SCREENING TO SAVE LIVES Janet Reeves University of Alabama Birmingham Purpose of the Project To create, implement, and evaluate a standardized screening tool for pesticide exposures among migrant farmworkers. Migrant Farmworker Statistics •Estimated 2.5 – 5 million •80% Foreign born •95% Mexican •80% Male, avg. age 31 years •> ½ Undocumented •84% Spanish speaking •12% can speak English •Median education : 6 yrs • 3/4 earn less than $10,000yr • 3/ 5 income below poverty level Health Disparities • Morbidity and mortality statistics are sparse • Substandard housing , work environment , and poor access to healthcare contribute to health disparities • Higher rates of infectious disease, TB, parasites & diarrhea than general population • Diabetes, cancer, TB, HIV and depression are some causes of morbidity in this group Occupational Health Concerns • • • • • • Respiratory Illnesses Skin disease Dehydration Heat Stroke UTI Pesticide poisoning Pesticide Exposures in Farm Work • EPA estimates between 10,000 and 20,000 identified incidents of pesticide illness/year • Lack of national reporting system produces wide variation in the estimated incidents • Severe under reporting of pesticide related illnesses due to misdiagnosis or patient not treated. Review of Literature • A need for systematic health monitoring used proven measurement methods • Examiners rely heavily on self-reported data • Lack of effectively functioning tools • Provider and farmworker education needed • A uniform exposure assessment will improve patient care and research • Exposure screening before disease development. Project Design • Low literacy screening questionnaire • NCFH, mentor, migrant health center and IRB approval • Staff training on project • Form will be a part of the initial visit paperwork • Cost will be for printing, incentives, and provider time away from current job Questionnaire Example • What kind of work do you do? • Are you currently or in the past been exposed to chemicals, dusts , or fumes? • Do you know the names of the chemicals used on the crops that you are working in? • Does anyone living with you have contact with to chemicals? y/n, dusts y/n, fumes? y/n; • Do you get the material on your skin or clothing? • Do you use or wear protective equipment such as dust mask, gloves, goggles (safety glasses). Which ones? • If you are concerned about re-entry into a field after chemicals have been recently applied who do you talk to about it? Project Community • • • • • • • Located in SC 2 large tomato/melon farms 2 packing houses 9 camps 1400-1600 workers 90% Hispanic, 10% Haitian Paid 75 cents/4 gal. bucket Participants • • • • Every patient Initial paper work Assistance with form Incentives Anticipated Barriers and Solutions • Patient concerns – Utilize community outreach worker • Staff participation – Develop rapport – Education • Provider buy in – Education, student available to assist. • Agency cooperation – Demonstrate a need for project and advantages • Time constraints Evaluation Plan • Daily chart review – Distribution – Completeness • Provider survey – Likert scale – Ease of use – Provider satisfaction – Patient care value Expected Outcomes • Patient participation • Provider participation and education • Acceptance of tool by NCFH • Further development "We cannot seek achievement for ourselves and forget about progress and prosperity for our community...Our ambitions must be broad enough to include the aspirations and needs of others, for their sakes and for our own.“ Cesar Chavez References Agricultural health study. (2009, March 5).Retrieved from www.epa.gov/pesticides/health/aghealth.html Arcury. T.A., Quandt, S.A., Barr, D.B., Hopping, J.A., McCauley, L., Grzywacz, J.G., & Robson, M.G. (2006). Farmworker exposure to pesticides: methodological issues for the collection of comparable data. Environmental Health Perspectives, 114 (6), 923-928. Blair, A, Sandler, D., Thomas, K., Hoppin, J.A., Kamel, F., Coble, J., Lee, W.J., Rusiecki, J., Knott, C., Dosemeci, M., Lynch, C.F., Lublin, J., & Alavanja, M. (2005). Disease and injury among participants in the agricultural health study. Journal of agricultural safety and health, 11(2), 141-150. References Calvert, G.M., Mahler, L.N., Rosales, R., Baum, L., Thomsen, C., and Male, D. (2003). Acute pesticide related illnesses among working youths, 1988-1999. American Journal of Public Health, 93, 605-610. McCauley, L.A., Anger, W.K., Keifer, M., Langley, R., Robson, M.G., & Rohlman, D. (2006). Studying health outcomes in farmworker populations exposed to pesticides. Environmental Health Perspectives, 114 (6), 953-960. Villarejo, D. (2003). The health of US hired farmworkers. Annual Review of Public Health, 24, 175-193. Williams, J.M. & Avery, A.M. (2008). Health needs of migrant and seasonal farmworkers. Journal of community health nursing, 25, 153-160.