate that there are immediate and long‐term negative health consequences of exposure to agricultural chemicals. 

The goal of this study was to describe acute occupational pesticide-related illnesses among youths and to provide prevention recommendations. Survey data from 8 states and from poison control center data were analyzed.

Concern about the adverse public health and environmental effects of pesticide use is persistent. Recognizing the importance of surveillance for acute occupational pesticide-related illness, we report on surveillance for this condition across multiple states. Between 1998 and 1999, a total of 1,009 individuals with acute occupational pesticide-related illness were identified by states participating in the SENSOR-pesticides program. 

In response to limitations in state-based occupational disease surveillance, the California Department of Health Services developed a model for surveillance of acute, work-related pesticide illness. The objectives were to enhance case reporting and link case reports to preventive interventions. Risk factors for pesticide illness were prevalent. 

The California Pesticide Illness Surveillance Program (PISP) is a major resource for pesticide illness epidemiology. This work attempts to improve characterization of pesticide illness in California, evaluate case ascertainment of the PISP and identify PISP’s limitations and biases for studying the incidence and epidemiology of pesticide-related illness. 

Public health surveillance for acute pesticide intoxications is discussed. Explanation of the goals, components and functions of population-based surveillance is provided with reference to key informational sources.

Pesticide Action Network, United Farmworkers of America, and California Rural Legal Assistance Foundation analyzed California government data on agricultural poisonings and enforcement of worker safety standards. Nearly 500 pesticide poisonings were reported for California farmworkers every year. The actual number of pesticide-related illnesses is unknown, since many poisonings go unreported. 

Surveillance data show that pesticide-related illness is an important cause of acute morbidity among migrant farm workers in California. Exposures occur in various ways (e.g., residues, drift), suggesting that the use of pesticides creates a hazardous work environment for all farm workers  Improved education for health care providers should be a priority. Growers should be educated about alternative forms of pest control and incentives should be provided to encourage their use.

Describes the growth from 1987 through 1996 of the Occupational Pesticide Poisoning Surveillance Program at the Texas Department of Health. The program was initially based on a Sentinel Event Notification System for Occupational Risks (SENSOR) model, using sentinel providers to report cases, supplementing the passive reporting by physicians that was required by law. 

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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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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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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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.

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

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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Barbara C. Lee PhD, Susan S. Gallagher MPH, Amy K. Liebman MPA, MA, Mary E. Miller RN, MN & Barbara Marlenga PhD (2012)Journal of Agromedicine, 17:2, 88-93ABSTRACT. In 1996 the US launched a National Childhood Agricultural Injury Prevention Initiative, guided by an action plan generated by a 42-member multidisciplinary committee. A major update to the plan was released following the 2001 Summit on Childhood Agricultural Injury Prevention. From the year 2010 through 2011 a comprehensive assessment of progress to date was conducted followed by the drafting, review and finalizing of a new action plan—“The 2012 Blueprint for Protecting Children in Agriculture.” This paper briefly describes the purpose and process for generating the new action plan then provides a listing of the 7 goals and 26 strategies within the plan. These goals and strategies account for trends in childhood agricultural injuries, changes in agricultural production and the demographics of its workforce, effectiveness of interventions, and the increasing use of social media, marketing and social networking. Primary funding for this  project was provided by the National Institute for Occupational Safety and Health (NIOSH), which continues to serve as the lead federal agency for the national initiative.

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American Journal of Public Health. October 2012, Vol 102, No. 10

Werner E. Bischoff, MD, PhD, Maria Weir, MAA, MPH, Phillip Summers, MPH, Haiying Chen, MD, PhD, Sara A. Quandt, PhD,
Amy K. Liebman, MPA, MA, and Thomas A. Arcury, PhD

Objectives. The purpose of this study was to assess water quality in migrant farmworker camps in North Carolina and determine associations of water quality with migrant farmworker housing characteristics. Methods. We collected data from 181 farmworker camps in eastern North Carolina during the 2010 agricultural season. Water samples were tested using the Total Coliform Rule (TCR) and housing characteristics were assessed using North Carolina Department of Labor standards. Results. A total of 61 (34%) of 181 camps failed the TCR. Total coliform bacteria were found in all 61 camps, with Escherichia coli also being detected in 2. Water quality was not associated with farmworker housing characteristics or with access to registered public water supplies. Multiple official violations of water quality standards had been reported for the registered public water supplies. Conclusions. Water supplied to farmworker camps often does not comply with current standards and poses a great risk to the physical health of farmworkers and surrounding communities. Expansion of water monitoring to more camps and changes to the regulations such as testing during occupancy and stronger enforcement are needed to secure water safety. (Am J Public Health. 2012;102: e49–e54. doi:10.2105/AJPH.2012.300738)

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The 2012 Blueprint for Protecting Children in Agriculture. Awarded 2013 Paper of the year by the International Society for Agricultural Safety and Health (ISASH), this National Action Plan takes an updated look at preventing childhood agricultural injury and death.

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The Alliance of Nurses for Healthy Environments (ANHE) is a network of nurses from around the country (and world) who are acting on the notion that our environment and health are inextricably connected. We are a group of nurses from all walks of our profession – hospital-based, public health, school-based, academics, and advanced practice, to name a few.   

We are helping to integrate environmental health into nursing education, greening our many workplaces, incorporating environmental exposure questions into our patient histories, providing anticipatory guidance to pregnant women and parents about environmental risks to children, implementing research that addresses environmental health questions, and advocating for environmental health in our workplaces and governmental institutions.