Heat index in migrant farmworker housing: implications for rest and recovery from work-related heat stress

Occupational heat-related illness in Washington State: A descriptive study of day of illness and prior day ambient temperatures among cases and clusters, 2006-2021

BACKGROUND

Insufficient heat acclimatization is a risk factor for heat-related illness (HRI) morbidity, particularly during periods of sudden temperature increase. We sought to characterize heat exposure on days before, and days of, occupational HRIs.

METHODS

A total of 1241 Washington State workers' compensation State Fund HRI claims from 2006 to 2021 were linked with modeled parameter-elevation regressions on independent slopes model (PRISM) meteorological data. We determined location-specific maximum temperatures (Tmax,PRISM ) on the day of illness (DOI) and prior days, and whether the Tmax,PRISM was ≥10.0°F (~5.6°C) higher than the average of past 5 days ("sudden increase") for each HRI claim. Claims occurring on days with ≥10 HRI claims ("clusters") were compared with "non-cluster" claims using t tests and χ2 tests.

RESULTS

Seventy-six percent of analyzed HRI claims occurred on days with a Tmax,PRISM  ≥ 80°F. Claims occurring on "cluster" days, compared to "non-cluster" days, had both a significantly higher mean DOI Tmax,PRISM (99.3°F vs. 85.8°F [37.4°C vs. 29.9°C], t(148) = -18, p < 0.001) and a higher proportion of "sudden increase" claims (80.2% vs. 24.3%, χ2 [1] = 132.9, p < 0.001). Compared to "cluster" days, HRI claims occurring during the 2021 Pacific Northwest "heat dome" had a similar increased trajectory of mean Tmax,PRISM on the days before the DOI, but with higher mean Tmax,PRISM. CONCLUSIONS: Occupational HRI risk assessments should consider both current temperatures and changes in temperatures relative to prior days. Heat prevention programs should include provisions to address acclimatization and, when increases in temperature occur too quickly to allow for sufficient acclimatization, additional precautions.

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.

The Effect of Participatory Heat Education on Agricultural Worker Knowledge

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.

Development of a multidimensional housing and environmental quality index (HEQI): application to the American Housing Survey

BACKGROUND

Substandard housing conditions and hazardous indoor environmental exposures contribute to significant morbidity and mortality worldwide. Housing indices that capture the multiple dimensions of healthy housing are important for tracking conditions and identifying vulnerable households. However, most indices focus on physical deficiencies and repair costs and omit indoor environmental exposures, as few national data sources routinely collect this information.

METHODS

We developed a multidimensional Housing and Environmental Quality Index (HEQI) based on the World Health Organization's Housing and Health Guidelines and applied it to the 2019 American Housing Survey (AHS). The HEQI consisted of ten domains associated with poor health: household fuel combustion, dampness and mold, pests and allergens, lead paint risk, high indoor temperatures, low indoor temperatures, household crowding, injury hazards, inadequate water and sanitation, and ventilation. We evaluated the validity and performance of the HEQI against three housing characteristics (i.e., year built, monthly rent costs, unit satisfaction rating) and two established indices (i.e., Adequacy Index, Poor Quality Index).

RESULTS

Approximately 79% (92 million) of U.S. households reported at least one HEQI domain associated with poor health (mean per household: 1.3; range: 0,8). Prevalent domains included household fuel combustion (61.4%), dampness and mold (15.9%), inadequate water and sanitation (14.3%), and injury hazards (11.9%). Pests and allergens, low indoor temperatures, and injury hazards were consistently associated with older homes, lower rent costs, and lower unit satisfaction. Compared to established housing indices, the HEQI captured four new environmental domains which enabled the identification of 57.7 million (63%) more households with environmental risk factors like mold, cockroaches, crowding, household fuel combustion, and higher building leakage.

CONCLUSIONS

Indoor environmental exposures are prevalent in U.S. households and not well-captured by existing housing indices. The HEQI is a multidimensional tool that can be used to monitor indoor environmental exposures and housing quality trends in the U.S. Some domains, including radon, pesticides, asbestos, noise, and housing accessibility could not be assessed due to the lack of available data in the AHS. The mounting evidence linking residential environmental exposures with adverse health outcomes underscore the need for this data in the AHS and other national surveys.

Advancing the Health of Migrant and Seasonal Farmworkers in the United States: Identifying Gaps in the Existing Literature, 2021

There are profound health inequities for agricultural workers. We sought to assess the literature on migrant and seasonal farmworker health with an eye toward health promotion interventions, special populations, use of community health workers (CHWs), and technology. We conducted a systematic mapping review by searching five databases in March 2021. Using quantitative content analysis after establishing interrater reliability, we coded titles and abstracts to assess 13 topics and six characteristics of the research such as its focus on health promotion, use of technology, and inclusion of CHWs. We identified 1,083 records. Just 8.2% of records described or evaluated a health promotion effort to intervene in farmworker well-being and even fewer (4.2%) examined unique populations of farmworkers such as indigenous farmworkers (n = 11) or sexual minority farmworkers (n = 1). A small body of literature focused on the role of CHWs or promotores most frequently described their role in implementing health interventions. The literature on farmworker health has gaps regarding health promotion interventions, special populations, and integration of CHWs into research projects. We offer suggestions to fill in identified gaps in the literature.

Heat-Related Illness Among Latinx Child Farmworkers in North Carolina: A Mixed-Methods Study

Children as young as ten are legally hired for farm work. In North Carolina, many of these hired children are Latinx; they often work long hours during hot and humid summer conditions. Heat-related illness occurs along a continuum of severity ranging from heat cramps and rashes to heat exhaustion and heat stroke, which can be fatal. The literature on the negative health effects of occupational heat exposure is growing; however, few studies have examined this exposure and health outcomes among child agricultural workers. To understand Latinx child farmworkers' experiences of working in heat, we conducted in-depth interviews (n = 30). To estimate the prevalence of heat-related illness symptoms and associated factors, we conducted survey interviews (n = 165). Heat-related illness is common among these child farmworkers. While children often understand the dangers of working in heat, work organization often prevents their taking precautions. Formal workplace protections to prevent heat-related illness are limited.

An Occupational Heat Stress and Hydration Assessment of Agricultural Workers in North Mexico

Expanding agribusiness in Northern Mexico has increased demand for workers from Southern Mexico, with hundreds of thousands migrating for work annually. Extreme temperatures, physical labor, and low fluid consumption place workers at risk for heat strain and dehydration, commonly underreported hazards in the agricultural industry. The objectives of this pilot study were to assess heat exposure and hydration status of a population of migratory agricultural workers in Northern Mexico throughout the grape harvest season. In addition to demographic information, environmental conditions, hydration status, and core body temperatures were collected. The majority listed Chiapas as their home state, nearly half spoke an Indigenous language, and none had completed high school. The wet-bulb globe temperature was significantly higher during the harvest and post-harvest seasons compared to the pre-harvest season. Across the different seasons, the majority were dehydrated post-shift, and mean core body temperature of workers was not significantly different. This project highlights the need for targeted interventions to improve hydration and prevent heat stress in this region. As the number of warm days is expected to rise each year worldwide, it will be increasingly important to engage in practices to protect vulnerable populations, such as migratory agriculture workers.

Migrant Farmworker Nutritional Strategies: Implications for Diabetes Management

OBJECTIVES

Diabetes is a chronic disease prevalent in Hispanic/Latino adults, including migrant farmworkers in the US. Its management requires that individuals follow dietary guidelines, which may be difficult for migrant farmworkers due to work and environmental constraints. This analysis is designed to explore potential barriers to and supports for migrant farmworkers' practice of effective dietary self-management.

METHODS

Interviews were conducted with 200 Latino migrant farmworkers in North Carolina, including workers with and without diabetes, recruited at housing sites throughout the 2017 agricultural season. The survey instrument included questions designed to elucidate how workers obtain food, prepare and consume food, and maintain food security.

RESULTS

Most purchased food is obtained once per week at large grocery stores, with most farmworkers depending on others for transportation. Less than 1 in 5 supplement with garden produce and food from food pantries, farmers markets, and hunting and fishing. About half of lunches and a quarter of dinners are purchased from vendors or other commercial sources. More than 2 in 5 workers report they have to compromise on or lack control of meal content. About 1 in 5 report issues with food security.

CONCLUSIONS

The food-related practices of farmworkers would require change to accommodate effective dietary self-management of diabetes. Greater use of sources of fresh produce and other nutrient-dense foods, coupled with greater control over meal content and cooking techniques would be needed. While some accommodations could be encouraged through education, others would require policy change in housing or access to community resources.

A pilot project to increase health literacy among youth from seasonal farmworker families in rural eastern North Carolina: a qualitative exploration of implementation and impact

Objective

There are substantial health inequalities for seasonal agricultural workers and their families in the United States. One identified inequality is in health literacy. The authors explored the implementation and impact of connecting youth from seasonal farmworker families who participated in a leadership and college pipeline program with Internet access by providing a tablet with a paid cellular data plan and university library–based health literacy training.

Methods

With the support of a National Network of Libraries of Medicine Health Information Outreach Award, we conducted a qualitative, utilization-focused evaluation by conducting semi-structured interviews from December 2017 through February 2018 with middle and high school age participants in the program (n=10). After parental consent and youth assent, we recorded interviews with participants at program activity locations or in their homes. We then utilized inductive thematic analysis with 2 primary coders.

Results

We identified four themes: (1) having access to the Internet can be transformative, (2) access resulted in increased knowledge of and interest in one’s own and others’ health, (3) “Google” is the norm, and (4) participant training increased self-efficacy to determine credible sources and resources.

Conclusion

Providing Internet access and iPads was possible to implement and resulted in increased utilization of health information. The combination of Internet access with training on information literacy was a key factor in achieving these positive outcomes. The findings suggest the importance of ensuring equitable access to the Internet in efforts to improve educational and health outcomes for seasonal farmworkers and their families.

Heat-Related Illness in Midwestern Hispanic Farmworkers: A Descriptive Analysis of Hydration Status and Reported Symptoms

Heat-related illness (HRI) is a largely undocumented phenomenon in Midwestern Hispanic migrant and seasonal farmworkers in the United States. Frequently, the physiological burden of crop production is overlooked while workers are in the fields. We completed a mixed-methods study using a cross-sectional survey among migrant and seasonal farmworkers about their experience with HRI symptoms ( N = 148) and conducted an intensive surveillance on a smaller group of workers ( N = 20) in field trials ( N = 57 trials) using a chest-strapped multi-parameter monitoring wearable sensor (MPMWS) that measured skin/body temperature, heart and breathing rate, kilocalories burned per hour, and provided a physiological intensity (PI) score. The field trials were conducted across three classes of climate conditions and three PI score categories. We found that those in the uncomfortable category (PI score > 4.0) had a statistically significant ( F ratio = 16.41, p < .001) higher body temperatures ( M = 100.05°F) than those with a mild PI (range = 0-5) score ⩽ 2.5 ( M = 99.56°F) or moderate PI score > 2.5-4 (99.84°F). We also found that those in the uncomfortable climate condition category had a higher mean heart rate and breathing rate than those working under mild and moderate field trials.

Healthy-Sustainable Housing Index: A Pilot Study to Link Architecture and Public Health in a Semi-Urban Community in Mexico

The aim of this pilot study was to evaluate the link between housing and children´s respiratory symptoms, through the construction of an index (HSHI) based on the definition of healthy-sustainable housing criteria, in a semi-urban community from Morelos, Mexico. A general and household questionnaire, and respiratory symptoms diary were applied in 60 households to gather information about schoolchildren, respiratory health, housing and lifestyle characteristics. HSHI was constructed using principal component analysis. The association between HSHI and the presence and duration of respiratory symptoms was assessed using logistic and Poisson regression models. HSHI had five components, which accounted for 63% of variance, and were classified into poor and sufficient quality. It was observed that schoolchildren who inhabit a sufficient-quality house, showed a reduction in nose irritation duration and in the allergic symptoms probability regarding component 1 (ventilation, lighting and cloth washing) and presented three times less duration of common cold by component 2 (construction material, painted walls inside the house and type of bathroom) compared to poor-quality house inhabitants. Our results suggest that living in a sufficient-quality house, as described by the HSHI, reduced the prevalence of wheezing episodes and the probability of ear pain, providing evidence about the positive association of a healthy-sustainable housing on the respiratory health of schoolchildren.

Engaging Youth Advocates in Community-Based Participatory Research on Child Farmworker Health in North Carolina

BACKGROUND

Wake Forest School of Medicine (WFSM) investigators and Student Action with Farmworkers' (SAF) Levante Leadership Institute, a farmworker youth program, are collaborating on a community-based participatory research (CBPR) study.

OBJECTIVES

1) Describe the collaborative process between WFSM investigators and the Levante advisory board during the strategic planning and implementation phase and 2) highlight practices that support the collaboration and project success.

METHODS

The longitudinal Hired Child Farmworker Study examines the health and safety of hired Latino child farm-workers in North Carolina. Two Levante alumni co- investigators lead research-related activities with the Levante advisory board.

LESSONS LEARNED

Challenges to CBPR with youth are overcome by the longstanding partnership between WFSM and SAF, attention to logistical details, power sharing, building on shared values, and assessment of youth preferences.

CONCLUSIONS

The partnership between WFSM and Levante demonstrates the mutual benefit of CBPR and will continue during the upcoming study phases.

"I Think the Temperature was 110 Degrees!": Work Safety Discussions Among Hispanic Farmworkers

Heat-related illness (HRI) among migrant and seasonal farmworkers is an occupational risk addressed through varying mitigation strategies by individual workers and supervisors. The purpose of this pilot study was to describe farmworkers' experience with HRI prevention strategies and assess HRI information seeking preferences, especially the feasibility of using mobile phone apps to access this information. Five focus groups were administered to Hispanic farmworkers in South Carolina. Questions included the following topics: health information seeking preferences; farmworkers' perceptions of occupational risks; coping strategies; past experiences with HRIs; water, rest, and shade practices; access to health care; and any employer-provided training received. There was consensus across the groups that the workers at highest risk for HRIs were either inexperienced or new workers in the fields. Farmworkers ascribed responsibility for one's well-being while working in the heat more as an individual factor than as an employer's responsibility. Farmworkers received training on the OSHA Heat Safety Tool app and provided positive feedback about the educational content and temperature information warnings. These findings suggest the potential for supervisors to take a more active role in heat safety education using mobile technology.

Without Warning: Worker Deaths From Heat 2014-2016

Worker deaths from heat exposure are unlike heat deaths in the general population; workers tend to be outside in variable temperatures and younger than sixty-five years. Climate change will increase the frequency, duration, and variability of hot temperatures. Public health warning systems, such as the Heat Index of the National Weather Service, do not generally account for workers' greater likelihood of exposure to direct sunlight or exertion. Only 28% of the 79 worker heat-related fatalities during 2014-2016 occurred on days when the National Weather Service warning would have included the possibility of fatal heat stroke. Common heat illness prevention advice ignores workers' lack of control over their ability to rest and seek cooler temperatures. Additionally, acclimatization, or phased-in work in the heat, may be less useful given temperature variability under climate change. Workers' vulnerability and context of heat exposure should inform public health surveillance and response to prevent heat illness and death.

Mortality and Morbidity during Extreme Heat Events and Prevalence of Outdoor Work: An Analysis of Community-Level Data from Los Angeles County, California

Heat is a well-recognized hazard for workers in many outdoor settings, yet few investigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction, agriculture, and other outdoor industries. Using 2005–2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We find generally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits. The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and responding to extreme heat events.

Farmworker Vulnerability to Heat Hazards: A Conceptual Framework

PURPOSE

To review factors that impact the effect of hot environments on the human body in order to develop a conceptual model of human biological response.

METHODS

The organizing concept for the model development was the multilevel integration of three major factors, exposure to heat, sensitivity and adaptive capacity, and the heat stress response. Exposure of a vulnerable occupational group was used to illustrate the components of the model.

FINDINGS

Components of this framework include the hazard (environmental heat stress), vulnerability factors (workplace exposure, sensitivity and adaptive capacity), and the heat stress response. The combination of the vulnerability factors of workplace exposure (work intensity, duration), sensitivity (age, gender, etc.), and adaptive capacity (hydration, clothing, work hygiene) mediate a worker's heat stress response to the hazard. A worker's heat stress response can be classified as progressing towards two outcomes: physiologic equilibrium or physiologic disequilibrium.

CONCLUSIONS

This framework provides a starting point for the design and development of studies of heat-related illness (HRI) in farmworker and other vulnerable populations exposed to rising global temperatures.

CLINICAL RELEVANCE

Identification of vulnerability factors to HRI, informs research designs which will lead to the development of public health interventions.

"The Only Thing I Wish I Could Change Is That They Treat Us Like People and Not Like Animals": Injury and Discrimination Among Latino Farmworkers

OBJECTIVE

This article describes how perceived discrimination shapes the way Latino farmworkers encounter injuries and seek out treatment.

METHODS

After 5 months of ethnographic fieldwork, 89 open-ended, semistructured interviews were analyzed. NVivo was used to code and qualitatively organize the interviews and field notes. Finally, codes, notes, and co-occurring dynamics were used to iteratively assess the data for major themes.

RESULTS

The primary source of perceived discrimination was the "boss" or farm owner. Immigrant status was also a significant influence on how farmworkers perceived the discrimination. Specifically, the ability to speak English and length of stay in the United States were related to stronger perceptions of discrimination. Finally, farm owners compelled their Latino employees to work through their injuries without treatment.

CONCLUSIONS

This ethnographic account brings attention to how discrimination and lack of worksite protections are implicated in farmworkers' injury experiences and suggests the need for policies that better safeguard vulnerable workers.

Syndemic vulnerability and the right to health

Investigators working both in syndemics, a field of applied health research with roots in medical anthropology, and in the field of health and human rights recognise that upstream social, political, and structural determinants contribute more to health inequities than do biological factors or personal choices. Syndemics investigates synergistic, often deleterious interactions among comorbid health conditions, especially under circumstances of structural and political adversity. Health and human rights research draws on international law to argue that all people deserve access not only to health care, but also to the underlying determinants of good health. Taking the urgent matter of migrant health as an empirical focus, we juxtapose the fields of syndemics and health and human rights, identify their complementarities, and advocate for a combined approach. By melding insights from these fields, the combined syndemics/health and human rights approach advanced here can provide clinicians and other key stakeholders with concrete insights, tools, and strategies to tackle the health inequities that affect migrants and other vulnerable groups by: (1) mapping the effect of social, political, and structural determinants on health; (2) identifying opportunities for upstream intervention; and (3) working collaboratively to tackle the structures, institutions, and processes that cause and exacerbate health inequities. Undergirding this approach is an egalitarian interpretation of the right to health that differs from narrow legalistic and individual interpretations by insisting that all people are equal in worth and, as a result, equally deserving of protection from syndemic vulnerability.

"Aguantamos": Limits to Latino Migrant Farmworker Agency in North Carolina Labor Camps

Each year, tens of thousands of Latino migrant farmworkers return to the hills and fields of North Carolina to live in employer-provided labor camps that often fail to meet regulatory and ethical standards. Little attention has been paid to how these workers and their families perceive and respond to substandard housing conditions. This paper analyzes how far and in what ways Latino migrant farmworkers living in eastern North Carolina labor camps feel their agency extends in responding to substandard housing and work conditions, while also considering who among them has the power to exercise this agency. Based on qualitative analysis of interviews with twenty-three migrant farmworkers or partners of farmworkers, our findings indicate that the limits of migrant farmworker agency are strongly dictated by the close relationship between migrant farmworker employment and housing; by the importance of remittance wages for dependents; and by individual immigration, gender, and education characteristics. In the current context, the informal and reparative nature of agentive acts in substandard labor camps creates real but minor improvements while also co-constructing the very structural neglect to which it responds. We conclude that current housing and labor policy frameworks do little to amplify and support differentially distributed migrant farmworker agency and its individualized successes.

Impact of Extreme Heat Events on Emergency Department Visits in North Carolina (2007-2011)

Extreme heat is the leading cause of weather-related mortality in the U.S. Extreme heat also affects human health through heat stress and can exacerbate underlying medical conditions that lead to increased morbidity and mortality. In this study, data on emergency department (ED) visits for heat-related illness (HRI) and other selected diseases were analyzed during three heat events across North Carolina from 2007 to 2011. These heat events were identified based on the issuance and verification of heat products from local National Weather Service forecast offices (i.e. Heat Advisory, Heat Watch, and Excessive Heat Warning). The observed number of ED visits during these events were compared to the expected number of ED visits during several control periods to determine excess morbidity resulting from extreme heat. All recorded diagnoses were analyzed for each ED visit, thereby providing insight into the specific pathophysiological mechanisms and underlying health conditions associated with exposure to extreme heat. The most common form of HRI was heat exhaustion, while the percentage of visits with heat stroke was relatively low (<10%). The elderly (>65 years of age) were at greatest risk for HRI during the early summer heat event (8.9 visits per 100,000), while young and middle age adults (18-44 years of age) were at greatest risk during the mid-summer event (6.3 visits per 100,000). Many of these visits were likely due to work-related exposure. The most vulnerable demographic during the late summer heat event was adolescents (15-17 years of age), which may relate to the timing of organized sports. This demographic also exhibited the highest visit rate for HRI among all three heat events (10.5 visits per 100,000). Significant increases (p < 0.05) in visits with cardiovascular and cerebrovascular diseases were noted during the three heat events (3-8%). The greatest increases were found in visits with hypotension during the late summer event (23%) and sequelae during the early summer event (30%), while decreases were noted for visits with hemorrhagic stroke during the middle and late summer events (13-24%) and for visits with aneurysm during the early summer event (15%). Significant increases were also noted in visits with respiratory diseases (5-7%). The greatest increases in this category were found in visits with pneumonia and influenza (16%), bronchitis and emphysema (12%), and COPD (14%) during the early summer event. Significant increases in visits with nervous system disorders were also found during the early summer event (16%), while increases in visits with diabetes were noted during the mid-summer event (10%).

Relationships between maximum temperature and heat-related illness across North Carolina, USA

Heat kills more people than any other weather-related event in the USA, resulting in hundreds of fatalities each year. In North Carolina, heat-related illness accounts for over 2,000 yearly emergency department admissions. In this study, data on emergency department (ED) visits for heat-related illness (HRI) were obtained from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool to identify spatiotemporal relationships between temperature and morbidity across six warm seasons (May-September) from 2007 to 2012. Spatiotemporal relationships are explored across different regions (e.g., coastal plain, rural) and demographics (e.g., gender, age) to determine the differential impact of heat stress on populations. This research reveals that most cases of HRI occur on days with climatologically normal temperatures (e.g., 31 to 35 °C); however, HRI rates increase substantially on days with abnormally high daily maximum temperatures (e.g., 31 to 38 °C). HRI ED visits decreased on days with extreme heat (e.g., greater than 38 °C), suggesting that populations are taking preventative measures during extreme heat and therefore mitigating heat-related illness.

Alcohol Consumption and Risk for Dependence Among Male Latino Migrant Farmworkers Compared to Latino Nonfarmworkers in North Carolina

BACKGROUND

Our aim was to describe alcohol consumption behavior of male Latino migrant farmworkers, compare their alcohol consumption behavior with that of other male Latino immigrants, and determine factors associated with risk for alcohol dependence among Latino immigrant workers.

METHODS

Cross-sectional data were drawn from baseline interviews conducted as part of a larger community-based participatory research project examining the cognitive and neurological outcomes of pesticide exposure. A total of 235 farmworkers and 212 nonfarmworkers completed interviews between May and August 2012.

RESULTS

Although 17.5% of the North Carolina Latino farmworkers report never having drunk alcohol, and a total of 34.5% report not having drunk alcohol in the previous 3 months, 48.5% engaged in heavy episodic drinking (HED) in the previous 3 months, and 23.8% frequently engaged in HED during this period. Farmworkers and nonfarmworkers did not differ significantly in alcohol consumption behavior. Farmworkers and nonfarmworkers did differ significantly in each component of the CAGE scale, with 37.9% of farmworkers and 16.0% of nonfarmworkers being at risk for alcohol dependence (p < 0.0001). Significant factors for being at risk for alcohol dependence were stress (odds ratio 1.06, 95% confidence interval 1.03, 1.09) and being a farmworker (odds ratio 3.58, 95% confidence interval 2.12, 6.06). Being married reduced the risk of alcohol dependence (odds ratio 0.45, 95% confidence interval 0.23, 0.87).

CONCLUSIONS

Latino farmworkers and nonfarmworkers consume relatively large amounts of alcohol and engage in HED at relatively high rates. Latino farmworkers have very high rates of risk for alcohol dependence. Policy changes and public health interventions are needed to address these concerns for a population that is vital to the agricultural economy.

Heat Illness Among North Carolina Latino Farmworkers

OBJECTIVE

Heat exposure is an important hazard for workers in manual occupations, including farmworkers. This analysis delineates the prevalence of heat illness among farmworkers, and the factors associated with heat illness.

METHODS

North Carolina Latino male farmworkers completed interviews in August, 2013. They reported on heat exposure and behaviors over the previous 3 months while working both outdoors and indoors.

RESULTS

A third (35.6%) of the participants reported heat illness while working outside, and 13.9% while working inside. Factors associated with heat illness while working outside included working in wet clothes and shoes, harvesting and topping tobacco, and spending after-work time in an extremely hot house.

CONCLUSIONS

Policy addressing heat illness is needed, as is more detailed research on occupational heat exposure that uses common measures.

Collecting Comparative Data on Farmworker Housing and Health: Recommendations for Collecting Housing and Health Data Across Places and Time

The substandard nature of the housing in which most farmworkers live has detrimental effects on their health, as well as on their children's health and development. However, little research has directly documented associations between farmworker housing and health; existing research is not always comparable due to differences in design and measurement. Comparative data can help determine actual causal links between housing characteristics and farmworker health and help to evaluate the efficacy of current housing policy. The goal of this paper is to provide guidelines promoting comparable research on farmworker housing and the association of this housing with health. This paper reviews general concepts relevant to measuring farmworker housing and health, issues that should be considered in designing farmworker housing and health research, data collection methods, and measures. It concludes with recommendations for a research agenda on farmworker housing and health.

Hidden Farmworker Labor Camps in North Carolina: An Indicator of Structural Vulnerability

OBJECTIVES

We used geographic information systems (GIS) to delineate whether farmworker labor camps were hidden and to determine whether hidden camps differed from visible camps in terms of physical and resident characteristics.

METHODS

We collected data using observation, interview, and public domain GIS data for 180 farmworker labor camps in east central North Carolina. A hidden camp was defined as one that was at least 0.15 miles from an all-weather road or located behind natural or manufactured objects. Hidden camps were compared with visible camps in terms of physical and resident characteristics.

RESULTS

More than one third (37.8%) of the farmworker labor camps were hidden. Hidden camps were significantly larger (42.7% vs 17.0% with 21 or more residents; P ≤ .001; and 29.4% vs 13.5% with 3 or more dwellings; P = .002) and were more likely to include barracks (50% vs 19.6%; P ≤ .001) than were visible camps.

CONCLUSIONS

Poor housing conditions in farmworker labor camps often go unnoticed because they are hidden in the rural landscape, increasing farmworker vulnerability. Policies that promote greater community engagement with farmworker labor camp residents to reduce structural vulnerability should be considered.

Housing and Neighborhood Characteristics and Latino Farmworker Family Well-Being

Housing quality and neighborhood characteristics affect individual health and family well-being. This analysis describes characteristics of farmworker housing and neighborhoods and delineates the associations of housing and local neighborhood with indicators of family well-being. Mothers in North Carolina farmworker families (n = 248) completed interviews in 2011-2012. Family well-being measures included stress, family conflict, and outward orientation. Housing measures included ownership and facilities, and neighborhood measures included heavy traffic and driving time to grocery stores. Families experienced elevated stress and conflict, and limited outward orientation. Few owned their homes, which were generally crowded. Few had enclosed play spaces for their children. For many, traffic made it difficult to walk on the street. Housing and neighborhood characteristics were related to increased stress and limited outward orientation. Housing and neighborhood characteristics are important for research on the health of families in vulnerable populations, such as farmworker families.

Farmworker Housing: A Photo Essay

Migrant and seasonal farmworkers often reside in poor housing conditions which expose them to numerous hazards. These housing conditions are an issue of environmental health and justice. The photographs in this essay illustrate the living conditions confronted by farmworkers, offering a visual context for the reviews published in this issue of New Solutions. Farmworker housing conditions are often shocking to those who have not visited farmworker communities. Continued research is needed to document these conditions, how they affect the health of farmworkers, and provide leverage in the struggle to improve farmworker housing conditions.

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.

Federal Farmworker Housing Standards and Regulations, Their Promise and Limitations, and Implications for Farmworker Health

The housing available to most farmworkers is substandard and unacceptable in 21st-century America. The federal government established minimal occupational safety and health standards applicable to migrant farmworker labor camps decades ago, and some states have statutory schemes and regulations that set standards for farm labor camps and employee housing. Many of these federal and state regulations no longer reflect current employment and housing trends, and enforcement success varies greatly. These regulations implicitly recognize the connection between housing conditions and health, but do not effectively address that connection. This review describes the current state of farmworker housing, discusses laws and regulations pertaining to such housing, and highlights the literature on health risks associated with inadequate housing. We propose specific recommendations to strengthen enforcement and reduce the risks of substandard housing for the health of farmworkers and their families.

Farmworker Housing in the United States and Its Impact on Health

Farmworkers in the United States occupy a range of housing, including both on- and off-farm family and communal dwellings. As the farmworker population is becoming more settled, housing needs are changing. Existing regulations designed originally for grower-supplied migrant housing may need to be expanded. Much of farmworker housing is in poor condition, and likely linked to negative mental and physical health outcomes of residents because of exposures to crowding; mold, mildew, and other allergens; pesticides; and structural deficiencies. The existing research literature, both on housing conditions and their associations with farmworker health, is sparse, and large areas of the country and significant domains of health are omitted. This paper reviews this literature and formulates research and policy recommendations for addressing these deficiencies.

Understanding the Role of Social Factors in Farmworker Housing and Health

Differences in social advantage significantly influence health conditions and life expectancy within any population. Such factors reproduce historic class, race, and ethnic disparities in community success. Few populations in the United States face more social and economic disadvantage than farmworkers, and farmworker housing has significant potential to ameliorate or amplify the health impact of those disadvantages. Drawing on the limited direct research on farmworkers, and on additional research about poor, isolated, and immigrant societies, we propose four mechanisms through which housing can be expected to affect farmworker health: quality of social capital within farmworker communities, stress effects of poor housing situations, effects of housing on social support for healthy behaviors, and interactions among these factors, especially effects on children that can last for generations. Policy and planning definitions of "adequate" farmworker housing should take a more holistic view of housing needs to support specific social and community benefits in design decisions.

Perceptions of Workplace Heat Exposure and Controls among Occupational Hygienists and Relevant Specialists in Australia

With warmer weather projections, workplace heat exposure is presenting a growing challenge to workers' health and safety. Occupational hygienists are the specialist group conducting measurements and providing advice on heat stress management to industry. In order to provide insights into hygienists perceptions on workplace heat exposure, current and future preparedness for extreme heat, and barriers to possible heat adaptation strategies, a self-administered questionnaire survey was conducted during a national conference of the Australian Institute of Occupational Hygienists. Nearly 90% of the 180 respondents were at least moderately concerned about extreme heat and 19% were dissatisfied with current heat stress prevention measures. Barriers recognized by the participants were lack of awareness (68%), insufficient training (56%), unsatisfactory management commitment (52%), and low compliance with prevention policies (40%). The findings suggest a need to refine occupational heat management and prevention strategies.

Heat-related symptoms in sugarcane harvesters

BACKGROUND

Exposure to heat stress is a documented risk for Central American sugarcane harvesters. However, little is known about heat-related illness in this population.

METHODS

This study examined the frequency of heat-related health effects among harvesters (n = 106) exposed to occupational heat stress compared to non-harvesters (n = 63). Chi-square test and gamma statistic were used to evaluate differences in self-reported symptoms and trends over heat exposure categories.

RESULTS

Heat and dehydration symptoms (headache, tachycardia, muscle cramps, fever, nausea, difficulty breathing, dizziness, swelling of hands/feet, and dysuria) were experienced at least once per week significantly more frequently among harvesters. Percentages of workers reporting heat and dehydration symptoms increased in accordance with increasing heat exposure categories.

CONCLUSIONS

A large percentage of harvesters are experiencing heat illness throughout the harvest demonstrating an urgent need for improved workplace practices, particularly in light of climate change and the epidemic of chronic kidney disease prevalent in this population.

Perceptions of housing conditions among migrant farmworkers and their families: implications for health, safety and social policy

INTRODUCTION

In the USA, migrant farmworkers are a vulnerable group due to their low socioeconomic status, risk of occupational exposures and injury, lack of social mobility, lack of adequate access to health services and dependency on employer for provided housing. Previous reports have documented migrant farmworker housing conditions to be variable, but poor overall. This paper explores the perceptions of housing conditions among migrant farmworkers in rural North Carolina, and develops an understanding of potential impacts of their housing on health and safety.

METHODS

This study used qualitative descriptive data and directed content analysis to analyse semi-structured interviews and photographs that were data elements of a larger community-based participatory research study designed to document housing quality and health among North Carolina farmworkers.

RESULTS

Many of the study participants described poor housing conditions that were reflected in the photographic analysis of the houses and camps. Specific problems described by the participants include exposure to pesticides, safety issues, pests, water supply and air quality, temperature and moisture.

CONCLUSIONS

This study describes migrant farmworkers' perceptions of housing quality and numerous potential impacts on health and safety. Research, social policy and practice-based implications derived from this research could serve to improve the health status of these individuals and their families. This study suggests there is much room for sustained advocacy and action, given that many of the farmworkers' descriptions and photographs depicted housing conditions below accepted standards of living. Access to adequate and safe employer-provided housing for migrant farmworkers should be considered a basic human right.

Re-evaluating occupational heat stress in a changing climate

The potential consequences of occupational heat stress in a changing climate on workers, workplaces, and global economies are substantial. Occupational heat stress risk is projected to become particularly high in middle- and low-income tropical and subtropical regions, where optimal controls may not be readily available. This commentary presents occupational heat stress in the context of climate change, reviews its impacts, and reflects on implications for heat stress assessment and control. Future efforts should address limitations of existing heat stress assessment methods and generate economical, practical, and universal approaches that can incorporate data of varying levels of detail, depending on resources. Validation of these methods should be performed in a wider variety of environments, and data should be collected and analyzed centrally for both local and large-scale hazard assessments and to guide heat stress adaptation planning. Heat stress standards should take into account variability in worker acclimatization, other vulnerabilities, and workplace resources. The effectiveness of controls that are feasible and acceptable should be evaluated. Exposure scientists are needed, in collaboration with experts in other areas, to effectively prevent and control occupational heat stress in a changing climate.

Heat-related illness in Washington State agriculture and forestry sectors

BACKGROUND

We sought to describe heat-related illness (HRI) in agriculture and forestry workers in Washington State.

METHODS

Demographic and clinical Washington State Fund workers' compensation agriculture and forestry HRI claims data (1995-2009) and Washington Agriculture Heat Rule citations (2009-2012) were accessed and described. Maximum daily temperature (Tmax) and Heat Index (HImax) were estimated by claim date and location using AgWeatherNet's weather station network.

RESULTS

There were 84 Washington State Fund agriculture and forestry HRI claims and 60 Heat Rule citations during the study period. HRI claims and citations were most common in crop production and support subsectors. The mean Tmax (HImax) was 95°F (99°F) for outdoor HRI claims. Potential HRI risk factors and HRI-related injuries were documented for some claims.

CONCLUSIONS

Agriculture and forestry HRI cases are characterized by potential work-related, environmental, and personal risk factors. Further work is needed to elucidate the relationship between heat exposure and occupational injuries.