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
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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
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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
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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.