Risk factors associated with indicators of dehydration among migrant farmworkers.

OBJECTIVE: Farmworkers are at increased risk of adverse health outcomes related to occupational heat exposure and inadequate access to water, shade, or rest breaks. Presently, there is a dearth of studies examining the prevalence of dehydration and related factors in U.S. farmworkers. Our objectives were to characterize hydration status during typical workdays and to identify risk factors associated with increased dehydration in migrant farmworkers employed in Florida. METHODS: Urine samples were collected and analyzed for urine specific gravity (USG) 2-3 times per person per day over five days in May 2021 and 2022. Data collection included demographic characteristics, wet-bulb-globe-temperature (WBGT), and information on working conditions (task type, duration, and crop units harvested), fluid intake, clothing worn, and heat safety behaviors. Multivariable mixed regression models were used to evaluate risk factors associated with change in USG levels (continuous) during a work shift. RESULTS: A total of 111 farmworkers participated in this study providing 1020 cumulative USG measurements, of which 96.8% of end-of-shift USG samples were above 1.020 indicating potential dehydration. In multivariable models, dehydration assessed using change in USG levels significantly declined with age (ß = -0.078; 95%CI: 0.150, -0.006) but showed significant increase with body mass index (ß = 0.016; 95%CI: 0.003, 0.028), WGBT (ß = 0.054; 95%CI:0.044, 0.064), mean shift duration, and state of primary residence. We did not find significant associations of dehydration with type of clothing worn, intake of employer-provided water, or crop units harvested during a shift in this sample of farmworkers. CONCLUSION: Our findings underscore the need for additional research to evaluate adverse outcomes related to dehydration and to better understand recovery patterns from chronic dehydration across workweeks and harvest seasons in migrant farmworkers.

COVID-19 vaccination requirements, encouragement and hesitancy among non-health care, non-congregate workers in Chicago: results from the WEVax survey.

BACKGROUND: While frontline and essential workers were prioritized for COVID-19 vaccination in the United States, coverage rates and encouragement strategies among non-health care workers have not been well-described. The Chicago Department of Public Health surveyed non-health care businesses to fill these knowledge gaps and identify potential mechanisms for improving vaccine uptake. METHODS: The Workplace Encouragement for COVID-19 Vaccination in Chicago survey (WEVax Chicago) was administered using REDCap from July 11 to September 12, 2022, to businesses previously contacted for COVID-19 surveillance and vaccine-related outreach. Stratified random sampling by industry was used to select businesses for phone follow-up; zip codes with low COVID-19 vaccine coverage were oversampled. Business and workforce characteristics including employee vaccination rates were reported. Frequencies of requirement, verification, and eight other strategies to encourage employee vaccination were assessed, along with barriers to uptake. Fisher's exact test compared business characteristics, and Kruskal-Wallis test compared numbers of encouragement strategies reported among businesses with high (> 75%) vs. lower or missing vaccination rates. RESULTS: Forty-nine businesses completed the survey, with 86% having 500 or fewer employees and 35% in frontline essential industries. More than half (59%) reported high COVID-19 vaccination rates among full-time employees; most (75%) workplaces reporting lower coverage were manufacturing businesses with fewer than 100 employees. Verifying vaccination was more common than requiring vaccination (51% vs. 28%). The most frequently reported encouragement strategies aimed to improve convenience of vaccination (e.g., offering leave to be vaccinated (67%) or to recover from side effects (71%)), while most barriers to uptake were related to vaccine confidence (concerns of safety, side effects, and other skepticism). More high-coverage workplaces reported requiring (p = 0.03) or verifying vaccination (p = 0.07), though the mean and median numbers of strategies used were slightly greater among lower-coverage versus higher-coverage businesses. CONCLUSIONS: Many WEVax respondents reported high COVID-19 vaccine coverage among employees. Vaccine requirement, verification and addressing vaccine mistrust may have more potential to improve coverage among working-age Chicagoans than increasing convenience of vaccination. Vaccine promotion strategies among non-health care workers should target low-coverage businesses and assess motivators in addition to barriers among workers and businesses.

Comparison of State Hospital Visits With Housing and Urban Development Estimates of Homeless: Illinois, 2011-2018.

Objectives. To assess the value of hospital records in augmenting information on homelessness counts at a state level.Methods. We used data from the Illinois Hospital Discharge Database (2011-2018) to identify outpatients and inpatients identified as affected by homelessness. We used probabilistic linkage methodology to estimate unique individuals rather than visits and compared them with US Department of Housing and Urban Development annual estimates of homelessness based on point-in-time counts.Results. Department of Housing and Urban Development point-in-time estimates indicate a substantial decline of approximately 24% in homelessness in Illinois; however, estimates of unique individuals visiting the hospital with a code for homelessness more than doubled in this same period.Conclusions. Other data sources, such as hospital records, are increasingly able to identify and report information related to homelessness. Using these additional data sources may help to augment the Department of Housing and Urban Development point-in-time estimates to provide more accurate estimates of homelessness that are used to direct resources and assess policy and support services for those affected by homelessness.

Work as a social determinant of health; a landscape assessment of employers in two historically disinvested urban communities.

BACKGROUND: Work is considered a structural determinant of health, yet specific determinants that could be targeted at the community level have not been elaborated. The aim of this research is to develop a methodology for incorporating employers and employment into community health assessment. METHODS: As part of a community based participatory research (CBPR) collaboration, we inventoried and characterized businesses in two neighborhoods using multiple data sources and walk-around surveys. Community and academic researchers planned, executed, discussed, and debated the methodology, the findings, and the potential for incorporating "work" in community health considerations. RESULTS: In two contiguous communities with a total population of roughly 100,000, we identified 1,127 employers: 85% were small employers; almost 70% of businesses were in retail, service, financial/business services, and food/accommodations sectors. Cash economy, hidden employment, and phantom businesses were uncovered. CONCLUSION: We developed a CBPR approach to incorporating local businesses and employment sectors into community health assessment in economically and socially disadvantaged communities. Knowing about "work" in a community will form the basis for including business owners into CBPR partnerships and incorporating work-related health and economic factors into community health improvement and quality of life plans.

Impact of precarious work on neighborhood health: Concept mapping by a community/academic partnership.

OBJECTIVE: As part of community-based participatory research (CBPR) examining precarious employment and community health, academic, and community researchers used concept mapping to explore how residents in two high hardship neighborhoods perceive the impact of work on health. METHODS: Between January and May 2017, 292 individuals who lived or worked in two contiguous Chicago neighborhoods were engaged in brainstorming, sorting, and rating activities. Multidimensional scaling and hierarchical cluster analysis were applied, and findings were interpreted by a community-academic partnership. RESULTS: Brainstorming resulted in 55 unique ways that work impacts health, each of which was rated on its perceived impact on health and prevalence in the neighborhood. Four major themes emerged: Healthy Aspects of Work, Systemic/Structural Injustices, Lack of Control/Exploitation, and Psychological/Physical Stress, which was a multidimensional, cross-cutting theme. CONCLUSION: These findings provide critical insight into community perceptions of the mechanisms by which work influences health, providing a basis for community-driven, sustainable, work-focused interventions that promote community health.

Workers' compensation and the working poor: Occupational health experience among low wage workers in federally qualified health centers.

BACKGROUND: The working poor are at highest risk of work-related injuries and have limited access to occupational health care. OBJECTIVES: To explore community health centers (CHCs) as a venue for accessing at risk workers; and to examine the experience, knowledge, and perceptions of workers' compensation (WC) among the working poor. METHODS: Key informant interviews were conducted among patients in waiting rooms of rural and urban CHCs. RESULT: Fifty-one interviews of minority workers across sectors identified 23 prior work-related injuries and mixed experiences with the WC system. Barriers to reporting and ways to overcome these barriers were elucidated. CONCLUSIONS: Patients in CHCs work in jobs that put them at risk for work-related injuries. CHCs are a good site for accessing at-risk workers. Improving occupational healthcare and appropriate billing of WC insurance should be explored, as should best practices for employers to communicate WC laws to low wage workers.

Workers' compensation filings of temporary workers compared to direct hire workers in Illinois, 2007-2012.

BACKGROUND: The physical and psychological risks of temporary employment are well documented but there are still many questions regarding the consequences of injuries among these workers. METHODS: This analysis examines Illinois Workers' Compensation Commission filings from 2007 through 2012 to compare total cost of the decision, days of work missed, and percent disability of employees of temporary agencies with direct hire claims. RESULTS: Total award median was $5,813.66 for direct hire employees and $2,625.00 for temporary workers. Of those employees claiming time off from work, median total time off was 1.3 weeks for direct hire employees compared to 1.2 weeks for temporary workers. Median total percent disability was 16.0% for direct hire and 10.0% for temporary employees. CONCLUSIONS: There are differences between temporary workers and direct hire employees in terms of total workers' compensation awards, total time off, and percent disability. Additional studies are needed to validate these findings. Am. J. Ind. Med. 60:11-19, 2017. © 2016 Wiley Periodicals, Inc.

Occupational Safety and Health and Healthy Housing: A Review of Opportunities and Challenges.

PURPOSE: Occupational safety and health (OSH) risks in construction of healthy housing (HH) have not been examined and collaboration between HH and OSH professionals is inadequate. The World Health Organization is developing international HH guidelines and the International Labour Organization is working to improve OSH in construction globally. METHODS: We searched for exemplary reports (including gray literature) on construction hazards; preventive measures for occupants and workers; OSH frameworks, laws, and regulations; definitions; and HH. RESULTS: Healthy housing construction typically improves ventilation, moisture and mold, pest control, injury hazards, cleanability, maintenance, accessibility, thermal conditioning, and avoidance of toxic building materials. To date, this work is done without explicit requirements for worker health. Construction is among the most hazardous sectors around the globe, although protective measures are well known, including engineering and administrative controls and provision of personal protective equipment. Residential construction, renovation, repair, and maintenance are fragmented, consisting mostly of small companies without proper OSH training, equipment, and knowledge of HH principles. Residential construction is often undertaken by informal or unauthorized workers, putting them at high risk. Reduced exposure to toxic building materials is an example of a benefit for both workers and occupants if OSH and HH collaboration can be improved. By recognizing that homes under new construction or renovation are both a workplace and a residence, HH and OSH initiatives can apply public health principles to occupants and workers simultaneously. This article publishes key definitions, hazards and interventions common to both fields. CONCLUSIONS: A global increase in residential construction and renewed global interest in HH poses both risks and opportunities for primary prevention. Policy and practice interventions can benefit the health of occupants and those who work on their homes. Improvements in legislation, regulation, and international frameworks are needed to maximize OSH and HH collaboration and realize significant cobenefits. Occupational safety and health and HH standards should include requirements to protect both workers and occupants. Because homes can also be workplaces, both workers and housing occupants will receive important cobenefits when OSH and HH standards use proven interventions to protect workers and occupants.

Spatial clustering of occupational injuries in communities.

OBJECTIVES: Using the social-ecological model, we hypothesized that the home residences of injured workers would be clustered predictably and geographically. METHODS: We linked health care and publicly available datasets by home zip code for traumatically injured workers in Illinois from 2000 to 2009. We calculated numbers and rates of injuries, determined the spatial relationships, and developed 3 models. RESULTS: Among the 23 200 occupational injuries, 80% of cases were located in 20% of zip codes and clustered in 10 locations. After component analysis, numbers and clusters of injuries correlated directly with immigrants; injury rates inversely correlated with urban poverty. CONCLUSIONS: Traumatic occupational injuries were clustered spatially by home location of the affected workers and in a predictable way. This put an inequitable burden on communities and provided evidence for the possible value of community-based interventions for prevention of occupational injuries. Work should be included in health disparities research. Stakeholders should determine whether and how to intervene at the community level to prevent occupational injuries.

The impact of low-level lead toxicity on school performance among children in the Chicago Public Schools: a population-based retrospective cohort study.

BACKGROUND: Environmental lead exposure poses a risk to educational performance, especially among poor, urban children. Previous studies found low-level lead exposure was a risk factor for diminished academic abilities, however, this study is distinct because of the very large sample size and because it controlled for very low birth weight and early preterm birth-two factors closely associated with lower academic performance. In this study we examined the association between lead concentration in whole blood (B-Pb) of Chicago Public School (CPS) children and their performance on the 3(rd) grade Illinois Standard Achievement Tests (ISAT) reading and math scores. METHODS: We examined 58,650 children born in Chicago between 1994 and 1998 who were tested for blood lead concentration between birth and 2006 and enrolled in the 3(rd) grade at a CPS school between 2003 and 2006. We linked the Chicago birth registry, the Chicago Blood Lead Registry, and 3(rd) grade ISAT scores to examine associations between B-Pb and school performance. RESULTS: After adjusting for other predictors of school performance including poverty, race/ethnicity, gender, maternal education and very low birth weight or preterm-birth, we found that B-Pbs below 10 µg/dL were inversely associated with reading and math scores in 3(rd) grade children. For a 5 µg/dL increase in B-Pb, the risk of failing increased by 32% for reading (RR = 1.32, 95%CI = 1.26, 1.39) and math (RR = 1.32, 95%CI = 1.26, 1.39). The effect of lead on reading was non-linear with steeper failure rates at lower B-Pbs. We estimated that 13% of reading failure and 14.8% of math failure can be attributed to exposure to blood lead concentrations of 5 to 9 vs. 0 to 4 µg/dL in Chicago school children. CONCLUSIONS: Early childhood lead exposure is associated with poorer achievement on standardized reading and math tests in the third grade, even at very low B-Pbs. Preventing lead exposure in early childhood is critical to improving school performance.

Promoting integrated approaches to reducing health inequities among low-income workers: applying a social ecological framework.

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.

Injuries Among Hispanic/Latinx Agricultural Workers Seen in Illinois Hospitals.

OBJECTIVE: Agriculture is a dangerous industry, with evidence indicating a disproportionate burden among Hispanic/Latinx workers. There is a need to expand the utilization of different data systems to improve the surveillance of precarious workers within agriculture. This analysis describes inclusion criteria to identify farm-related injuries and illnesses in hospital data utilizing ICD-10 codes to better assess health equity issues involving Hispanic/Latinx workers and their associated costs. METHODS: Discharge data of agriculture-related injuries and illnesses treated in Illinois hospitals and emergency departments from 2018 to 2021 were extracted using ICD-10 diagnosis and location of injury codes. Injury cause, nature, severity, and course of clinical care are stratified by ethnicity. Multivariable models were developed to assess differences in injury severity, level of care required, and cost of care. RESULTS: We identified 3,745 farm-related injuries and illnesses treated in Illinois hospitals between 2018 and 2021, of which 196 involved Hispanic/Latinx individuals. Hispanic/Latinx patients were substantially younger and disproportionately covered by workers' compensation insurance or uninsured. Compared to non-Hispanic/Latinx individuals, Hispanic/Latinx patients suffered injuries from different mechanisms, particularly involving animals and cutting/piercing instruments. While non-Hispanic/Latinx individuals demonstrated more severe injuries based on the descriptive statistics, after controlling for confounding (particularly age), we did not observe ethnic disparities in injury severity or level of care required. However, the cost of care was equivalent to or higher among Hispanic/Latinx persons. CONCLUSION: The case definition used for this analysis identified agriculture-related cases and provided insights on the course of clinical care by ethnicity. This strategy would likely yield valuable information in states with larger and more diverse agricultural workforces. More targeted research to appropriately scope the issue and inform interventions is needed to understand differential exposure and reduce agricultural workplace hazards and address the financial burden resulting from farm-related injuries.

More than training: Community-based participatory research to reduce injuries among hispanic construction workers.

BACKGROUND: Workplace mortality and severe injury are disproportionately distributed among foreign born and Hispanic construction workers. Worker Centers (WCs) provide services and advocacy for low-wage workers and a way for investigators to reach them. The goal of this project is to prevent occupational injuries by increasing awareness of hazards and self-efficacy among foreign born, Hispanic construction workers and by expanding the agenda of WCs to include occupational health and safety (H&S). METHODS: Investigators partnered with eight WCs in seven cities to train worker leaders to deliver a modified OSHA 10-hr curriculum to their peers. RESULTS: Thirty-two worker leaders trained 446 workers over 3 years. There was a demonstrated improvement in knowledge, hazard identification, self-efficacy, and sustainable H&S activities. CONCLUSIONS: This study provides evidence for successful implementation of a training intervention for low wage, low literacy Hispanic construction workers using a community-based participatory research approach.

Determination of Mercury with a Miniature Sensor for Point-of-care Testing.

In developing countries, subsistence gold mining entails mixing metallic mercury with crushed sediments to extract gold. In this approach, the gold-mercury amalgam is heated to evaporate mercury and obtain gold. Thus, the highly volatile mercury can be absorbed through inhalation, resulting in adverse health effects. Urinalysis can be used to detect mercury, which is excreted in urine and feces, and correlate exposure with toxic effects. The current gold standard analytical methods are based on fluorescence or inductively coupled plasma mass spectrometry methods, but are expensive, time consuming, and are not easily accessible in countries where testing is needed. In this work, we report on a miniature electrochemical sensor that can rapidly detect mercury in urine at levels well below the US Biological Exposure Index (BEI) limit of 50 ppb (µg/L). The sensor is based on a thin-film gold electrode and anodic stripping voltammetry electroanalytical approach. The sensor successfully detected mercury at trace levels in urine, with a limit of detection of ~15 ppb Hg in the linear range of 20-80 ppb. With the low-cost disposable sensors and portable instrumentation, it is well suited for point-of-care applications.

COVID-19 Clusters and Outbreaks Among Non-Health Care, Noncongregate Workers in Chicago, Illinois: Surveillance Through the First Omicron Wave.

OBJECTIVE: To describe COVID-19 investigations by a large urban health department among non-health care, noncongregate workplaces and the utility of surveillance methods over time. METHODS: Frequencies of workplace-associated clusters and outbreaks are described by workplace type, workforce size, and method of identification over time. RESULTS: From April 2020 through January 2022, 496 COVID-19 investigations identified 442 clusters (89%) and 54 outbreaks (11%). Frontline essential workplaces comprised 36% of investigations before versus 15% after vaccine eligibility. Pre-Omicron, most investigations (84%) were identified through case interviews. During Omicron predominance, case interviews decreased dramatically and identified 10% of investigations. Offices (41%) and bars and restaurants (36%) were overrepresented, and only one outbreak was identified, given decreases in confirmatory testing. CONCLUSIONS: Findings suggest that vaccine prioritization reduced COVID-19 burden among highest-risk workplaces, but surveillance methods likely became less representative over time.

Building Leadership Through Partnerships: Using Concept Mapping to Develop Community Capacity to Address Gender-Based Violence.

BACKGROUND: To address an unmet need for community-driven gender-based violence (GBV) responses in areas with high levels of precarious employment, a community-based organization partnered with academic researchers and community members to use concept mapping to inform the design of a leadership development program. OBJECTIVES: The objectives of the research were to identify and prioritize the skills, knowledge, and resources that "worker-leaders" (informal activists) need to help prevent and reduce acts of GBV directed toward individuals working in low-wage and precarious employment situations. METHODS: Using concept mapping as part of a community-based participatory project, the community-academic research team elicited input from Latinx and Korean residents from low-income immigrant communities. Individuals brainstormed, sorted, and rated the skills and resources necessary to reduce and respond to GBV. Quantitative analyses were jointly interpreted by community and academic researchers. RESULTS: Sixty-nine individuals participated in at least one concept mapping activity. Twenty-one unique skills and resources across seven thematic constructs were identified. Participants believed that skills and resources related to Workplace Violence would be most effective at building trainee capacity to address GBV, but Employee and Survivor Support topics were more likely to draw worker-leaders to a program. Access to organizations that support survivors was considered both highly effective and likely to be of great interest. CONCLUSIONS: This research ensures that the GBV leadership training program is grounded in community-generated evidence. The process of undertaking this research was at least as useful in the development of the leadership of the program as the results themselves.

Health Equity and Worker Justice in Temporary Staffing: The Illinois Case.

Temporary staffing has an increasing role in world economies, contracting workers and dispatching them to work for leasing employers within countries and across borders. Using Illinois as a case study, co-authors have undertaken investigations to understand the occupational health, safety, and well-being challenges for workers hired through temporary staffing companies; to determine knowledge and attitudes of temp workers and temp staffing employers; and to assess temporary staffing at a community level. Temporary staffing workers in Illinois tend to be people of color who are employed in the most hazardous sectors of the economy. They have a higher rate of injury, are compensated less, and often lose their jobs when injured. Laws allow for ambiguity of responsibility for training, reporting, and compensation between the staffing agency and host employers. Our findings illustrate the ways in which principles of fairness and equity are violated in temporary staffing. Shared responsibility for reporting injuries, providing workers' compensation insurance, and training workers should be mandated in law and required in contractual language between temporary staffing and host/contracting employers. Monitoring, enforcement, and adjustment of the law based on experience are required to "promote inclusive and sustainable economic growth, employment and decent work for all.

A day in the life: Using contextual interviews to understand the health of home-based Mapuche weavers.

The craft sector employs 305 million people worldwide, primarily women, rural and home-based workers. Home-based weavers, an understudied workforce, are subject to a range of hazards and adverse health effects related to their weaving work and domestic responsibilities (e.g., housework, farm work, childcare, eldercare). The Mapuche represent Chile's largest Indigenous group with about 20 percent residing in the Araucanía region, where agriculture and tourism, including craftwork, are important sources of income. Using a purposive sampling approach, we conducted Spanish-language contextual interviews (N = 10) with Mapuche weavers across four communities, allowing us to observe participants in their home settings, watching them weave and discussing tasks, decision-making, and behaviors during the work process. Participants ranged in age from 29-55 years. A combination of semi-structured, audio-recorded interviews, videos, photographs and written observations yielded a time-wheel of a typical day for each weaver; the types of weaving and non-weaving work (including hours per day); workspace visuals; self-reported health problems, causes and treatments; exposure hazards; and potential ergonomic interventions. In addition to weaving, housework (n = 10), farm work (n = 7), wool production (n = 7), natural and chemical dyeing (n = 7) and child-rearing (n = 4) were identified as work activities. The most commonly cited weaving-related health problems were eyestrain (n = 7) and pain in the back (n = 6), shoulder (n = 5), arm (n = 4), hand (n = 4), neck (n = 3), wrist (n = 3) and fingers (n = 3). When asked to identify potential improvements to their weaving workspace, participants identified the need to having a dedicated workspace for weaving (n = 7), improving their existing workspace with better seating (n = 4), lighting (n = 3), insulation (n = 2) and increasing the size of their workspace (n = 2). This methodology, blending traditional occupational health tools with qualitative methods, was instrumental in understanding the range of hazards associated with home-based work and identifying potential ergonomic interventions for this global workforce.

Design, implementation and evaluation of a participatory ergonomics program among home-based Mapuche weavers.

The Mapuche comprise 80% of the indigenous population of Chile. The Araucanía has the highest concentration of Mapuche peoples and is also the poorest region of the country. The region's proximity to a large tourist sector provides opportunities for weavers to work from home and sell their products as a primary or secondary income source. The adverse health effects related to craft production and home-based work are significant and not well described in the literature. Participatory ergonomics (PE), an approach that emphasizes the input and participation of individuals directly impacted by the work being studied, is a strong fit for this population. This article describes a PE project among 33 Mapuche weavers that characterizes the hazards, risks and perceived adverse health effects associated with home-based weaving and the identification, implementation and evaluation of three ergonomic interventions. This project can inform the development of sustainable ergonomics health programs for home-based artisans.