Farmworker Housing in the United States and Its Impact on Health

Upper respiratory Streptococcus pneumoniae colonization among working-age adults with prevalent exposure to overcrowding

Most pneumococcal disease occurs among infants and older adults and is thought to be driven by the transmission of Streptococcus pneumoniae from young children to these vulnerable age groups. However, pneumococcal disease outbreaks also affect non-elderly adults living or working in congregate, close-contact settings. Little is known about pneumococcal carriage in such populations. From July to November 2020, we collected saliva from low-income adult farmworkers in Monterey County, California, and tested for pneumococcal carriage following culture enrichment via quantitative PCR assays targeting the pneumococcal lytA and piaB genes. Participants were considered to carry pneumococci if lytA and piaB cycle threshold values were both below 40. Among 1,283 participants enrolled in our study, 117 (9.1%) carried pneumococci. Carriers tended more often than non-carriers to be exposed to children aged <5 years [odds ratio (OR) = 1.45 (0.95-2.20)] and overcrowding [OR = 1.48 (0.96-2.30) and 2.84 (1.20-6.73), respectively, for participants in households with >2-4 and >4 persons per bedroom vs ≤2 persons per bedroom]. Household overcrowding remained associated with increased risk of carriage among participants not exposed to children aged <5 years [OR = 2.05 (1.18-3.59) for participants living in households with >2 vs ≤2 persons per bedroom]. Exposure to children aged <5 years and overcrowding were each associated with increased pneumococcal density among carriers [piaB cT difference of 2.04 (0.36-3.73) and 2.44 (0.80-4.11), respectively]. While exposure to young children was a predictor of pneumococcal carriage, associations of overcrowding with increased prevalence and density of carriage in households without young children suggest that transmission also occurs among adults in close-contact settings.IMPORTANCEAlthough infants and older adults are the groups most commonly affected by pneumococcal disease, outbreaks are known to occur among healthy, working-age populations exposed to overcrowding, including miners, shipyard workers, military recruits, and prisoners. Carriage of Streptococcus pneumoniae is the precursor to pneumococcal disease, and its relation to overcrowding in adult populations is poorly understood. We used molecular methods to characterize pneumococcal carriage in culture-enriched saliva samples from low-income adult farmworkers in Monterey County, CA. While exposure to children in the household was an important risk factor for pneumococcal carriage, living in an overcrowded household without young children was an independent predictor of carriage as well. Moreover, participants exposed to children or overcrowding carried pneumococci at higher density than those without such exposures, suggesting recent transmission. Our findings suggest that, in addition to transmission from young children, pneumococcal transmission may occur independently among adults in overcrowded settings.

Housing Conditions and Health Implications for Migrant Agricultural Workers in Canada: A Scoping Review

Migrant agricultural workers face various health inequities that have led to preventable illness and death. This paper investigates how material housing conditions have shaped physical and mental health outcomes for temporary foreign workers in Canadian agriculture. We conducted a scoping review of literature on migrant agricultural worker housing in Canada published between 2000-2022, analysing insights on the physical quality of workers' housing in relation to international frameworks on housing quality. Our review revealed a range of housing-related health risks, including: (1) Sanitation, food security, and water; (2) Thermal safety, electricity, and utilities; (3) Habitability of structure, air quality, and exposure to hazards; (4) Spacing, privacy, and co-worker relations and; (5) Geographic proximity to necessary services and social opportunities. Although housing has been increasingly recognized as a social determinant of health, little research examines how migrant farmworkers' accommodations shape their health outcomes, particularly in Canada. This scoping review provides timely insights and recommendations to inform research, policy, and public health interventions.

Density and precarious housing: overcrowding, sensorial urbanism, and intervention in Hong Kong

This paper offers an approach to understanding high-density living in precarious housing. Developing a conception of housing density based on 'density expressions' and 'density modalities', we argue for a focus on how domestic density is experienced and intervened in by residents and other groups. This approach builds in existing work in Housing Studies and Urban Studies on domestic overcrowding by demonstrating the value of attending to its sensorial experiences, and practices that seek to alleviate those experiences. Drawing on fieldwork in Hong Kong, one of the densest and more unequal housing markets in the world, we identify 'infiltration' as a key form of density expression. We go on explore two density modalities through which residents and other groups, including civil society organisations and the state, practice modest forms of intervention in the struggles of precarious housing: 'improvisation' and 'transition'. We conclude by considering the implications both on housing in Hong Kong and for future research on precarious housing.

Combined Infection Control Interventions Protect Essential Food Workers from Occupational Exposures to SARS-CoV-2 in the Agricultural Environment

Essential food workers experience elevated risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to prolonged occupational exposures in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. Our goal was to quantify the daily cumulative risk of SARS-CoV-2 infection for healthy susceptible produce workers and to evaluate the relative reduction in risk attributable to food industry interventions and vaccination. We simulated daily SARS-CoV-2 exposures of indoor and outdoor produce workers through six linked quantitative microbial risk assessment (QMRA) model scenarios. For each scenario, the infectious viral dose emitted by a symptomatic worker was calculated across aerosol, droplet, and fomite-mediated transmission pathways. Standard industry interventions (2-m physical distancing, handwashing, surface disinfection, universal masking, ventilation) were simulated to assess relative risk reductions from baseline risk (no interventions, 1-m distance). Implementation of industry interventions reduced an indoor worker's relative infection risk by 98.0% (0.020; 95% uncertainty interval [UI], 0.005 to 0.104) from baseline risk (1.00; 95% UI, 0.995 to 1.00) and an outdoor worker's relative infection risk by 94.5% (0.027; 95% UI, 0.013 to 0.055) from baseline risk (0.487; 95% UI, 0.257 to 0.825). Integrating these interventions with two-dose mRNA vaccinations (86 to 99% efficacy), representing a worker's protective immunity to infection, reduced the relative infection risk from baseline for indoor workers by 99.9% (0.001; 95% UI, 0.0002 to 0.005) and outdoor workers by 99.6% (0.002; 95% UI, 0.0003 to 0.005). Consistent implementation of combined industry interventions, paired with vaccination, effectively mitigates the elevated risks from occupationally acquired SARS-CoV-2 infection faced by produce workers. IMPORTANCE This is the first study to estimate the daily risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across a variety of indoor and outdoor environmental settings relevant to food workers (e.g., shared transportation [car or bus], enclosed produce processing facility and accompanying breakroom, outdoor produce harvesting field, shared housing facility) through a linked quantitative microbial risk assessment framework. Our model has demonstrated that the elevated daily SARS-CoV-2 infection risk experienced by indoor and outdoor produce workers can be reduced below 1% when vaccinations (optimal vaccine efficacy, 86 to 99%) are implemented with recommended infection control strategies (e.g., handwashing, surface disinfection, universal masking, physical distancing, and increased ventilation). Our novel findings provide scenario-specific infection risk estimates that can be utilized by food industry managers to target high-risk scenarios with effective infection mitigation strategies, which was informed through more realistic and context-driven modeling estimates of the infection risk faced by essential food workers daily. Bundled interventions, particularly if they include vaccination, yield significant reductions (>99%) in daily SARS-CoV-2 infection risk for essential food workers in enclosed and open-air environments.

Determining Regional Differences in Barriers to Accessing Health Care Among Farmworkers Using the National Agricultural Workers Survey

Farmworkers are an essential workforce in the U.S. We assessed the regions in the National Agricultural Workers Survey on the difficulty of accessing health care among farmworkers in the U.S. The study included 9577 farmworkers. Farmworkers in all regions were more likely to report having difficulty accessing health care because it was too expensive. The overall odds ratio for difficulty accessing health care was lower in the MW after adjusting. Farmworkers employed in the SE had greater difficulty accessing health care because of language barriers. Farmworkers employed in CA had difficulty accessing health care in the U.S. because it was too expensive or far away. Results follow previous studies on barriers to access health care among the farmworker population. Understanding regional disparities in the presence of barriers to accessing health care among farmworkers is an essential step to improving equitable health care access in the U.S.

Overcrowding and Hazardous Dwelling Condition Characteristics: A Systematic Search and Scoping Review of Relevance for Health

Crowding in dwellings is an important public health issue. We hypothesize that overcrowding may cause indirect health effects by adversely affecting the dwelling itself, for example, by increasing dampness leading to mold. We therefore performed a systematic search and a scoping review on overcrowding leading to dwelling condition characteristics of relevance for health. A literature search was performed using the PubMed and Scopus databases up to 5 March 2021. The search yielded 100 records with relevant information. We found that overcrowding is defined in numerous ways and often address "socially deprived" populations. Six studies report associations of overcrowding with at least one dwelling condition characteristic, namely lead, cadmium, microorganism distribution, dust mite and cockroach allergens in dust, cockroach infestation, peeling paint, and mold. One of the studies reports associations between several characteristics, e.g., association of mold with cleanliness and rodent infestation, and points out the common use of pesticides. Additional characteristics were extracted from the remaining 94 records, without data on statistical associations with overcrowding. Our review suggests that multiple potentially hazardous dwelling condition characteristics often coincide in overcrowded dwellings. The epidemiological attribution of health effects to any characteristic is therefore difficult. Causal relationships are even more difficult to establish, as overcrowding is also associated with a range of social and other circumstances that may affect health. The complexity should be considered by scientists and practitioners dealing with overcrowding in dwellings.

Health conditions among farmworkers in the Southwest: An analysis of the National Agricultural Workers Survey

Agricultural jobs pose many challenges to the health and wellbeing of a disadvantaged population. In the Southwest region, the socioeconomic factors of living along the U.S.-Mexico border, migration patterns, lack of access to health care, low utilization of health care services, lack of health insurance, and highly demanding occupation may uniquely affect health outcomes for farmworkers. This paper presents descriptive information for professionals to improve access to care by tackling barriers afforded by the agricultural industry. The National Agricultural Worker Survey (NAWS) is an employment-based, random-sample survey of U.S. agricultural workers in six regions: East, Southeast, Midwest, Southwest, Northwest, and California. We examined farmworkers' self-reported health conditions, including asthma, diabetes, high blood pressure, other chronic conditions, or any condition by region from 2013 to 2016. We used logistic regression to determine differences in lifetime prevalence of health conditions between farmworkers in the Southwest region (n = 727) and farmworkers in other regions (n = 8,850) using weighted data. After adjusting for age, gender, income, insurance status, and English-speaking ability, the odds of high blood pressure and other condition were similar in all regions. The prevalence of diabetes was almost double in the Southwest (114.2 per 1,000 farmworkers). The odds of diabetes were 1.31 (95% CI 0.99, 1.74) times greater in the Southwest region than in the other regions. Asthma was the only condition that was lower in the Southwest (22 per 1,000 farmworkers) compared to the other regions. The odds of asthma were 0.61 (95% CI 0.36, 1.03) times lower in the Southwest region than in other regions. The results follow previous studies on the prevalence of asthma among the farmworker population and elevated probability of chronic diseases including diabetes among the Latino population in the U.S.

COVID-19 and Agricultural Workers: A Descriptive Study

Agricultural workers, designated as "essential" at the start of the COVID-19 pandemic, work in harsh labor conditions, and now have the added challenge of continuing to work during the COVID-19 pandemic. The aim of this study was to assess agricultural workers' COVID-19 related history, employer-based safety measures, individual preventive practices, and COVID-19 vaccination uptake. A questionnaire study was conducted among agricultural workers in Central Florida about COVID-19 during the month of June 2020 and again in July 2021. Among 92 agricultural workers in June 2020, 47% were obese; 11% had had a COVID-19 nasal test; 87% were able to social distance at work and 34% reported employer provided face masks; 15% reported not willing to get the COVID-19 vaccine and 25% were unsure. 40% could self-isolate if they contracted COVID-19. In a follow-up visit in July 2021, 53% of participants reported receiving a COVID-19 vaccine. Agricultural workers are particularly vulnerable to COVID-19 due to existing health risk factors and lack of essential protective resources. Occupational health protections social safety net programs are urgently needed to prevent infections in vulnerable workers, and reduce community spread, and increase COVID-19 vaccination rates.

Innovative Cohort Process to Minimize COVID-19 Infection for Migrant Farmworkers During Travel to Iowa

Background: Migrant and seasonal farmworkers (MSFW) experience disproportionate infection, severe disease and death from COVID-19. This report describes an innovative process to address the safety of MSFW that utilized cohorting that eventually allowed for safe release to work in the fields on a large family farm in Iowa. Methods: Upon worker departure from Mexico, the employer arranged for bus seat assignments, mask use, and hand hygiene practice during the 3-day trip to Iowa. Upon arrival at the farm, surveillance testing and low-density housing cohorting based upon travel seat assignments allowed for early identification of infected workers and appropriate quarantine as per CDC guidelines. Upon completion of isolation or quarantine as appropriate, workers were released to congregate housing and work in the fields. Findings: Compared to a migrant farmworker COVID-19 outbreak without travel pre-planning, the cohorting process produced a 3.5% positivity rate compared to an earlier season July farmworker group on the same farm with a 12.7% positivity rate. Conclusions/Application to Practice: The success of this model points to the power of collaboration between farm employer, health care providers and workers to minimize worker infection and enable safe work in the fields. Increased state and federal support for MSFW protections could support infrastructure to proactively plan for prevention mechanisms to prevent the spread of known communicable disease. With support in place from the top down, employers, workers, and health care providers will be able to prioritize the management of infectious diseases and the needs of essential workers.

The invisibility of farmworkers: Implications and remedies

This article highlights the invisibility of farmworkers in Michigan, a state dependent on migrant labor for more than one hundred years. The study describes migrant housing camps using data from fieldwork, visits to housing camps, and the shadowing of outreach staff from service organizations. Although regulated, accommodations are minimal, substandard, and overcrowded, affecting the health and well-being of workers. The study describes what farmworkers do in their scant evening hours, the vulnerability of H-2A guest workers, the meticulousness accompanying outreach, and how farmworkers are visible to outreach staff. The study concludes by highlighting how farmworkers are just as invisible as are their housing camps, their contributions to the food movement, and their erasure from historic tales and promotional materials in local tourist towns, which stress the contributions of only some groups. The article underscores the value of outreach, the outstanding work performed by outreach staff, and avenues for increasing the visibility and advocacy on behalf of farmworkers.

Structural Vulnerability and Occupational Injury Among Latinx Child Farmworkers in North Carolina

Children as young as ten-years-old can legally work as hired farm labor in the United States. In North Carolina, many hired children are part of the Latinx farmworker community. Agriculture is a hazardous industry, and child workers experience high rates of injury, illness, and mortality. As part of a community-based participatory research study, we draw from thirty in-depth interviews with Latinx child farmworkers aged ten to seventeen to describe their experiences of personal and observed workplace injury and close calls. Nearly all child workers had experienced or observed some form of injury, with several reporting close calls that could have resulted in severe injury or fatality. Overall, children reported a reactive approach to injury prevention and normalized pain as part of the job. Highlighting Latinx child farmworkers' structural "vulnerability, this analysis contextualizes understanding of workplace injury among this largely hidden population. We offer policy recommendations to protect and support these vulnerable workers.

Developing and implementing a co-curricular IPE program: AHEC Scholars Program

As part of a new directive, the Human Resources Services Administration (HRSA) mandated Area Health Education Center (AHEC) Programs across the nation to implement an interprofessional education (IPE) program for health professional students, with the goal of fostering collaborative practice among health profession students and motivating students to work in medically underserved areas post-graduation. The South Texas AHEC Program collaboratively developed and implemented a co-curricular IPE initiative, the AHEC Scholars Program, including didactic and practicum components, focused on the needs of communities in our area. A pre-post quasi-experimental design was used to evaluate the student outcomes related to IPEC Competencies and knowledge and preparation for the practice of core topic areas mandated by HRSA. Student outcomes showed statistically significant improvement in all measures. In order to obtain more detailed accounts of students' practicum experiences, students were asked to complete reflective journals after each practicum. The AHEC Scholars Program provides students with opportunities to work with underserved populations and enables students to explore the benefits of team-based care. This article summarizes the collaborative process of the development and implementation of the AHEC Scholars Program; secondly, it details student outcomes from a 3-month pilot study.

A Mobile Primary Care Clinic Mitigates an Early COVID-19 Outbreak Among Migrant Farmworkers in Iowa

Migrant and seasonal farmworkers are a vulnerable population with unique health and safety challenges related to the entire spectrum of the social determinants of health. These challenges place migrant and seasonal farmworkers at a disproportionate risk of infection and illness because of the COVID-19 pandemic. This report presents a case study of an early COVID-19 outbreak among migrant farmworkers in Iowa and describes the role that a nimble and responsive mobile federally qualified health center played in the successful mitigation and response to this outbreak. Early during the pandemic, the clinic adopted a new model of service delivery utilizing telemedicine primary care visits, followed by in-person visits when necessary. As the pandemic progressed, clinic staff strategized to provide increased pandemic-related support to agricultural employers and migrant farmworkers across the state. Emphasis was placed on on-site testing and education regarding social distancing, mask utilization, and hand washing. Eventually, as migrant workers were infected and became symptomatic, more complex mitigation strategies such as isolation, quarantine, and clinical follow-up were also implemented. This report describes how a mobile primary care clinic developed a pandemic responsive model to provide successful mitigation of an early COVID-19 outbreak among essential and highly vulnerable migrant farmworkers.

Environmental Health Threats to Latino Migrant Farmworkers

Approximately 75% of farmworkers in the United States are Latino migrants, and about 50% of hired farmworkers do not have authorization to work in the United States. Farmworkers face numerous chemical, physical, and biological threats to their health. The adverse effects of these hazards may be amplified among Latino migrant farmworkers, who are concurrently exposed to various psychosocial stressors. Factors such as documentation status, potential lack of authorization to work in the United States, and language and cultural barriers may also prevent Latino migrants from accessing federal aid, legal assistance, and health programs. These environmental, occupational, and social hazards may further exacerbate existing health disparities among US Latinos. This population is also likely to be disproportionately impacted by emerging threats, including climate change and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Latino migrant farmworkers are essential to agriculture in the United States, and actions are needed to protect this vulnerable population.

Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020

We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.

Genetic Knowledge and Communication Among Mexican Farmworkers and Non-farmworkers in North Carolina

It is important to understand genetics within the context of health. This paper assesses (a) genetic knowledge among Mexican-born farmworker and non-farmworker adults; (b) their interpersonal and device sources of genetic knowledge; and (c) the association between their genetic knowledge and the sources of this genetic knowledge.Interviews were conducted with Mexican-born farmworkers (100) and non-farmworkers (100) in North Carolina. Participants answered 15 questions to assess genetic knowledge, and sources from which they had seen or heard about genes and genetics.Results show limited knowledge of genetics, with farmworkers and non-farmworkers providing a similar level of correct responses (6.6 versus 7.3), but with farmworkers providing more incorrect responses (4.0 versus 2.7). Important sources of genetic information for farmworkers were promotoras (47%), compared to teachers (49%) for non-farmworkers.This study demonstrates a need for increased dissemination of genetic information to Mexican-origin farmworkers and non-farmworkers.

Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data-including interviews, photovoice, and participant observation-we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

The (in)visible victims of disaster: Understanding the vulnerability of undocumented Latino/a and indigenous immigrants

As climate change advances, communities across the United States are adapting to the increased threat of wildfires, drought, heatwaves, and infectious diseases. Such disasters are expected to become more frequent and severe. Now more than ever, it is crucial to understand how these events amplify existing inequalities, and how to lessen the resulting harms. Differences in human vulnerability to disaster stem from a range of social, economic, historical, and political factors. We argue that given their social status, undocumented Latino/a and Indigenous immigrants are particularly vulnerable to disasters and require special consideration in disaster planning. They are disproportionately affected by racial discrimination, exploitation, economic hardships, less English and Spanish proficiency, and fear of deportation in their everyday lives- their pre-disaster marginalized status. In the case of the Thomas Fire in California's Ventura and Santa Barbara counties, we show that emergency response and recovery efforts ignored their needs. Resources were directed toward privileged individuals, leaving local immigrant rights and environmental justice groups to provide essential services such as language access to emergency information in Spanish and Indigenous tongues; labor protections for farmworkers endangered in the fields; and a private disaster relief fund for undocumented immigrants ineligible for federal aid. The article concludes with preliminary participant observations from the COVID-19 pandemic response in the region, indicating how lessons from the fire have informed official actions. As governments grapple with the increasing severity of disasters, understanding the differential impacts on undocumented immigrants can help improve disaster planning to protect the most vulnerable and stigmatized populations.

Work Adaptations Insufficient to Address Growing Heat Risk for U.S. Agricultural Workers

The over one million agricultural workers in the United States (U.S.) are amongst the populations most vulnerable to the health impacts of extreme heat. Climate change will further increase this vulnerability. Here we estimate the magnitude and spatial patterns of the growing heat exposure and health risk faced by U.S. crop workers and assess the effect of workplace adaptations on mitigating that risk. We find that the average number of days spent working in unsafe conditions will double by mid-century, and, without mitigation, triple by the end of it. Increases in rest time and the availability of climate-controlled recovery areas can eliminate this risk but could affect farm productivity, farm worker earnings, and/or labor costs much more than alternative measures. Safeguarding the health and well-being of U.S. crop workers will therefore require systemic change beyond the worker and workplace level.

Migrant Farmworkers' Exposure to Pesticides in Sonora, Mexico

Expanding agribusiness in Sonora, a state in Northern Mexico, has increased the demand for temporary migrant agricultural workers. Sonora is one of the top states in Mexico for pesticide utilization. We conducted an exploratory study to evaluate exposure to organophosphate (OP) and pyrethroid pesticides among migrant farmworkers. A sample of 20 migrant farmworkers was recruited from a large commercial grape farm during the harvest season. We administered a questionnaire on work activities, exposure characteristics, and socio-demographics. We collected urine samples to quantify pesticide metabolite concentrations. Most participants were originally from the state of Chiapas, Mexico, none had completed high school, and about half spoke an indigenous language as well as Spanish. The majority of participants had detectable concentrations of pyrethroid and organophosphate biomarkers. Geometric mean creatinine-adjusted concentrations for 3-phenoxybenzoic acid (1.83 µg/g), trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (0.88 µg/g), 4-fluoro-3-phenoxybenzoic acid (0.94 µg/g), 3,5,6-trichloro-2-pyridinol (3.56 µg/g), and para-nitrophenol (0.63 µg/g) were significantly higher than in the general United States' population and Mexican Americans. Our results also suggest that migrant farmworkers in this region are exposed to pesticides at higher levels than other farmworkers' studies. Farmworkers' age, language, training on personal protective equipment, time at the farm, and season, were significant exposure determinants.

Exploring the Role of Depression as a Moderator of a Workplace Obesity Intervention for Latino Immigrant Farmworkers

We explored if and how depression moderated the treatment effect of Pasos Saludables, a successful pilot workplace obesity intervention for Latino immigrant farmworkers. The original randomized controlled study assigned 254 participants 2:1 to a 10-session educational intervention versus control. We assessed the relationship between change in BMI (primary outcome) and interaction of treatment allocation and baseline risk for depression. Baseline CES-D scores indicated that 27.3% of participants were at risk for depression. The interaction between treatment allocation and baseline risk for depression was significant (p = 0.004). In adjusted models among women, intervention participants with no indication of depression at baseline reduced their BMI by 0.77 on average (95% CI - 1.25, - 0.30) compared to controls. The reduction im BMI between the intervention group at risk for depression at baseline and either control was not significantly different from zero. Findings from our post-hoc, exploratory study indicate that depression may inhibit significant weight loss.

The Impact of Work Demand and Gender on Occupational and Psychosocial Stress in Hispanic Farmworkers

Hispanic farmworkers experience hazardous work conditions, language barriers, poverty, and limited healthcare access that increase their risk for health problems. We sought to characterize occupational and lifestyle stressors in farmworker couples and to examine the impact of seasonal work demand and gender on health outcomes. We administered surveys to 31 couples (N = 62) in May (low work demand) and September (high work demand) of 2012. Measures included acculturation, perceived stress, depressive symptoms, quality of life, decision latitude, support (supervisor, co-worker), and work-family conflict. This population did not report significant differences in stress in low and high work demand times. Women reported more work-family conflict (F = 19.06, p 0.0001; F = 11.28, p = 0.0015) and less supervisor support (F = 6.56, p = 0.0135). Women experienced more conflict between work and family and less support at work. This group reported low depressive symptomology and moderate levels of stress; a subset reported elevated levels.

Stability of Household and Housing Characteristics Among Farmworker Families in North Carolina: Implications for Health

Household and housing stability are important for health and well-being of individuals, particularly children. This analysis examines stability in household and housing over 2 years for North Carolina farmworker families with children. Mothers with a child aged 2-4 years in farmworker families (n = 248) completed interviews over 2 years. Household measures included number of adults and children, moves, and spouse absence. Housing measures included tenure, persons per bedroom, and kitchen facilities. Household and housing characteristics for participants retained in the study over 2 years (n = 221) were stable in number of persons, tenure, persons per bedroom, and kitchen facilities. Households were large with one-third having 3 or more adults, and one-quarter having 4 or more children. Most families rented houses (over 15 % owned), which were crowded. Participants lost to follow-up were similar to retained participants in household characteristics, but had worse housing characteristics. Comparative research on farmworker family household composition is needed.

Pesticide Urinary Metabolites Among Latina Farmworkers and Nonfarmworkers in North Carolina

OBJECTIVES

This paper compares detections and concentrations of pesticide urinary metabolites for Latina farmworkers and nonfarmworkers in North Carolina.

METHODS

Thirty-one farmworkers and 55 nonfarmworkers provided urine samples in 2012 and 2013. Urine samples were analyzed for detections and concentrations of organophosphate insecticide, bis-dithiocarbamate fungicide, and pyrethroid insecticide urinary metabolites.

RESULTS

Detections for several organophosphate and pyrethroid pesticide urinary metabolites were present for substantial proportions of the farmworkers and nonfarmworkers. Concentrations for several of these metabolites were high. Farmworkers and nonfarmworkers were similar in detections and concentrations for the pesticide urinary metabolites included in this analysis.

CONCLUSIONS

Participant pesticide exposure increases health risks for them and their children. Research needs to document pesticide exposure, its health effects, and ways to reduce it. Current information justifies policy development to reduce pesticide exposure in all communities.

Providing Health Information to Latino Farmworkers: The Case of the Affordable Care Act

OBJECTIVE

Providing health program information to vulnerable communities, such as Latino farmworkers, is difficult. This analysis describes the manner in which farmworkers receive information about the Affordable Care Act, comparing farmworkers with other Latinos.

METHODS

Interviews were conducted with 100 Latino farmworkers and 100 urban Latino North Carolina residents in 2015.

RESULTS

Most farmworkers had received health information from a community organization. Trusted sources for health information were health care providers and community organizations. Sources that would influence decisions to enroll were Latino nurses and doctors, religious leaders, and family members. Traditional media, including oral presentation and printed material at the doctor's office, were preferred by the majority of farmworkers and non-farmworkers. Farmworkers used traditional electronic media: radio, television, and telephone. More non-farmworkers used current electronic media: e-mail and Internet.

CONCLUSIONS

Latino farmworkers and non-farmworkers prefer traditional media in the context of a health care setting. They are willing to try contemporary electronic media for this information.

Covariates of Identified Stress and Depression among Seasonal Farmworkers

Many noted difficulties of farmworker life result in increased risk for stress and depression. To date, limited research has focused primarily on seasonal farmworkers; much of the prior research examines migrant farmworkers or both groups collectively. This study aims to: (1) describe levels of stress and depression among a sample of seasonal farmworkers; and (2) identify if covariates (age, gender, marital status, education level, years of residency, problems obtaining healthcare due to documentation, language barriers, transportation, costs, medical insurance, and stress level) are significant predictors of depressive symptoms. Survey data were collected from 150 Latino seasonal farmworkers. A hierarchical binary logistic regression was conducted to identify significant covariates. The results indicated that the only statistically significant covariates were health insurance coverage (p = 0.025) and stress (p = 0.008). Those farmworkers without health insurance were 1.8 times more likely than those with health insurance to possess depressive symptoms, while those demonstrating higher stress levels were over 7 times more likely to demonstrate symptoms of depression. The implications of the results are discussed in the manuscript.

Associations of Poor Housing with Mental Health Among North Carolina Latino Migrant Farmworkers

This analysis examines the associations of housing conditions with mental health among migrant farmworkers. Data are from a 2010 cross-sectional study conducted in 16 North Carolina counties. Interviews and housing inspections were completed with 371 farmworkers in 186 camps. Mental health measures included depression (Center for Epidemiologic Studies Depression Scale, CES-D), anxiety (Personality Assessment Inventory, PAI), and alcohol misuse (Alcohol Use Disorders Identification Test, AUDIT-C). Housing measures were number of people per sleeping room, perceived security of self and belongings, having a key to dwelling's door, having bedroom storage, toilet privacy issues, and number of housing regulation violations. Sixty (16.7%) participants had substantial depressive symptoms (CES-D ≥10), 31 (8.8%) had substantial anxiety (PAI ≥27), and 185 (50.1%) had the potential for alcohol misuse (AUDIT-C ≥4). Those with 5+ persons sleeping per room were more likely to have a depression score ≥10 (31.5% vs. 13-14%, P = .01) and an anxiety scores ≥27 (19.6% vs. 5-9%, P = .02). Those who did not feel they or their belongings were secure were more likely to have a depression score ≥10 (19.4% vs. 9.1%, P = .01). Those without a key were more likely to have an anxiety score ≥27 (11.5% vs. 5.1%, P = .04). Those with no bedroom storage were more likely to have a depression score ≥10 (28.9% vs. 14.9%, P = .03). This article suggests links between poor housing and farmworkers' mental health. These results inform regulations surrounding farmworker housing and inform health care providers on how to prevent and treat poor mental health among migrant farmworkers.

Farmworker Housing Quality and Health

On 11 November 2014, Farmworker Housing Quality and Health: A Transdisciplinary Conference was convened to draw together experts from the variety of disciplines who contribute to research and practice focused on farmworker housing and health in order to delineate current knowledge and propose next steps. The conference addressed three specific aims: (1) to consolidate current knowledge on characteristics and quality of housing provided for farmworkers; (2) to delineate pertinent directions and areas for farmworker housing health and safety research and policy; and (3) to facilitate the development of working groups to support the implementation of research, education, and engineering projects to improve farmworker housing. This article provides an overview of the conference.