Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project.

BACKGROUND: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers' compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. OBJECTIVE: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners' and managers' attitudes toward and barriers to adopting mobile health tools for themselves or their employees. METHODS: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. RESULTS: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. CONCLUSIONS: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company's human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software's impact on patients and employers.

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.

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.

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.

Blood α-synuclein in agricultural pesticide handlers in central Washington State.

Epidemiologic studies suggest that occupational exposure to pesticides might increase Parkinson disease risk. Some pesticides, such as the organophosphorus insecticide chlorpyrifos, appear to increase the expression of α-synuclein, a protein critically involved in Parkinson disease. Therefore, we assessed total blood cell α-synuclein in 90 specimens from 63 agricultural pesticide handlers, mainly Hispanic men from central Washington State, who participated in the state's cholinesterase monitoring program in 2007-2010. Additionally, in age-adjusted linear regression models for repeated measures, we assessed whether α-synuclein levels were associated with butyrylcholinesterase-chlorpyrifos adducts or cholinesterase inhibition measured in peripheral blood, or with self-reported pesticide exposure or paraoxonase (PON1) genotype. There was no evidence by any of those indicators that exposure to chlorpyrifos was associated with greater blood α-synuclein. We observed somewhat greater α-synuclein with the PON1-108T (lower paraoxonase enzyme) allele, and with ≥ 10 h of exposure to cholinesterase inhibiting insecticides in the preceding 30 days, but neither of these associations followed a clear dose-response pattern. These results suggest that selected genetic and environmental factors may affect α-synuclein blood levels. However, longitudinal studies with larger numbers of pesticide handlers will be required to confirm and elucidate the possible associations observed in this exploratory cross-sectional study.

Determinants of butyrylcholinesterase inhibition among agricultural pesticide handlers in Washington State: an update.

OBJECTIVES: Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are used widely in agriculture to manage insect pests of economic importance. Agricultural workers are more likely to suffer exposure because of the widespread use of OP/CBs in agriculture, and pesticide-related illnesses among handlers may be more severe when compared to other farm workers. The goal of this study was to identify occupational and personal characteristics associated with butyrylcholinesterase (BuChE) inhibition in participants recruited from the Washington State Cholinesterase Monitoring Program from 2006 to 2011. METHODS: We conducted a longitudinal study among agricultural pesticide handlers in Washington State during the OP/CB spray season (March-July) over a 6-year period (2006-2011). Linear mixed effects regression models were used to evaluate BuChE inhibition in relation to self-reported occupational and personal characteristics. RESULTS: Relative to pre-season baseline levels, the mean decrease in BuChE activity during the OP/CB spray season over all years of the study period was 3.77% (P < 0.001). Greater BuChE inhibition was observed among handlers who reported using multiple OP/CBs (ß = -2.70, P = 0.045), mixed or loaded OP/CBs (ß = -3.97, P = 0.002), did not store personal protective equipment (PPE) in a locker at work (ß = -3.4, P = 0.014), or did not wear chemical-resistant boots (ß = -16.6, P < 0.001). DISCUSSION AND CONCLUSIONS: The Washington State Cholinesterase Monitoring Program has provided a valuable opportunity to evaluate potential sources of OP/CB exposure among agricultural pesticide handlers. Several previously reported associations were confirmed in the current analysis, which included a larger number of pesticide handlers enrolled over a longer time period. The use of multiple OP/CBs and mixing/loading activities were significant risk factors, and the use of chemical-resistant boots and lockers for PPE storage were protective factors. Our findings point toward logical interventions to reduce exposure such as the implementation of engineering controls for mixing/loading activities, requirements for appropriate footwear, and the regular use of lockers for PPE storage.

Blood acetylcholinesterase and butyrylcholinesterase as biomarkers of cholinesterase depression among pesticide handlers.

OBJECTIVE: Agricultural pesticide handlers are at an elevated risk for overexposure to organophosphate (OP) pesticides, but symptoms can be difficult to recognise, making biomarkers invaluable for diagnosis. Occupational monitoring programmes for cholinesterase depression generally rely on measuring activity of either of the two common blood cholinesterases which serve as proxy measurements for nervous-system acetylcholinesterase activity: red blood cell acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BChE). These biomarkers, however, may be affected differentially by some OPs and the relationship between them has not been well characterised. We aim to determine the association between blood AChE and BChE activity levels and assess whether they produce comparable classifications of clinical cholinesterase depression among OP pesticide handlers. METHODS: Using blood samples from 215 participants of the Washington State Cholinesterase Monitoring Program, we quantified changes in AChE and BChE activity from before and after exposure to OP pesticides and calculated Pearson correlation statistics for correlation of AChE and BChE changes in activity, as well as weighted κ statistics for agreement of classification of clinical cholinesterase depression based on AChE versus BChE measurements. RESULTS: AChE and BChE activity measurements are weakly negatively correlated in our study population. Reaching a clinical threshold for diagnosis of cholinesterase depression based on the AChE marker did not correlate with reaching clinical depression based on the BChE marker. CONCLUSIONS: Both AChE and BChE should be measured in monitoring programmes because they may both give potentially important but disparate classifications of clinical cholinesterase depression.

Effects of social, economic, and labor policies on occupational health disparities.

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.

Hazards faced by informal recyclers in the squatter communities of Asunción, Paraguay.

BACKGROUND: Informal recycling is widespread in developing countries and involves the collection, sorting, and selling of recyclable materials. Workers are exposed to hazards including the risk of cuts and musculoskeletal injury, infection, exposure to medical waste, and respiratory conditions like bronchitis, pneumonia, and sinusitis and often use insufficient personal protective equipment. OBJECTIVE: Assess the occupational and environmental health hazards faced by informal recyclers working at a landfill in Asunción, Paraguay. METHODS: We surveyed 102 informal recyclers and 12 formal recyclers about occupational health, workplace safety, general health, and household economics. Personal air samples were used to assess respirable dust and nobel metal exposure on 18 workers. RESULTS: Exposures to hazards such as syringes, medical waste, and broken glass as well as risk factors such as eating food found in the trash, lack of personal protective equipment (PPE), and inadequate sanitation were frequent among informal recyclers. Minors under 18 years of age constituted 13% of the workforce and experienced equal or greater exposure to these hazards. Formal recyclers had better access to water, sanitation, PPE, and experienced fewer cuts, injuries, and illnesses than formal recyclers. Informal recyclers were exposed to respirable dust that were considerably higher than they would have been exposed to at home or doing other work in their neighborhood. CONCLUSIONS: Better regulation of sharps and medical waste and the provision of adequate sanitation and personal protective equipment would address the most pressing occupational health issues in this high risk group.

Using community-based methods and a social ecological framework to explore workplace health and safety of bloqueros on the Olympic Peninsula.

BACKGROUND: Occupational health and safety issues among Latino immigrants are increasingly important as increased immigration has led to a burgeoning workforce with limited English language skills or lack of documentation status. Foreign-born Latino immigrants are consistently the ethnic group with the highest occupational mortality rates in the United States. We aimed to understand and document the occupational safety and health hazards faced by a particularly at-risk Latino immigrant workforce--cedar block cutters, or bloqueros--on the Olympic Peninsula. METHODS: Key informant interviews were conducted using community-based participatory methods. Qualitative analysis was guided by grounded theory and a social ecological framework. RESULTS: Thirteen interviews were conducted lasting 1-2 hr each. Three prominent findings arose: (1) bloqueros face occupational risks similar to those found in other forestry occupations, (2) bloqueros face unexpected risks that are likely unique to block cutting, and (3) bloqueros face four overlapping marginalization forces (societal, economical, political, and occupational) that undermine workplace health and safety. CONCLUSIONS: Bloqueros work low-paying, high-risk jobs with little health and safety regulation, documentation, or coverage. Workers' precarious socio-economic position and various structural factors compound workplace risks and contribute to a lack of ability to advocate for safer and healthier working conditions.

Using problem-based learning for occupational and environmental health nursing education: pesticide exposures among migrant agricultural workers.

Problem-based learning, which emphasizes group collaboration to solve real-world case scenarios, is an instructional approach that is well suited to occupational and environmental health nursing education. Learners actively work through case studies rather than passively receive information presented through lectures. Problem-based learning methods promote critical thinking skills and motivate learning, preparing learners for professional practice in complex, ever-changing environments. Despite these advantages, problem-based learning is under-utilized in nursing education compared to more traditional lecture methods. This article presents key concepts of problem-based learning, discusses problem-based learning in educating occupational and environmental health nurses, and describes the development of a problem-based learning case aimed at increasing occupational and environmental health nurses capacity to address pesticide exposure among migrant and seasonal agricultural workers.

Occupational determinants of serum cholinesterase inhibition among organophosphate-exposed agricultural pesticide handlers in Washington State.

OBJECTIVE: To identify potential risk factors for serum cholinesterase (BuChE) inhibition among agricultural pesticide handlers exposed to organophosphate (OP) and N-methyl-carbamate (CB) insecticides. METHODS: We conducted a longitudinal study among 154 agricultural pesticide handlers who participated in the Washington State cholinesterase monitoring program in 2006 and 2007. BuChE inhibition was analysed in relation to reported exposures before and after adjustment for potential confounders using linear regression. ORs estimating the risk of BuChE depression (>20% from baseline) were also calculated for selected exposures based on unconditional logistic regression analyses. RESULTS: An overall decrease in mean BuChE activity was observed among study participants at the time of follow-up testing during the OP/CB spray season relative to pre-season baseline levels (mean decrease of 5.6%, p<0.001). Score for estimated cumulative exposure to OP/CB insecticides in the past 30 days was a significant predictor of BuChE inhibition (beta=-1.74, p<0.001). Several specific work practices and workplace conditions were associated with greater BuChE inhibition, including mixing/loading pesticides and cleaning spray equipment. Factors that were protective against BuChE inhibition included full-face respirator use, wearing chemical-resistant boots and storing personal protective equipment in a locker at work. CONCLUSIONS: Despite existing regulations, agricultural pesticide handlers continue to be exposed to OP/CB insecticides at levels resulting in BuChE inhibition. These findings suggest that modifying certain work practices could potentially reduce BuChE inhibition. Replication from other studies will be valuable.

Symptoms of psychological distress and suicidal ideation among banana workers with a history of poisoning by organophosphate or n-methyl carbamate pesticides.

OBJECTIVES: Neuropsychiatric disorders and increased suicide rates have been associated with exposure to cholinesterase inhibiting organophosphates. This study examined symptoms of psychological distress, including suicidal ideation, among banana workers in Costa Rica previously exposed to a cholinesterase inhibiting pesticide. METHODS: 78 workers who had received medical attention 1-3 years previously for occupational pesticide poisoning were recruited: 54 had been exposed to organophosphate, 24 to carbamate, and 43 and 35, respectively, had single and multiple poisoning episodes with a cholinesterase inhibitor. Referents were 130 non-poisoned workers randomly selected from company payrolls. Psychological distress symptoms during the month prior to interview were obtained using the Brief Symptom Inventory (BSI), which has a general severity index and nine subscale scores. Differences in abnormal BSI scores (T score≥63) were assessed through multivariate logistic regression for all poisoned and for subcategories of poisoned as compared to non-poisoned workers. RESULTS: Organophosphate poisoned workers reported significantly more symptoms than non-poisoned on all but one symptom dimension. Significant trends of increasing symptoms with increasing number of previous poisonings were seen for somatisation, obsessive-compulsiveness, interpersonal sensitivity, depression and anxiety. Carbamate poisoned workers only had increased scores for somatisation. The ORs for suicidal thoughts were: all poisoned 3.58 (95% CI 1.45 to 8.84); organophosphate poisoned 3.72 (1.41 to 9.81); carbamate poisoned 2.57 (0.73 to 9.81); and 2.65 and 4.98, respectively for 1 and ≥2 poisonings (trend p=0.01). CONCLUSIONS: This cross-sectional study showed a relationship between acute occupational poisoning with organophosphates and psychological distress including suicidal ideation. Stronger designs are needed to address causality.

Development of a computer-based survey instrument for organophosphate and N-methyl-carbamate exposure assessment among agricultural pesticide handlers.

BACKGROUND: Assessment of occupational pesticide exposures based on self-reported information can be challenging, particularly with immigrant farm worker populations for whom specialized methods are needed to address language and cultural barriers and account for limited literacy. An audio computer-assisted self-interview (A-CASI) survey instrument was developed to collect information about organophosphate (OP) and N-methyl-carbamate (CB) exposures and other personal characteristics among male agricultural pesticide handlers for an ongoing cholinesterase biomonitoring study in Washington State. OBJECTIVES: To assess the feasibility of collecting data using the A-CASI instrument and evaluate reliability for a subset of survey items. METHODS: The survey consisted of 64 items administered in Spanish or English on a touch-screen tablet computer. Participants listened to digitally recorded questions on headphones and selected responses on the screen, most of which were displayed as images or icons to facilitate participation of low literacy respondents. From 2006-2008, a total of 195 participants completed the survey during the OP/CB application seasons on at least one occasion. Percent agreement and kappa coefficients were calculated to evaluate test-retest reliability for selected characteristics among 45 participants who completed the survey on two separate occasions within the same year. RESULTS: Almost all participants self-identified as Hispanic or Latino (98%), and 97% completed the survey in Spanish. Most participants completed the survey in a half-hour or less, with minimal assistance from on-site research staff. Analyses of test-retest reliability showed substantial agreement for most demographic, work history, and health characteristics and at least moderate agreement for most variables related to personal protective equipment use during pesticide applications. CONCLUSIONS: This A-CASI survey instrument is a novel method that has been used successfully to collect information about OP/CB exposures and other personal characteristics among Spanish-speaking agricultural pesticide handlers.

Biomarkers of sensitivity and exposure in Washington state pesticide handlers.

Organophosphate (OP) and N-methyl-carbamate (CB) insecticides are widely used in agriculture in the US and abroad. These compounds - which inhibit acetylcholinestersase (AChE) enzyme activity - continue to be responsible for a high proportion of pesticide poisonings among US agricultural workers. It is possible that some individuals may be especially susceptible to health effects related to OP/CB exposure. The paraoxonase (PON1) enzyme metabolizes the highly toxic oxon forms of some OPs, and an individual's PON1 status may be an important determinant of his or her sensitivity to these chemicals. This chapter discusses methods used to characterize the PON1 status of individuals and reviews previous epidemiologic studies that have evaluated PON1-related sensitivity to OPs in relation to various health endpoints. It also describes an ongoing longitudinal study among OP-exposed agricultural pesticide handlers who are participating in a recently implemented cholinesterase monitoring program in Washington State. This study will evaluate handlers' PON1 status as a hypothesized determinant of butyrylcholinesterase (BuChE) inhibition. Such studies will be useful to determine how regulatory risk assessments might account for differences in PON1-related OP sensitivity when characterizing inter-individual variability in risk related to OP exposure. Recent work assessing newer and more sensitive biomarkers of OP exposure is also discussed briefly in this chapter.

Rubberwood dust and lung function among Thai furniture factory workers.

The objective of this study was to assess factors affecting lung function among 685 workers in the rubberwood (Hevea brasiliensis) furniture industry in the Chonburi and Rayung provinces of eastern Thailand. Study data were gathered using questionnaires, by sampling wood dust, and by spirometry. The mean wood dust exposure level in the factories was 4.08 mg/m3 (SD = 1.42, range: 1.15-11.17 mg/m3). The mean overall percent of predicted forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC values were 84 % (SD = 13.41), 86 % (SD = 14.40), and 99% (SD = 10.42), respectively. Significant negative correlations were found between mean dust exposure levels and FVC (p = 0.0008), and FEV1/FVC% (p < 0.001), but not FEV1 (p = 0.074). An association between decline in lung function and wood dust levels among wood workers suggests that rubberwood dust exposure negatively affects lung function.

Economic Evaluation and Systematic Review of Publicly Available Workers' Compensation Practice Details and Mod Rate Calculators Applied to Upper Midwest Agriculture.

Background: Agricultural employment is one of the most dangerous occupations in the United States. Workers' compensation coverage requirements for agricultural work vary from state to state, and experience modifier rates (E-mods) affecting insurance premiums sometimes vary drastically across state lines and according to claim severities and farm sizes. We proposed to develop an interactive software application that would educate farmers on the impact of employee time loss on annual E-mod factor change specific to their geographic location and farm size.Methods: We conducted a comparative analysis of workers' compensation formulations, including E-mods among Upper Midwestern states. We performed sensitivity analysis of the formulas to claim amount and payroll to highlight differences related to claim severity and to farm size.Results: The state to state variation and remarkable complexity of these formulas was confirmed. E-Mod factors are shown to increase substantially across states with both claim size and payroll, though are found to be similar across Wisconsin and Minnesota which were examined in detail.Conclusions: The findings confirm that creating a nationally applicable interactive educational software tool for farmers and ranchers to view hypothetical rate changes by inputting on-farm injury scenarios represents a significant challenge and that educational outreach coupled with the use of commercial software, especially as less costly options become available, may serve the role of minimizing misunderstandings by current producers as may other informational sources.

An exploration of Hispanic workers' perspectives about risks and hazards associated with orchard work.

Orchard workers are a population at risk for serious and disabling occupational injuries and illnesses. The purpose of this descriptive, exploratory study was to gather information about orchard workers' perceptions and experiences related to their work to better understand factors that contribute to their occupational risk. The sample consisted of 180 Hispanic orchard workers from 3 counties in Washington State; about a third of these reported at least 1 occupational injury. A Likert scale was used to gather workers' perceptions about individual, work-related, and environmental factors that have the potential to contribute to the occurrence of occupational injuries and illnesses. Psychosocial factors emerged as particularly important influences on workers' health and safety. Injured workers were more likely than noninjured workers to feel (1) that they are more likely to be fired, (2) that the "boss cares more about the fruit than the worker," (3) that their employer was demanding, and (4) that orchard work was dangerous. There is a compelling need to develop and test interventions that address factors that adversely affect orchard workers' health and safety.