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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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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.

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 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.

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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Cancer statistics for Hispanics/Latinos, 2012 by Rebecca Siegel MPH, Deepa Naishadham MA, MS, Ahmedin Jemal DVM, PhD

Article first published online: 17 SEP 2012

Abstract

Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use. CA Cancer J Clin 2012;. © 2012 American Cancer Society.

New research out of Cornell University's College of Human Ecology found that low-income children of immigrants have much poorer health than low-income children of citizens, as reported in a special section of the journal Child Development.

This article describes an excellent integrated behavioral health program at a Federally Funded Health Center. The full abstract from the article is as follows: In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization’s unique circumstances inform the best approach for that particular organization, we highlight the clinical level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships.

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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 This research study was conducted on 8 dates of an annual flu shot clinic at the San Francisco General Hospital. Patients were offered flu shots as usual (control group) and on 9 other dates, patients were offered both flu shots and FOBT kits (intervention group). Researchers wanted to determine whether providing home fecal occult blood test (FOBT) kits to eligible patients during influenza inoculation (flu shot) clinics can contribute to higher colorectal cancer screening (CRCS) rates. The study concluded that offering FOBT kits during flu shot clinics dramatically increased the CRCS rate for flu shot clinic attendees. Pairing home FOBT kits with annual flu shots may be a useful strategy to improve CRCS rates in other primary care or public health settings.

An estimated 1.1 million people in the USA are living with HIV/AIDS.  Nearly 200,000 of these individuals do not know that they are infected.  In 2006, the CDC recommended that all healthcare providers routinely offer HIV screening to adolescent and adult patients.  Nurse-dentist collaborations present unique opportunities to provide rapid oral HIV screening to patients in dental clinic settings and reach the many adults who lack primary medical providers.  However, little is known about the feasibility and acceptability of this type of innovative practice. Thus, elicitation research was undertaken with dental providers, students, and patients. This paper reports the results of qualitative interviews with 19 adults attending a university-based dental clinic in New York City. Overall, patients held very positive attitudes and beliefs toward HIV screening in dental sites and identified important factors that should be incorporated into the design of nurse-dentist collaborative HIV screening programs.

Published by HRSA's MCHB in September 2011, the chartbook is based on data from the 2007 National Survey of Children's Health (NSCH). This is the second round of the survey; however, some questions were revised since the 2003 survey, and not all findings are comparable to those from the 2003 survey.

Indicators report on the health and well-being of children in rural areas, presenting information on the health status and risk and protective factors experienced by children on a National level.

 

The Place, Migration, and Health (PMH) network, a diverse group of researchers committed to understanding the links between migration processes and the health of migrants, their families.
The PMH website aims to generate and improve knowledge on the links between migration processes and the health of (im)migrants, their families, and their sending and receiving communities using across-national lens for research and policy.
The work of the researchers in the PMH network seeks to address knowledge gaps in areas critical for understanding the determinants of immigrant health and to inform intervention and policy opportunities to promote the the health of first-generation immigrants and their offspring.

The Place, Migration, and Health (PMH) network, a diverse group of researchers committed to understanding the links between migration processes and the health of migrants, their families.

The PMH website aims to generate and improve knowledge on the links between migration processes and the health of (im)migrants, their families, and their sending and receiving communities using across-national lens for research and policy.

The work of the researchers in the PMH network seeks to address knowledge gaps in areas critical for understanding the determinants of immigrant health and to inform intervention and policy opportunities to promote the the health of first-generation immigrants and their offspring.

The Applied Research Center released this report offering the first national data available on the perilous intersection of immigration enforcement and the child welfare system. ARC's Investigative Research package includes a poignant video and Colorlines.com articles which bring to life the story of one family trying desperately to stay together.

Issue Brief Co-Authored by Health Outreach Partners and the Kaiser Family Foundation
Information provided by the Kaiser Commission on Medicaid and the Uninsured

Publication Number: 8249
Publish Date: 2011-10-27

This brief examines how the Affordable Care Act (ACA) may impact immigrant families based on data collected from Outreach/Eligibility Workers in four regions of the country and supported by needs data from several health outreach programs around the country.  You will note that the pivotal role of Community Health Centers (CHCs)  to connect immigrant families to coverage and care is highlighted.  Migrant Health Centers and Homeless Health Centers are specifically cited because of their history of pioneering and strengthening many of the models and strategies that will be needed to connect immigrant families to health coverage and care come 2014.

Download report here.

This issue of Forced Migration Review, features an article about the Strengthening What Works initiative called "Preventing partner violence in refugee and immigrant communities." The article provides an overview of the Robert Wood Johnson Foundation initiative for readers in the humanitarian and public health sectors and features information about MCN's program Hombres Unidos.

This EPA report contains the latest estimates of agricultural and nonagricultural pesticide use in the United States.

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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.