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Marquez D, Krenz JE, Santos EC, Torres E, Palmández P, Sampson PD, Blancas M, Carmona J, Spector JT. The Effect of Participatory Heat Education on Agricultural Worker Knowledge. J Agromedicine 2023; 28:187-198. [PMID: 35345983 PMCID: PMC9573936 DOI: 10.1080/1059924x.2022.2058667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Farmworkers disproportionately experience preventable adverse health effects from heat exposure. We sought to evaluate the effect of participatory heat education on farmworker knowledge. METHODS We conducted a parallel, comparison group intervention study to investigate the effectiveness of a Spanish/English participatory, culturally-tailored, heat education-based intervention on farmworker heat knowledge in the Summer 2019. We used convenience sampling to recruit adult outdoor farmworkers from Central/Eastern Washington State, USA. Crews were randomized to receive the intervention (n = 40 participants) versus not receive the intervention (n = 43 participants). We assessed changes in heat knowledge, scored on a scale from 0 to 11, between baseline, immediate post-intervention, and post-season, which was approximately three months after baseline, using the Wilcoxon signed-rank test. We compared differences in knowledge scores from baseline to post-season between groups using analysis of variance. RESULTS Average knowledge scores improved from 4.6 (standard deviation [sd] 1.5) to 6.3 (sd 2.0) pre to post season in the intervention group (p < 0.001). There was a greater improvement in pre-post knowledge scores in the intervention (average difference 1.6, sd 2.0) versus the comparison group (average difference 0.41, sd 1.7) (p = 0.04). CONCLUSIONS Participatory heat training was effective in improving farmworker heat knowledge over the course of a summer season. Results of this study will be used to guide heat prevention efforts for farmworkers. TRIAL REGISTRATION ClinicalTrials.gov Registration Number: NCT04234802.
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Affiliation(s)
- Diana Marquez
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jennifer E. Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | | | - Elizabeth Torres
- Northwest Communities Education Center/Radio KDNA, Granger, WA, USA
| | - Pablo Palmández
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Paul D. Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Maria Blancas
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Jose Carmona
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - June T. Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
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Chavez Santos E, Spector JT, Egbert J, Krenz J, Sampson PD, Palmández P, Torres E, Blancas M, Carmona J, Jung J, Flunker JC. The effect of the participatory heat education and awareness tools (HEAT) intervention on agricultural worker physiological heat strain: results from a parallel, comparison, group randomized study. BMC Public Health 2022; 22:1746. [PMID: 36104813 PMCID: PMC9476265 DOI: 10.1186/s12889-022-14144-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 09/06/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Farmworkers are at risk of heat-related illness (HRI). We sought to: 1) evaluate the effectiveness of farmworker Spanish/English participatory heat education and a supervisor decision-support mobile application (HEAT intervention) on physiological heat strain; and 2) describe factors associated with HRI symptoms reporting. METHODS We conducted a parallel, comparison group intervention study from May-September of 2019 in Central/Eastern Washington State, USA. We used convenience sampling to recruit adult outdoor farmworkers and allocated participating crews to intervention (n = 37 participants) and alternative-training comparison (n = 38 participants) groups. We measured heat strain monthly using heart rate and estimated core body temperature to compute the maximum work-shift physiological strain index (PSImax) and assessed self-reported HRI symptoms using a weekly survey. Multivariable linear mixed effects models were used to assess associations of the HEAT intervention with PSImax, and bivariate mixed models were used to describe factors associated with HRI symptoms reported (0, 1, 2+ symptoms), with random effects for workers. RESULTS We observed larger decreases in PSImax in the intervention versus comparison group for higher work exertion levels (categorized as low, low/medium-low, and high effort), after adjustment for maximum work-shift ambient Heat Index (HImax), but this was not statistically significant (interaction - 0.91 for high versus low/medium-low effort, t = - 1.60, p = 0.11). We observed a higher PSImax with high versus low/medium-low effort (main effect 1.96, t = 3.81, p < 0.001) and a lower PSImax with older age (- 0.03, t = - 2.95, p = 0.004), after covariate adjustment. There was no clear relationship between PSImax and the number of HRI symptoms reported. Reporting more symptoms was associated with older age, higher HImax, 10+ years agricultural work, not being an H-2A guest worker, and walking > 3 min to get to the toilet at work. CONCLUSIONS Effort level should be addressed in heat management plans, for example through work/rest cycles, rotation, and pacing, in addition to education and other factors that influence heat stress. Both symptoms and indicators of physiological heat strain should be monitored, if possible, during periods of high heat stress to increase the sensitivity of early HRI detection and prevention. Structural barriers to HRI prevention must also be addressed. TRIAL REGISTRATION ClinicalTrials.gov Registration Number: NCT04234802 , date first posted 21/01/2020.
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Affiliation(s)
- Erica Chavez Santos
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - June T Spector
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
- Department of Medicine, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA.
| | - Jared Egbert
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
- Department of Preventive Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Seattle, WA, USA
| | - Jennifer Krenz
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
| | - Paul D Sampson
- Department of Statistics, University of Washington, Seattle, WA, USA
| | - Pablo Palmández
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
| | - Elizabeth Torres
- Northwest Communities Education Center/Radio KDNA, Granger, WA, USA
| | - Maria Blancas
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
| | - Jose Carmona
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
| | - Jihoon Jung
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
| | - John C Flunker
- Department of Environmental and Occupational Health Sciences, University of Washington, 4225 Roosevelt Way NE, Seattle, WA, 98105, USA
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Grzywacz JG, Gonzales-Backen M, Liebman A, Trejo M, Ordaz Gudino C, Trejo M, Economos J, Xiuhtecutli N, Tovar-Aguilar JA. Comparative Effectiveness of Training Alternatives for the EPA's Worker Protection Standard Regulation Among Immigrant Latino Farmworkers. J Occup Environ Med 2022; 64:140-145. [PMID: 34456324 DOI: 10.1097/jom.0000000000002368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Joseph G Grzywacz
- Florida State University, Department of Family & Child Sciences (Dr Grzywacz, Dr Gonzales-Backen, Ms Trejo, Ms Ordaz Gudino, and Ms Trejo); Migrant Clinicians Network, Division of Environmental and Occupational Health (Ms Liebman); Farmworker Association of Florida (Ms Economos, Mr Xiuhtecutli, and Dr Tovar-Aguilar)
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