Preventing occupational exposure to pesticides: using participatory research with latino farmworkers to develop an intervention

Race, Toxic Exposures, and Environmental Health: The Contestation of Lupus among Farmworkers

Extant research has established that low-wage workers of color are at higher risk for occupational exposures. While the medical sociology literature regarding contested illness provides insights into the dynamics surrounding workplace exposures, some environmental illnesses such as lupus have gotten scant analytical attention. This is a significant gap because women of color, who are more likely to hold these high-risk jobs, are disproportionately affected by the disease. We examine a case of pesticide exposure among Black women farmworkers in Florida. We investigate how race and occupation intersect to shape lived experiences with toxics and what role race plays in the process of contesting exposures and illness. Our data include in-depth interviews (N = 36), media coverage, and archival materials. Our findings indicate that race-related factors played an important part in shaping the farmworkers' experiences with exposures, illness, and interaction with elite actors.

Predictors of Dairy Worker Pre-Test and Post-Test Performance on a Dairy Safety Knowledge Test: Impact of Education Level and Native Language

BACKGROUND

Efficacy-driven assessments of linguistically appropriate occupational health and safety training (OHS) for dairy workers remain uncommon. This study analyzes predictors of performance on a dairy safety knowledge test using pre-and-post knowledge assessments. The safety training course was delivered by iPad™ to Idahoan dairy workers, managers, and owners.

OBJECTIVE

To determine the predictors of safety knowledge scores among dairy worker course participants.

METHODS

Predictors of pre-test (baseline) scores and change in test scores of n = 1,336 participants were compared, and multivariate iterative linear regressions were used to predict test performance, adjusting for variables such as occupation, years of formal education, native language, and years in dairy work.

RESULTS

Test scores for Spanish and English speakers improved between pre-test and post-test. Years of formal education was the most predictive variable of higher baseline scores and change in test scores among dairy safety course participants, regardless of language.

CONCLUSION

Dairy worker safety training course results showed improvements in safety knowledge and test scores. Years of formal education of participants appears to be a key determinant of increases in safety knowledge, and therefore safety training programs need to address the learning needs of less educated workers.

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.

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.

Application of improved approach to evaluate a community intervention to reduce exposure of young children living in farmworker households to organophosphate pesticides

The take-home pathway is a significant source of organophosphate pesticide exposure for young children (3-5 years old) living with an adult farmworker. This avoidable exposure pathway is an important target for intervention. We selected 24 agricultural communities in the Yakima Valley of Washington State and randomly assigned them to receive an educational intervention (n = 12) to reduce children's pesticide exposure or usual care (n = 12). We assessed exposure to pesticides in nearly 200 adults and children during the pre and post-intervention periods by measuring metabolites in urine. We compared pre- and post-intervention exposures by expressing the child's pesticide metabolite concentration as a fraction of the adult's concentration living in the same household, because the amount of pesticides applied during the collection periods varied. Exposures in our community were consistently higher, sometimes above the 95^th percentile of the exposures reported by the National Health and Nutrition Examination Survey (NHANES). While intervention and control communities demonstrated a reduction in the ratio of child to adult exposure, this reduction was more pronounced in intervention communities (2.7-fold, p < 0.001 compared to 1.7-fold, p = 0.052 for intervention and control, respectively). By examining the child/adult biomarker ratio, we demonstrated that our community-based intervention was effective in reducing pesticide exposure to children in agricultural communities.

Effectiveness of occupational safety and health training for migrant farmworkers: a scoping review

OBJECTIVES

Migrant farmworkers report higher rates of work-related illnesses, injuries and fatalities compared with local workers. Language and cultural barriers represent a relevant source of risk, which can be reduced by means of targeted training interventions. However, very little evidence is available about the effectiveness of Occupational Safety and Health (OSH) training programmes addressing migrant farmworkers.

STUDY DESIGN

We carried out a scoping review.

METHODS

Currently available literature about the effectiveness of OSH training for migrant farmworkers-in terms of improvements in at least one of the following: safety knowledge, behaviours, attitudes and beliefs and health outcomes-was searched from four databases: PubMed, PsycINFO, Scopus and Web of Science. The screening was performed independently by two authors, and any disagreement was resolved through discussion until consensus was achieved. Once the articles eligible for inclusion were selected, the objectives, design, sample and setting, interventions and findings of each study were recorded. No quality assessment tool for publications considered by this study has been used because a scoping review does not aim for critical appraisal.

RESULTS

Twenty-nine publications met the inclusion criteria. Of these, nine cross-sectional studies discussed the effectiveness of training activities in terms of whether participating in any programme had or did not have a significant effect on the dependent variables, when training was considered along with other sociodemographic factors. In the majority of these studies, training appeared to have low or no effect on the dependent variables considered. Twenty mainly within-subject experimental studies addressed the effectiveness of specific training methods, reporting significant improvements especially for interventions based on a participatory approach.

CONCLUSIONS

Training could greatly contribute to an effective attainment of OSH information, but the present review shows that more evidence is needed to guide the future development of effective training activities.

Using "Policy Briefs" to Present Scientific Results of CBPR: Farmworkers in North Carolina

BACKGROUND

Using scientific results to inform policy that improves health and well-being of vulnerable community members is essential to community-based participatory research (CBPR).

OBJECTIVES

We describe "policy briefs," a mechanism developed to apply the results of CBPR projects with migrant and seasonal farmworkers to policy changes.

LESSONS LEARNED

Policy briefs are two-page summaries of published research that address a single policy issue using language and graphics to make the science accessible to diverse audiences. Policy brief topics are selected by community advocates, based on collaborative research, and address a specific policy or regulation. Development is an iterative process of discussion with community representatives. Briefs have been used to provide information to advocates, state and national policymakers, and the public.

CONCLUSIONS

Disseminating CBPR results to address policy is needed. Collaborating with community partners to produce policy briefs ensures that information about concerns and struggles reflects their priorities.

Anthropology in Agricultural Health and Safety Research and Intervention

Agriculture remains a dangerous industry, even as agricultural science and technology continue to advance. Research that goes beyond technological changes to address safety culture and policy are needed to improve health and safety in agriculture. In this commentary, I consider the potential for anthropology to contribute to agricultural health and safety research by addressing three aims: (1) I briefly consider what the articles in this issue of the Journal of Agromedicine say about anthropologists in agricultural health and safety; (2) I discuss what anthropologists can add to agricultural health and safety research; and (3) I examine ways in which anthropologists can participate in agricultural health and safety research. In using their traditions of rigorous field research to understand how those working in agriculture perceive and interpret factors affecting occupational health and safety (their "emic" perspective), and translating this perspective to improve the understanding of occupational health professionals and policy makers (an "etic" perspective), anthropologists can expose myths that limit improvements in agricultural health and safety. Addressing significant questions, working with the most vulnerable agricultural communities, and being outside establishment agriculture provide anthropologists with the opportunity to improve health and safety policy and regulation in agriculture.

A Guide to the Design of Occupational Safety and Health Training for Immigrant, Latino/a Dairy Workers

Industrialized dairy production in the U.S. relies on an immigrant, primarily Latino/a, workforce to meet greater production demands. Given the high rates of injuries and illnesses on U.S. dairies, there is pressing need to develop culturally appropriate training to promote safe practices among immigrant, Latino/a dairy workers. To date, there have been few published research articles or guidelines specific to developing effective occupational safety and health (OSH) training for immigrant, Latino/a workers in the dairy industry. Literature relevant to safety training for immigrant workers in agriculture and other high-risk industries (e.g., construction) was examined to identify promising approaches. The aim of this paper is to provide a practical guide for researchers and practitioners involved in the design and implementation of effective OSH training programs for immigrant, Latino/a workers in the dairy industry. The search was restricted to peer-reviewed academic journals and guidelines published between 1980 and 2015 by universities or extension programs, written in English, and related to health and safety training among immigrant, Latino/a workers within agriculture and other high-risk industries. Relevant recommendations regarding effective training transfer were also included from literature in the field of industrial-organizational psychology. A total of 97 articles were identified, of which 65 met the inclusion criteria and made a unique and significant contribution. The review revealed a number of promising strategies for how to effectively tailor health and safety training for immigrant, Latino/a workers in the dairy industry grouped under five main themes: (1) understanding and involving workers; (2) training content and materials; (3) training methods; (4) maximizing worker engagement; and (5) program evaluation. The identification of best practices in the design and implementation of training programs for immigrant, Latino/a workers within agriculture and other high-risk industries can inform the development of more effective and sustainable health and safety training for immigrant, Latino/a dairy workers in the U.S. and other countries.

Hispanic Adolescent Farmworkers’ Perceptions Associated with Pesticide Exposure1

The migrant farmworker population in the United States is a vulnerable and understudied population whose characteristics are constantly shifting. The number of youth involved in agriculture work is increasing, and they, in particular, may be at increased risk for occupational hazards, such as pesticide exposure. The present study utilized an ecological framework for focus group discussions with 33 adolescent migrant farmworkers in Oregon. Adolescents’ risk perception and health beliefs associated with pesticide exposure are examined on four levels of environmental influence: microenvironment, organizational environment, social/community environment, and macroenvironment. Adolescents provided insight on such topics as perceived vulnerability of illness due to pesticide exposure, attitudes toward farmwork, influence of their boss, knowledge of occupational hazards, safety training, and barriers to occupational choice. Cultural influences on occupational safety and health are discussed and increased attention to safety training is recommended.

Observed and self-reported pesticide protective behaviors of Latino migrant and seasonal farmworkers

Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agency's (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, although they are not required to be taught by the WPS. Farmworkers reported more long-sleeve (p=.028) and glove use (p=.000) than what was observed. It was uncommon to observe washing behavior before eating or drinking, even when washing supplies were available. Washing behaviors were significantly overreported for hand (p=.000; p=.000) and face (p=.000; p=.058) washing before eating and drinking in the field. This study documents that protective clothing behaviors that the WPS requires be taught, plus a few others are commonly practiced by Latino migrant and seasonal farmworkers, but washing behaviors in the field are not. Targeted strategies to improve washing behaviors in the field are needed.

Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations

BACKGROUND

Racial and ethnic disparities in health status are pervasive at all stages of the life cycle. One approach to reducing health disparities involves mobilizing community coalitions that include representatives of target populations to plan and implement interventions for community level change. A systematic examination of coalition-led interventions is needed to inform decision making about the use of community coalition models.

OBJECTIVES

To assess effects of community coalition-driven interventions in improving health status or reducing health disparities among racial and ethnic minority populations.

SEARCH METHODS

We searched MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index, Dissertation Abstracts, System for Information on Grey Literature in Europe (SIGLE) (from January 1990 through September 30, 2013), and Global Health Library (from January 1990 through March 31, 2014).

SELECTION CRITERIA

Cluster-randomized controlled trials, randomized controlled trials, quasi-experimental designs, controlled before-after studies, interrupted time series studies, and prospective controlled cohort studies. Only studies of community coalitions with at least one racial or ethnic minority group representing the target population and at least two community public or private organizations are included. Major outcomes of interest are direct measures of health status, as well as lifestyle factors when evidence indicates that these have an effect on the direct measures performed.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias for each study.

MAIN RESULTS

Fifty-eight community coalition-driven intervention studies were included. No study was considered to be at low risk of bias. Behavioral change outcomes and health status change outcomes were analyzed separately. Outcomes are grouped by intervention type. Pooled effects across intervention types are not presented because the diverse community coalition-led intervention studies did not examine the same constructs or relationships, and they used dissimilar methodological designs. Broad-scale community system level change strategies led to little or no difference in measures of health behavior or health status (very low-certainty evidence). Broad health and social care system level strategies leds to small beneficial changes in measures of health behavior or health status in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions led to beneficial changes in health behavior measures of moderate magnitude in large samples of community residents (very low-certainty evidence). Lay community health outreach worker interventions may lead to beneficial changes in health status measures in large samples of community residents; however, results were not consistent across studies (low-certainty evidence). Group-based health education led by professional staff resulted in moderate improvement in measures of health behavior (very low-certainty evidence) or health status (low-certainty evidence). Adverse outcomes of community coalition-led interventions were not reported.

AUTHORS' CONCLUSIONS

Coalition-led interventions are characterized by connection of multi-sectoral networks of health and human service providers with ethnic and racial minority communities. These interventions benefit a diverse range of individual health outcomes and behaviors, as well as health and social care delivery systems. Evidence in this review shows that interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems. However, because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects. Thus, a definitive answer as to whether a coalition-led intervention adds extra value to the types of community engagement intervention strategies described in this review remains unattainable.

Occupational safety beliefs among Latino residential roofing workers

BACKGROUND

This analysis describes beliefs about work safety and personal protective equipment (PPE) among Latino roofing workers, it delineates their perceptions of work environment characteristics that affect work safety and PPE use, and it describes how they experience work injuries and the consequences of these injuries.

METHODS

In-depth interviews were completed with 10 current and former Latino residential roofers. Interview transcripts were subjected to systematic qualitative analysis.

RESULTS

Participants' valued productivity over safety, and this had a negative influence on their safety behavior and reduced their PPE use. They understood that roofing was hazardous. They limited use of PPE when they felt it reduced productivity and when it was uncomfortable. Work environment characteristics that affected safety included company size, the physical demands of the job, lack of training, the need for work, general life stress, and distractions at work. An injury had to result in lost work time to be considered significant. Access to health care is limited by employers not providing Workers' compensation.

DISCUSSION

Future research is needed to substantiate these descriptive results and to delineate factors that are associated with safety behavior and use of PPE. Interventions, based on a lay health educator model, are needed to improve safety in this population. Safety regulations need to be evaluated and their enforcement needs to be improved.

Improving occupational safety and health among Mexican immigrant workers: a binational collaboration

Latino immigrants are 50% more likely than all workers in the United States to experience a fatal injury at work. Occupational safety and health (OSH) organizations often find that the approaches and networks they successfully use to promote OSH among U.S.-born workers are ineffective at reaching Latino immigrants. This article describes the collaboration between the National Institute for Occupational Safety and Health (NIOSH) and the Mexican Ministry of Foreign Affairs (Secretaría de Relaciones Exteriores) to promote OSH among Mexican immigrant workers. The Ministry of Foreign Affairs operates 50 consulates throughout the U.S. that provide four million discrete service contacts with Mexican citizens annually. The focus of this ongoing collaboration is to develop the internal capacity of Mexican institutions to promote OSH among Mexican immigrants while simultaneously developing NIOSH's internal capacity to create effective and sustainable initiatives to better document and reduce occupational health disparities for Mexican immigrants in the U.S.

Effectiveness of pesticide safety training and knowledge about pesticide exposure among Hispanic farmworkers

BACKGROUND

Pesticide poisoning rates remain high among farmworkers despite programs aimed at reducing pesticide exposure.

METHODS

A cross-sectional study was conducted among 187 Hispanic farmworkers in North Carolina. Farmworkers were interviewed to determine the association between pesticide safety training and knowledge about pesticides and use of personal protective equipment (PPE).

RESULTS

Use of PPE was higher among farmworkers who reported wearing gloves reduced the harmful effects of pesticides (adjusted odds ratio, 5.73; 95% confidence interval, 2.20-14.92) and those who received pesticide safety training at the extension office or growers association (adjusted odds ratio, 44.62; 95% confidence interval, 3.96-503.33).

CONCLUSION

Some farmworkers are still not using PPE. Evaluation of Environmental Protection Agency Worker Protection Standards pesticide safety training and requirements for providing PPE are crucial to encourage farm workers to use PPE.

The quality of drinking water in North Carolina farmworker camps

OBJECTIVES

The purpose of this study was to assess water quality in migrant farmworker camps in North Carolina and determine associations of water quality with migrant farmworker housing characteristics.

METHODS

We collected data from 181 farmworker camps in eastern North Carolina during the 2010 agricultural season. Water samples were tested using the Total Coliform Rule (TCR) and housing characteristics were assessed using North Carolina Department of Labor standards.

RESULTS

A total of 61 (34%) of 181 camps failed the TCR. Total coliform bacteria were found in all 61 camps, with Escherichia coli also being detected in 2. Water quality was not associated with farmworker housing characteristics or with access to registered public water supplies. Multiple official violations of water quality standards had been reported for the registered public water supplies.

CONCLUSIONS

Water supplied to farmworker camps often does not comply with current standards and poses a great risk to the physical health of farmworkers and surrounding communities. Expansion of water monitoring to more camps and changes to the regulations such as testing during occupancy and stronger enforcement are needed to secure water safety.

Social Justice

Nurse scholars with expertise in global health and culturally competent care recently proposed standards of practice for culturally competent nursing care that are founded on social justice as a broad framework. The purpose of this article is to respond to invited dialogue about the standards and to offer commentary on social justice and its relationship with context, advocacy, leadership, and culturally competent care. A model of culturally competent care for vulnerable groups informs this discussion. The context and culture that surround migrant and seasonal farmworkers illustrate how social justice illuminates their health inequities and necessitates their need for culturally competent care. The article concludes with recommendations for culturally competent education, practice, and research and offers suggestions for developing culturally competent interventions for migrant and seasonal farmworkers.

Student Participation in Community-Based Participatory Research To Improve Migrant and Seasonal Farmworker Environmental Health: Issues for Success

Involving students in community-based participatory research is a useful mechanism for engaging the community and helping it build future capacity. This article describes student involvement in a series of community-based environmental health research projects with migrant and seasonal farmworkers in North Carolina. High school, undergraduate, graduate, and professional school students have participated in various aspects of these projects, including planning, data collection, analysis, and reporting results. Students were required to invest time in learning about the farmworker population, as well as in learning to conduct community-based environmental health research. Drawing on these experiences, we offer observations regarding successful student integration in this type of research. Community-based projects benefit from student participation while encouraging the development of future community-oriented environmental health researchers.

School site visits for community-based participatory research on healthy eating

BACKGROUND

School nutrition policies are gaining support as a means of addressing childhood obesity. Community-based participatory research (CBPR) offers an approach for academic and community partners to collaborate to translate obesity-related school policies into practice. Site visits, in which trained observers visit settings to collect multilevel data (e.g., observation, qualitative interviews), may complement other methods that inform health promotion efforts. This paper demonstrates the utility of site visits in the development of an intervention to implement obesity-related policies in Los Angeles Unified School District (LAUSD) middle schools.

METHODS

In 2006, trained observers visited four LAUSD middle schools. Observers mapped cafeteria layout; observed food/beverage offerings, student consumption, waste patterns, and duration of cafeteria lines; spoke with school staff and students; and collected relevant documents. Data were examined for common themes and patterns.

RESULTS

Food and beverages sold in study schools met LAUSD nutritional guidelines, and nearly all observed students had time to eat most or all of their meal. Some LAUSD policies were not implemented, including posting nutritional information for cafeteria food, marketing school meals to improve student participation in the National School Lunch Program, and serving a variety of fruits and vegetables. Cafeteria understaffing and costs were obstacles to policy implementation.

CONCLUSIONS

Site visits were a valuable methodology for evaluating the implementation of school district obesity-related policies and contributed to the development of a CBPR intervention to translate school food policies into practice. Future CBPR studies may consider site visits in their toolbox of formative research methods.

Using logic models in a community-based agricultural injury prevention project

The National Institute for Occupational Safety and Health has long promoted the logic model as a useful tool in an evaluator's portfolio. Because a logic model supports a systematic approach to designing interventions, it is equally useful for program planners. Undertaken with community stakeholders, a logic model process articulates the underlying foundations of a particular programmatic effort and enhances program design and evaluation. Most often presented as sequenced diagrams or flow charts, logic models demonstrate relationships among the following components: statement of a problem, various causal and mitigating factors related to that problem, available resources to address the problem, theoretical foundations of the selected intervention, intervention goals and planned activities, and anticipated short- and long-term outcomes. This article describes a case example of how a logic model process was used to help community stakeholders on the Navajo Nation conceive, design, implement, and evaluate agricultural injury prevention projects.

Occupational behaviors and farmworkers' pesticide exposure: findings from a study in Monterey County, California

BACKGROUND

We studied the relationship between behaviors promoted through the US Environmental Protection Agency Worker Protection Standard (WPS) and other programs and agricultural pesticide exposures in 73 strawberry fieldworkers employed in Monterey County, California.

METHODS

Farmworkers' behaviors were assessed via self-report and organophosphorus (OP) pesticide exposure was measured using dimethyl alkylphosphate (DMAP) and malathion dicarboxylic acid (MDA) urinary metabolite levels.

RESULTS

Wearing WPS-recommended clothing, wearing clean work clothes, and the combination of handwashing with soap and wearing gloves were associated with decreases in DMAP and MDA metabolite levels. Despite these protective behaviors, however, participants had significantly higher levels of exposure as compared with a national reference sample.

CONCLUSIONS

Interventions that facilitate compliance with these behaviors may be effective in decreasing fieldworkers' pesticide exposures. However, further efforts are needed to reduce the exposure disparities experienced by farmworkers and decrease the potential for "take home" exposures to farmworkers' families.

Integrating research and action: a systematic review of community-based participatory research to address health disparities in environmental and occupational health in the USA

INTRODUCTION

Integrating research and action represents a goal and key principles of community-based participatory research (CBPR), but there has been little effort to synthesise the literature to evaluate whether such integration is occurring.

OBJECTIVES

(1) To examine the extent to which CBPR integrates action to effect community-level change and (2) to ascertain factors that facilitate such integration.

METHODS

Original articles reporting on CBPR in environmental and occupational health in the USA were identified primarily through a MEDLINE search. Inceptions, processes, methods and outcomes of the projects were reviewed.

RESULTS

In 14 of the 20 studies reviewed, CBPR led to community-level action to improve the health and well-being of the community members. Observational studies that investigated problems posed by the affected community and that incorporated qualitative methods were more likely to lead to action. The collaboration among government scientists, university researchers and community partners emerged as a new model of CBPR partnerships that effectively integrates research and action.

CONCLUSIONS

To help CBPR better integrate research and action, a shift towards community-initiated and action-oriented observational studies might be needed.

Para niños saludables: a community intervention trial to reduce organophosphate pesticide exposure in children of farmworkers

BACKGROUND

Exposure to organophosphate (OP) pesticides is an occupational hazard for farmworkers and affects their children through the take-home pathway.

OBJECTIVES

We examined the effectiveness of a randomized community intervention to reduce pesticide exposure among farmworkers and their children.

METHODS

We conducted a baseline survey of a cross-sectional sample of farmworkers (year 1) in 24 participating communities. Communities were randomized to intervention or control. After 2 years of intervention, a new cross-sectional survey of farmworkers was conducted (year 4). Farmworkers with a child 2-6 years of age were asked to participate in a substudy in which urine was collected from the farmworker and child, and dust was collected from the home and the vehicle driven to work.

RESULTS

The median concentration of urinary metabolites was higher in year 4 than in year 1 for dimethylthiophosphate (DMTP) and dimethyldithiophosphate in adults and for DMTP for children. There were significant increases within both the intervention and control communities between year 1 and year 4 (p < 0.005); however, the differences were not significant between study communities after adjusting for year (p = 0.21). The dust residue data showed azinphos-methyl having the highest percentage of detects in vehicles (86% and 84% in years 1 and 4, respectively) and in house dust (85% and 83% in years 1 and 4, respectively). There were no significant differences between intervention and control communities after adjusting for year (p = 0.49).

CONCLUSIONS

We found no significant decreases in urinary pesticide metabolite concentrations or in pesticide residue concentrations in house and vehicle dust from intervention community households compared with control community households after adjusting for baseline. These negative findings may have implications for future community-wide interventions.

Factors associated with pesticide safety practices in farmworkers

BACKGROUND

Farmworkers and their families are exposed to pesticides through multiple pathways. Few studies have examined the frequency with which farmworkers engage in pesticide safety practices and the factors associated with their adoption.

METHODS

Using a large sample of farmworkers (n = 554), we evaluated relationships between pesticide safety behaviors and farmworkers' beliefs, training history, handling of pesticides at work, perceived occupational exposure, and employers' provision of personal protective equipment.

RESULTS

Performing behaviors at work was determined largely by whether personal protective equipment was provided. For home behaviors, female gender, living in a labor camp, being trained in the last 5 years, handling pesticides directly, and not perceiving organizational barriers to protecting oneself were associated with taking more precautions.

CONCLUSIONS

These findings call for interventions that involve and engage multiple stakeholders to increase adoption of pesticide safety behaviors and reduce pesticide exposure in farmworkers.

"Pizza is cheaper than salad": assessing workers' views for an environmental food intervention

OBJECTIVE

"Images of a Healthy Worksite" aims to provide easy access to healthful foods and to reduce sedentarism at the worksite-to prevent weight gain. Formative research for the nutrition intervention component was aimed at gaining a broad understanding of the sociocultural role of food and eating among workers and worker perspectives on socially feasible and culturally acceptable environmental intervention strategies.

RESEARCH METHODS AND PROCEDURES

Using an adapted PRECEDE health planning model, we conducted ecological, educational, environmental, and administrative assessments at the worksite. Through 15 in-depth interviews, five focus groups, and community mapping at two sites with 79 administrators, managers, workers, and food service personnel (51% men, 82% white), we assessed workers' perspectives on physical, sociocultural, economic, and policy environments. Data were coded for predisposing, enabling, and reinforcing factors related to intervention strategies in vending, cafeteria, catering, and informal food environments. After classification for reach, intensity, and sustainability, objectives and evaluation plans were developed for each highly ranked strategy.

RESULTS

Key sociocultural factors affecting food and eating included: stress-related eating in a downsizing workplace, enthusiasm for employer-sponsored weight gain prevention efforts that respect personal privacy, and the consequences of organizational culture on worker access to the food and eating environment. Workers supported healthier cafeteria and catering options, bringing healthful foods closer, and labeling of healthful options.

DISCUSSION

We provide a practical and systematic approach to formative research and assess the interrelatedness of the physical, policy, economic, and sociocultural factors that affect environmental worksite interventions to prevent weight gain among employees.

Alcohol use among immigrant Latino farmworkers in North Carolina

BACKGROUND

Heavy alcohol use among Latino farmworkers is believed to be common, but it remains poorly documented.

METHODS

Interviewer-administered survey questionnaires were administered to 151 Latino male farmworkers in Eastern North Carolina; topics included frequency of alcohol consumption, amount of alcohol typically consumed, frequency of consuming five or more drinks in a single setting, and signs of alcohol abuse/dependence.

RESULTS

Over one-quarter (26%) completely abstain from alcohol, but 27% report frequent heavy drinking, or drinking five or more alcoholic beverages two or more times per month. Over one-third of farmworkers (39%) may be alcohol-dependent. Frequent heavy drinking is more common among single farmworkers and among those who do not follow the crops, and dependence is more common among farmworkers living in camps comprised of both H2A and non-contract workers.

CONCLUSIONS

There is substantial variation in alcohol use among Latino farmworkers. Although a substantial proportion of farmworkers abstain from alcohol, an equally substantial proportion report alcohol use that poses significant risk for injury on and off the job. More research is needed to document the potential threat to Latino farmworkers by their alcohol use. Interventions targeting alcohol are needed to minimize the risk of injury in an already dangerous occupation.

Understanding non-industrialized workers' approaches to safety: how do commercial fishermen "stay safe"?

BACKGROUND

Commercial fishing is carried out worldwide, often in non-industrialized forms, and is associated with high rates of fatal and non-fatal occupational injury.

PROBLEM

Fishermen who work independently in non-industrialized settings do not have access to union or industry sponsored safety services and must make their own decisions about safety practices. Learning the meaning of safety for them and the safety measures they employ is important before developing interventions.

METHODS

Two fieldworkers conducted in-depth ethnographic interviews with 31 commercial fishermen in North Carolina. Interviews and fieldnotes were analyzed using QSR N5.

RESULTS

Fishermen primarily related staying safe to work practices and attitudes. They identified specific safety measures, appropriate gear and boat maintenance, weather decisions, and working cooperatively when ocean fishing.

DISCUSSION

The ethnographic research process can produce information about a group's norms of preventive behavior and safety concerns. Knowledge of workers' concepts and practices will inform researchers' inquiries.

Workplace, household, and personal predictors of pesticide exposure for farmworkers

In this article we 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. Data sources we reviewed included Medline, Science Citation Index, Social Science Citation Index, PsycINFO, and AGRICOLA databases. Data extraction was restricted to those articles that reported primary data collection and analysis published in 1990 or later. We read and summarized evidence for pesticide exposure associations. For data synthesis, articles were graded by type of evidence for association of risk factor with pesticide exposure as follows: 1 = association demonstrated in farmworkers; 2 = association demonstrated in nonfarmworker sample; 3 = plausible association proposed for farmworkers; or 4 = association plausible but not published for farmworkers. Of more than 80 studies we identified, only a third used environmental or biomarker evidence to document farmworker exposure to pesticides. Summaries of articles were compiled by level of evidence and presented in tabular form. A minimum list of data to be collected in farmworker pesticide studies was derived from these evidence tables. Despite ongoing concern about pesticide exposure of farmworkers and their families, relatively few studies have tried to test directly the association of behavioral and environmental factors with pesticide exposure in this population. Future studies should attempt to use similar behavioral, environmental, and psychosocial measures to build a body of evidence with which to better understand the risk factors for pesticide exposure among farmworkers.

Reporting pesticide assessment results to farmworker families: development, implementation, and evaluation of a risk communication strategy

The collection of environmental samples presents a responsibility to return information to the affected participants. Explaining complex and often ambiguous scientific information to a lay audience is a challenge. As shown by environmental justice research, this audience frequently has limited formal education, increasing the challenge for researchers to explain the data collected, the risk indicated by the findings, and action the affected community should take. In this study we describe the development and implementation of a risk communication strategy for environmental pesticide samples collected in the homes of Latino/a migrant and seasonal farmworkers in a community-based participatory research project. The communication strategy was developed with community input and was based on face-to-face meetings with members of participating households. Using visual displays of data effectively conveyed information about individual household contamination and placed it in the context of community findings. The lack of national reference data and definitive standards for action necessitated a simplified risk message. We review the strengths and weaknesses of such an approach and suggest areas for future research in risk communication to communities affected by environmental health risks.

Methodologic advances and ongoing challenges in designing community-based health promotion programs

Community intervention trials continue to attract researchers as potential ways to achieve widespread, long-term change in health behaviors. The first generations of community studies were somewhat unsophisticated in design and analysis, and their promise may have been overstated. As design and analysis issues were better defined, as secular trends caught up with the behaviors that researchers were trying to change, or as other unknown variables affected community studies, small effects of interventions were observed in community trials. Discussions were held in professional meetings and reported in the literature: Should community trials be discontinued? In general, the answer was a qualified no. In this paper, we briefly review some of the many advances made in community intervention trials, and address in more detail the challenges ahead.