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"The Global Report on Internal Displacement presents the latest information on internal displacement worldwide caused by conflict, violence and disasters."

This 90-minute webinar was created for physicians, nurses, and other health professionals who treat and case manage patients with active TB.  The webinar introduced the 2016 Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis.  This training highlighted the guidelines development process, the key changes in recommendations, and discussed the evidence supporting the changes.  The webinar was originally presented on November 4, 2016. This training was jointly sponsored by all 5 RTMCCs.

The 1999–2013 United States Cancer Statistics (USCS): Incidence and Mortality Web-based Report includes the official federal statistics on cancer incidence from registries that have high-quality data, and cancer mortality statistics. It is produced by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI). This report shows that in 2013, 1,536,119 Americans received a new diagnosis of invasive cancer, and 584,872 Americans died of this disease (these counts do not include in situ cancers or the more than 1 million cases of basal and squamous cell skin cancers diagnosed each year).

This year’s report features information on invasive cancer cases diagnosed during 2013, the most recent year of incidence data available, among residents of 49 states, six metropolitan areas, and the District of Columbia—geographic areas in which about 99% of the U.S. population resides. Incidence data are from CDC’s National Program of Cancer Registries (NPCR) and NCI’s Surveillance, Epidemiology, and End Results (SEER) Program. Data from population-based central cancer registries in these states and metropolitan areas meet the criteria for inclusion in this report.

The report also provides cancer mortality data collected and processed by CDC’s National Center for Health Statistics. Mortality statistics, based on records of deaths that occurred during 2013, are available for all 50 states and the District of Columbia.

The report also includes incidence rates and counts for Puerto Rico for 2009 through 2013 by sex and age, as well brain tumor and childhood cancer data.

USCS data are presented in the following applications—


The National LGBT Health Education Center provides educational programs, resources, and consultation to health care organizations with the goal of optimizing quality, cost-effective health care for lesbian, gay, bisexual, and transgender (LGBT) people.

ADAO is the largest independent nonprofit in the U.S. dedicated to preventing asbestos exposure, eliminating asbestos-related diseases, and protecting asbestos victims' civil rights through education, advocacy, and community initiatives. 

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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Part 5 of the 6 webinar series: Essential Clinical Issues in Migration Health

DATE RECORDED: June 5, 2014
PRESENTED BY: Katherine Brieger, RD and Elizabeth Magenheimer

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Participant Evaluation  

Presentation Slides (PDF)

To receive CME* or CNE credit after viewing any of these webinars you must do the following:
  • Complete the Participant Evaluation associated with each webinar
  • Send an email with your first and last name stating which webinar you completed to

Diabetes continues to be one of the most common and challenging health condition confronting migrants and other underserved populations. It is clear that a healthy lifestyle is critical to mitigating the impact of diabetes on individuals and the population, however effective and appropriate interventions can be difficult to design. Fairhaven Community Health Center in Connecticut and Hudson River Healthcare in New York, are two health centers that have long led the way in creating culturally appropriate lifestyle programs for migrants and other underserved patients. In this session the presenters will discuss lessons learned from the development of a variety of programs for diabetics and other patients including a community garden, nutrition classes, cooking classes, weight management and strategies to encourage exercise. The session will address the clinical core measures related to nutrition and BMI and will also discuss current research test second line drug effectiveness in Type 2 DM. Available in English

Learning Objectives:

  1. Describe culturally appropriate diabetes intervention strategies
  2. Identify strategies to address clinical core competencies related to nutrition and BMI to improve quality care.
  3. Receive “take home” examples of how to incorporate effective nutrition, weight loss, exercise and other health lifestyle strategies.



Download the Spanish Toolkit Materials

National Diabetes Information Clearinghouse,

Bright Bodies,

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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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
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 Online 21 February 2007

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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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