Deepening the Divide: Health Inequities and Climate Change among Farmworkers.

Climate change amplifies social inequities, disproportionately impacting the health and well-being of populations already vulnerable to social risk factors associated with race, ethnicity, immigration status, and occupation. Recent hurricanes, extreme temperatures, wildfires, and droughts have directly impacted vulnerable populations, including farmworkers in the US and its territories. Understanding how systems increase poor health outcomes for farmworkers is important to create solutions that are practical, feasible, and sustainable. In this commentary, we discuss a framework to assess the climate crisis and its impact on farmworkers. Although environmental stressors impact all populations, the difference in the systems or structures surrounding individuals can increase the risks and diseases of vulnerable populations when responding to the effects of the climate crisis. This framework presents policies and systems that could be limiting for agricultural workers when exposed to environmental stressors and the direct or indirect consequences of not addressing them.

Pesticides and environmental injustice in the USA: root causes, current regulatory reinforcement and a path forward.

Many environmental pollutants are known to have disproportionate effects on Black, Indigenous and People of Color (BIPOC) as well as communities of low-income and wealth. The reasons for these disproportionate effects are complex and involve hundreds of years of systematic oppression kept in place through structural racism and classism in the USA. Here we analyze the available literature and existing datasets to determine the extent to which disparities in exposure and harm exist for one of the most widespread pollutants in the world - pesticides. Our objective was to identify and discuss not only the historical injustices that have led to these disparities, but also the current laws, policies and regulatory practices that perpetuate them to this day with the ultimate goal of proposing achievable solutions. Disparities in exposures and harms from pesticides are widespread, impacting BIPOC and low-income communities in both rural and urban settings and occurring throughout the entire lifecycle of the pesticide from production to end-use. These disparities are being perpetuated by current laws and regulations through 1) a pesticide safety double standard, 2) inadequate worker protections, and 3) export of dangerous pesticides to developing countries. Racial, ethnic and income disparities are also maintained through policies and regulatory practices that 4) fail to implement environmental justice Executive Orders, 5) fail to account for unintended pesticide use or provide adequate training and support, 6) fail to effectively monitor and follow-up with vulnerable communities post-approval, and 7) fail to implement essential protections for children. Here we've identified federal laws, regulations, policies, and practices that allow for disparities in pesticide exposure and harm to remain entrenched in everyday life for environmental justice communities. This is not simply a pesticides issue, but a broader public health and civil rights issue. The true fix is to shift the USA to a more just system based on the Precautionary Principle to prevent harmful pollution exposure to everyone, regardless of skin tone or income. However, there are actions that can be taken within our existing framework in the short term to make our unjust regulatory system work better for everyone.

Healthcare worker perspectives on COVID-19 vaccines: Implications for increasing vaccine acceptance among healthcare workers and patients.

OBJECTIVE: To understand COVID-19 vaccine perspectives among healthcare workers serving diverse communities. METHODS: A dual English/Spanish survey was distributed to healthcare workers in the United States from 3/12/2021-4/22/2021 by the Migrant Clinicians Network, Society of Refugee Healthcare Providers, a Federally Qualified Healthcare Center, and social media advertisement to general primary care workers. RESULTS: 517 responses were at least 50% complete and included in the analysis. Among these, 88% (457/517) indicated vaccine acceptance. Factors associated with acceptance included not reporting any vaccine concerns, identifying as male, ≥65 years of age, being a physician or advanced practice provider, and interacting directly with patients from refugee, immigrant, and migrant (RIM) communities. Participants identified educational information as most helpful for themselves when making a vaccine decision, but a healthcare provider's recommendation as most helpful for their patients. CONCLUSION: Healthcare workers, especially those serving RIM communities, are vaccine accepting. Tailoring vaccine-related information to healthcare workers may improve vaccine confidence for both themselves and patients who rely on them for information.

Comparative Effectiveness of Training Alternatives for the EPA's Worker Protection Standard Regulation Among Immigrant Latino Farmworkers.

OBJECTIVES: To determine the comparative effectiveness of two EPA-approved WPS training strategies. METHODS: Farmworkers in GA and FL blinded to content before training (N = 339) were randomly assigned to either a video training (n = 121) or a culturally tailored, facilitator-led training (n = 136), or an attention-placebo training focused on heat-related illness (n = 82). Data were obtained immediately before and after training and 3 months after training. RESULTS: Both active interventions increased pesticide knowledge. At the 3-month follow-up, participants in the EPA video lost acquired knowledge. Those in the facilitator-led group retained acquired knowledge and showed greater pesticide safety behavior. CONCLUSIONS: Standardized training through video improves short-term knowledge, but it is not retained and unable to support desired behavior to reduce pesticide exposure among farmworkers. A culturally tailored, facilitator-led training is more effective in achieving the spirit of the WPS regulation.

COVID-19 Awareness and Preparedness of Minnesota and Wisconsin Dairy Farms.

Dairy farms that had participated in previous and ongoing projects with the National Farm Medicine Center (NFMC), Migrant Clinicians Network (MCN), and Upper Midwest Agricultural Safety and Health Center (UMASH) were asked to participate in a 17-question survey by phone or email to investigate biosecurity principles on Minnesota and Wisconsin dairy farms in response to COVID-19 and the effects of the pandemic on the dairy industry. Three additional farms were recruited via a press release published in agricultural newsletters. Of 76 farms contacted, 37 chose to participate in this study from June to July 2020. In response to the COVID-19 pandemic, dairies have implemented or increased biosecurity measures and COVID-19 precautions. Dairies reported adequate personal protective equipment for their workers, though face masks were not required on most dairies (n = 32, 86%). Producers were concerned about the safety of their families, maintaining a healthy workforce, and keeping their farms profitable. Access to healthcare was not perceived to be an issue for their workers. One-quarter of dairies reported COVID-19 infections on their farms. Even though the majority had an isolation protocol in place if someone on the farm were to become ill, less than half of respondents felt their farm was protected against COVID-19. Two-thirds of producers have not had to decrease production, and a majority of operations have not furloughed or terminated employees due to COVID-19. Our data suggest that dairy farms in Minnesota and Wisconsin have implemented biosecurity and safety measures in response to COVID-19. These measures can be improved. Farms would benefit from additional guidance and education on implementation of personal protective measures and disease prevention strategies to keep workers employed and safe.

Ensuring COVID-19 Vaccines for Migrant and Immigrant Farmworkers.

Migrant and immigrant farmworkers are cornerstones to food security and production in many nations. In the United States, farmworkers have been disproportionately impacted by COVID-19. Because they are considered essential workers, vaccines may be made imminently available to them and offer an opportunity to reduce these COVID-19-related impacts. It is essential for a successful vaccination campaign to address the unique challenges arising from this workforce's inherently mobile nature and limited access to healthcare. Proposed strategies to overcome these challenges include ensuring farmworkers are prioritized in vaccine allocation and provided cost-free vaccines at convenient locations through partnerships among health authorities, community- and faith-based groups, and health centers with trusted community relationships. Further, a portable immunization record should be used, and coordination of care continued when a farmworker moves to a new geographic location. If implemented well, vaccinating farmworkers can reduce the COVID-19 disease burden among these essential workers, improve public health, and protect food and agriculture production.

Partnerships as an Avenue to Translate Emerging Disease Ecology of SARS-CoV-2 to Agricultural Groups.

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and associated coronavirus disease 19 (COVID-19) has brought farmers and farmworkers the designation of "essential", while placing them into heightened vulnerability for the disease. Many factors diminish access to education and prevention technologies emerging to combat COVID-19. For farmers, advanced age and rural location play a part. Farmworkers encounter numerous additional barriers including language and cultural differences, socioeconomic pressures, and immigration status. The unusual persistence and multiple transmission pathways of SARS-CoV-2 emerging from ongoing scientific study require customization of otherwise standard prevention messaging to farmers and farmworkers to prevent infection and disease exacerbation. AgriSafe Network and Migrant Clinicians Network, both national organizations and major stakeholders in agricultural health, are on the front lines of translating science into practical prevention strategies for those providing health services to farmworkers and farmers. The partnerships pursued provide a blueprint for quickly translating emerging disease ecology to support the health of agricultural populations during the COVID-19 pandemic.

The COVID-19 Impact on Childcare in Agricultural Populations.

The corona virus pandemic pulled back the curtain on rural America's already fragile childcare system and shed light on the critical role that quality, affordable, accessible childcare plays in the lives of workers and families, as well as in the success of agricultural businesses. This commentary aims to describe how existing childcare problems were exacerbated by the COVID-19 pandemic, potentially impacting both the health and economics of farm households and farmworker families. For solutions to be successful, efforts will need to be collaborative, with federal interventions spurred on by childcare stakeholders. Successful collaborations will result in a better childcare system that nurtures children while their parents contribute to our nation's production of agricultural products.

Attending to Pesticide Exposure and Heat Illness Among Farmworkers: Results From an Attention Placebo-Controlled Evaluation Design.

OBJECTIVE: The aim of this study was to determine the effectiveness of curricula for improving knowledge and attitudes pertaining to pesticide exposure and heat illness among immigrant Latino farmworkers. METHODS: A pesticide safety curriculum informed by the revised Worker Protection Standard (WPS) was tested against an attention placebo-controlled curriculum (heat illness) in a sample of Latino farmworkers (N = 127). RESULTS: Pesticide safety knowledge increased in the overall sample, but did not differ by curriculum assignment. Pesticide safety behavioral intentions increased among participants in the pesticide safety curriculum but decreased among those in the other curriculum (P < 0.05). Heat illness knowledge and behavioral intentions increased more for farmworkers assigned to the heat illness than the pesticide safety curriculum. CONCLUSION: The developed curricula show good promise for meeting the spirit of the revised WPS and for reducing the burden of heat-related fatality and morbidity among Latino farmworkers.

Aplicación de la teoría de aprendizaje en el entrenamiento acerca de seguridad y salud para trabajadores inmigrantes en las lecherías.

Resumen Con el propósito de prevenir lesiones y enfermedades ocupacionales, diseñamos un currículo de seguridad y salud para trabajadores inmigrantes en la industria lechera para aumentar el conocimiento, fomentar prácticas de seguridad, y reducir inequidades en la comunicación. El currículo se basa principalmente en la Taxonomía para el Aprendizaje Significativo-TAS ( Taxonomy of Significant Learning) e incorpora teorías de la conducta y de aprendizaje para adultos, así como también los principios de control de riesgos ocupacionales. Los entrenamientos se implementaron con 836 trabajadores de habla hispana de 67 lecherías en el estado de Wisconsin, en los Estados Unidos. El 67% de los trabajadores reportaron nunca haber recibido entrenamiento acerca de la seguridad en las lecherías, el 65% reportó haber trabajado en lecherías durante 5 años o menos, y el 26% de los trabajadores reportaron haber sufrido alguna lesión mientras trabajaban en la lechería. La evaluación cuantitativa y cualitativa de los entrenamientos sugiere que nuestro currículo efectivamente aumentó el conocimiento y fomentó la contemplación de prácticas de seguridad de los trabajadores. El aumento del conocimiento en general del 25% es estadísticamente significativo (p < .01). Los trabajadores recordaron al menos un concepto clave del contenido, expresaron sentirse confiados en adoptar al menos una conducta de seguridad, y mencionaron su intención de comunicar sus preocupaciones de seguridad a sus jefes en la lechería. De acuerdo a nuestro conocimiento, esta es la primera vez que se aplica la TAS en la educación acerca de seguridad y salud ocupacional. Este currículo puede ayudar a los productores en la industria lechera a cumplir con el entrenamiento anual de los trabajadores requerido por la Administración de Seguridad y Salud Ocupacional de los E. U. ( Occupational Safety and Health Administration-OSHA), ofreciendo este entrenamiento básico en seguridad y salud a sus trabajadores durante su etapa inicial de empleo.

An overview and impact assessment of OSHA large dairy local emphasis programs in New York and Wisconsin.

BACKGROUND: Farming has been exempted from most labor regulations and shielded from regulatory scrutiny by the Occupational Safety and Health Administration (OSHA). Yet, agriculture and dairy in particular, has relatively high injury and fatality rates. METHODS: A recent shift in OSHA's approach to agricultural worker safety and health includes two dairy-focused Local Emphasis Programs (LEPs), one launched in Wisconsin in 2011 and the other in New York in 2014. We examine data from LEP-related, OSHA consultations and inspections as well as non-governmental audit programs, and review farmer perceptions about the LEP. RESULTS: Inspections conducted by OSHA and private consultation programs highlight the presence and variety of hazards on dairy farms in Wisconsin and New York. CONCLUSION: The LEPs helped raise dairy producers' awareness of inherent hazards and methods to correct them. Farmers cited the LEP as beneficial, identifying it as a catalyst to reduce hazards on their farms.

Occupational Health in Community Health Centers: Practitioner Challenges and Recommendations.

Primary care clinicians may be the only source of occupational healthcare for many low-wage, high-risk workers who experience disproportionate occupational hazards. The authors explored barriers to providing occupational healthcare and recommendations for overcoming these challenges. The team conducted six focus groups and eleven key-informant interviews in two community health centers and among clinicians, community health workers, and other personnel from similar settings. Clinicians reported not utilizing occupational information during clinical encounters and identified competing priorities, limited appointment time, and lack of training as key barriers. They cited workers' compensation as a source of confusion and frustration. However, most participants recognized occupation as an important social determinant of health and expressed interest in additional training and resources. Participants agreed that referral mechanisms for occupational medicine specialists and worker centers and changes in quality performance measures and electronic health records would be useful and that workers' compensation and immigration policies need reform.

Using the Socio-Ecological Model to Frame Agricultural Safety and Health Interventions.

The Socio-Ecological Model (SEM) is a conceptual framework depicting spheres of influence over human behavior that has been applied in public health settings for nearly five decades. Core principles of all variations of the SEM are the multiple influences over an individual's behaviors, the interactions of those influences, and the multilevel approaches that can be applied to interventions intended to modify behaviors. A project team modified the standard SEM to address interventions for protecting children from agricultural disease and injury. The modified SEM placed the "child in the farm environment" at the core with five interrelated levels (spheres) of influence over the child. This framework provides guidance on how a multifaceted, multilevel intervention can maximize the potential for impact on behaviors and decisions made by parents/adults responsible for the safety of children on farms. An example of how this model could work to safeguard youth operating tractors is provided.

Employers' Perspective on Childcare Services for Hired Farm Workers.

The goal of this project was to protect children while parents work in agriculture by improving off-farm services for children of migrant and seasonal farm workers. Large agricultural enterprises have policies forbidding children in the worksite. At the same time, their employees, who are trying to generate income, seek as many work hours as possible but often lack viable options for childcare services. As employers strive to increase their labor pool, and workers seek off-farm childcare, there is mutual interest in improving access to childcare services in agricultural regions dependent on large numbers of full-time and seasonal workers. This report describes the employers' perspectives on childcare needs of hired farm workers' families and their barriers and motivators to facilitating off-farm childcare services. Using descriptive survey research methodology, data were collected from a convenience sample of 102 agribusiness owners and Human Resource directors attending an agricultural conference regarding labor laws or personnel management. Results revealed significant differences for those companies employing more than 25 workers compared to their counterparts. Primary motivators for offering childcare as an employment benefit were improved employee morale, enhanced company reputation, and a more stable workforce. A major barrier was that half of large-scale enterprises lack guidance on how to provide childcare options for their workers. Survey results are being used to facilitate collaboration among employers, farm workers, and childcare providers to offer a safe, nurturing environment for children while their parents work in agriculture.

Caring for Children While Working in Agriculture-The Perspectiveof Farmworker Parents.

Access to safe, off-farm childcare is often a challenge for farmworkers with young children and is likely to become an increasingly salient barrier as more agricultural workers migrate together with families and as the number of women entering the agricultural workforce increases. Agriculture is one of the most hazardous industries, and the presence of young children in the workplace puts them at risk. To better understand the current nature of childcare for farmworker families and the challenges to accessing services, this project facilitated in-person surveys with 132 parents in three communities in Florida. A convenience sample that intentionally targeted parents living and working in areas with limited access to Migrant and Seasonal Head Start facilities was used to recruit participants. Most participants reported childcare access as a challenge. They expressed a desire to work in an area based on childcare availability. These findings offer agribusiness leaders important data to consider. They also suggest that industry support of childcare may be an important workforce investment. Findings indicate that high quality, affordable off-farm childcare services could serve as a means for attracting farmworkers to regions currently experiencing labor shortages. Additional research is warranted to explore this subject in diverse geographic areas.

Applying Learning Theory to Safety and Health Training for Hispanic Immigrant Dairy Workers.

We designed a safety and health curriculum for dairy immigrant workers aiming to increase knowledge, encourage safe behavior, and reduce worker communication inequalities to prevent occupational injury and diseases. The design is largely based on the Taxonomy of Significant Learning and incorporated behavioral and adult learning theories and principles of occupational hazard control. Trainings were implemented with 836 Spanish-speaking workers from 67 farms in Wisconsin. Sixty-seven percent of workers reported never being trained before in dairy safety, 65% of these worked in dairy for 5 or fewers years, and 26% of workers reported being ever injured while working on dairy. Quantitative and qualitative evaluation of the trainings suggest that our curriculum successfully increased worker knowledge and promoted contemplation of safe practices. The overall knowledge gain of 25% was statistically significant ( p < .01). Workers recalled at least one key concept, expressed confidence of adopting at least one safety behavior, and mentioned their intention to communicate safety concerns to farmers. To our knowledge, this is the first Taxonomy of Significant Learning application to occupational safety and health education. Our curriculum can support dairy farmers' compliance with Occupational Safety and Health Administration's annual training requirements by providing our basic safety and health training to workers at early job stages.

Immigrant dairy workers' perceptions of health and safety on the farm in America's Heartland.

BACKGROUND: Dairy farming is dangerous. Yearly, farms grow fewer and larger by employing immigrant workers, who have limited industrial agriculture experience and safety and health training. METHODS: We examined results of five focus groups with 37 Hispanic, immigrant dairy workers. Analysis followed a grounded theory approach and employed ATLAS.ti. RESULTS: Reported injury experience affirmed the hazardous nature of dairy. Some workers received appropriate worker compensation benefits, whereas others were instructed to deny work-relatedness. Some employers covered medical injury costs out-of-pocket, whereas others did not. Cows were a major injury source. Pressure to work and weather were noted as injury risk factors. Worker compensation was poorly understood, and immigration status and fear of deportation influenced injury and hazard reporting. CONCLUSION: Injury management practices range from benevolent to threatening. Workers compensation is poorly understood and undocumented status is an occupational hazard. We underscore the need for further research and immigration policy change.