Occupational injury and treatment patterns of migrant and seasonal farmworkers

Hired crop worker injury risks on farms in the United States during three different periods between 2002 and 2015

BACKGROUND

Hired crop workers have high incidence of work-related injuries, but little has been documented about potential risks at the national level.

METHODS

Data were obtained from a national probability sample of hired crop workers in the United States (U.S.) during 2002-2004 (period I), 2008-2010 (period II), and 2014-2015 (period III). Multivariable logistic regression models of work-related injury were constructed using an occupational exposure adjustment for weeks worked in the previous year.

RESULTS

Hired crop workers reporting that their employer did not provide clean drinking water and disposable cups every day were estimated to be at greater odds of injury during all three periods. Having at least some English-speaking ability was associated with increased odds of injury in two periods, while owning a dwelling in the U.S. showed greater injury risk during period II but was associated with lower risk during period III. Other items significantly associated with injury during at least one of the study periods in the final multivariable logistic models included being a direct-hire, a migrant worker, U.S.-born, receiving public aid, and having a health condition.

CONCLUSIONS

Hired crop workers are an extremely marginalized population of workers in the U.S. Innovative intervention methods must extend beyond traditional occupational models to focus on the overall health of hired crop workers, including increasing healthcare access, ending agricultural exceptionalism to provide equal regulatory protections afforded to workers in other industries, and adequate enforcement of existing regulations. These findings contribute to the understanding of correlates related to increased work-related injury among hired crop workers, and have implications in fields of prevention, intervention, and policy.

Occupational Injuries among Latino/a Immigrant Cattle Feedyard Workers in the Central States Region of the United States

Agriculture is a dangerous industry with high rates of occupational injuries. Immigrants comprise the majority of the hired agricultural workforce in the United States, and these workers may be at a higher risk for job-related injuries. This study addressed the frequency, characteristics, and risk factors of occupational injuries among Latino immigrant cattle feedyard workers. Data were collected through structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska (n = 243; 90.9% male). Descriptive statistics and logistic regression were used to identify risk factors for injury. Nearly three-fourths of participants (71.2%) reported having experienced one or more injuries in the past while working on a cattle feedyard. The most frequent types of reported injuries, including those not requiring medical care, were bruises/contusions (40%), cuts/lacerations (21%), and sprains/strains (12%). These injuries were mainly caused by animals/livestock (33%), chemicals (23%), falls (12%), and tools (9%). Significant risk factors for injury included male gender (OR 5.9), being over age 35 (OR 2.6), working on a large or an extra-large feedyard (OR 5.4), having 11 or more employees on the feedyard (OR 3.6), and working more than eight hours a day (OR 4.7). Having received safety training was also associated with greater risk of injury in a univariable model (OR 2.6). Cattle feedyard workers are at high risk for injury and require more effective preventive measures.

Influence of Work-Related Factors on Work Ability Among Young Cambodian Migrant Workers in Thailand

This cross-sectional study was conducted to evaluate the effects of work-related factors on work ability among young Cambodian migrant workers in Thailand. The participants consisted of 258 Cambodian migrant workers working in farms in the northeast region of Thailand. Work-related factors consisted of a general work environment and a psychosocial factor. General work environment was assessed by perception of subjects on biological, chemical, physical, and ergonomic factors. The psychosocial factor was assessed by the Job Content Questionnaire. The Work Ability Index was used to evaluate their work ability. Logistic regression analysis was applied to test the association between work-related factors and work ability. The results indicate that a chemical work environment and psychosocial factor associated with Work Ability Index among young Cambodian migrant workers, after adjusting for sociodemographic factors. These findings suggest that improving the work environment would be the most effective way to increase the work ability of Cambodian migrant workers in Thailand.

Socio-environmental risk factors for medically-attended agricultural injuries in Wisconsin dairy farmers

BACKGROUND

Accidents are common in the agricultural industry, particularly among dairy farmers. How said farmers get hurt is well established, but far less is known about how distal, socio-environmental factors influence injuries. This study examined associations between medically-attended agricultural injuries and: (1) personal sociodemographic characteristics, and (2) farm environment features and general safety practices.

METHODS

A cross-sectional survey was implemented with linked data from electronic health records on prior agricultural injuries that occurred between 01/01/2002-12/31/2015. The sample included adult dairy producers who resided in north-central Wisconsin (USA) and were medically-homed to the Marshfield Clinic Health System. Multiple logistic regression was used to analyze associations between socio-environmental characteristics and agricultural injuries.

RESULTS

There were 620 dairy farmers in the analytical sample, with 50 medically-attended agricultural injuries observed during the 14-year study time period (5.7 injuries per 1000 dairy farmers per year). In the multivariable model, the odds of agricultural injury were significantly greater among farmers who have private individually-purchased health insurance (OR=4.25; 95% CI: 1.31, 13.84), do not live at their dairy operation (OR=2.91; CI: 1.27, 6.67), and do not provide safety training to their workers (OR=4.27; CI: 1.00, 18.21).

CONCLUSIONS

Dairy farmers in this analysis who did not live at their dairy operation, did not provide safety training to all their workers, or had individually-purchased health insurance were more apt to get injured, but more research is needed to confirm these findings in prospectively designed studies. How these factors can be directly addressed or otherwise used to better focus farm injury prevention initiatives should also be explored.

Stress, Depression, and Occupational Injury among Migrant Farmworkers in Nebraska

Agriculture is one of the most dangerous industries in the United States. Farmworkers, including migrant farmworkers, are at risk for work-related injuries. This study explores the association between stress, depression, and occupational injury among migrant farmworkers in Nebraska. Occupational injury was hypothesized to significantly increase the odds of farmworkers being stressed and depressed. Two hundred migrant farmworkers (mean age = 33.5 years, standard deviation (SD) = 12.53; 93.0% men, 92.9% of Mexican descent) were interviewed. In bivariate analyses, results indicated that stress and depression were positively associated with occupational injury. Two logistic regression models were developed. Occupational injury was a significant factor for depression, but not for stress. Participants who had been injured on the job were over seven times more likely to be depressed. These results highlight the interconnection between the work environment and mental health. More must be done to foster well-being in rural, agricultural communities. Improving occupational health and safety information and training, integrating behavioral health services into primary care settings, and strengthening the protections of the Migrant and Seasonal Agricultural Worker Protection Act may improve conditions for migrant farmworkers in the rural Midwest.

Reported work-related injuries and illnesses among Hispanic workers: Results from an emergency department surveillance system follow-back survey

BACKGROUND

Research suggests Hispanic workers underreport injuries/illnesses to their employer.

METHODS

The National Electronic Injury Surveillance System-occupational supplement was used to conduct a follow-back study of workers treated in emergency departments (EDs) from June 2012 through December 2013.

RESULTS

An estimated 448,000 (95%CI 230,000-665,000) Hispanic workers treated in EDs for a work-related injury or illness were represented by 362 completed interviews. Of these, an estimated 443,000 (95%CI 228,000-657,000) workers reported the injury or illness to their employer or were self-employed. The majority had not heard of workers' compensation. Only 10% expected workers' compensation to cover their medical payment while 62% expected payment to be covered by their employer.

CONCLUSION

We characterized our respondent workforce who reported their injury or illness. We determined that NEISS-Work data are not the most appropriate source to capture underreporting of work-related injuries and illnesses to employers among Hispanic workers. Am. J. Ind. Med. 59:621-629, 2016. © 2016 Wiley Periodicals, Inc.

Military Weapon Injury Among Illegal Immigrants at the Southern Border of Israel: A Single Level I Trauma Center Series

This article describes the characteristics of injuries of illegal immigrants admitted to a Level I trauma center after being shot at the southern border of Israel. This is a retrospective descriptive study. Some of the variables were compared to a group of soldiers who sustained penetrating injury at the same region where the illegal migrant were injured. The study includes 162 patients. The lower body absorbed a higher percentage of the injuries (61 %). The hospitalization time is longer for the migrant patients compared to the soldiers (13 ± 2 vs. 3 ± 0.3 days p = 0.0001). This study on wounded immigrants shows that a conjoint military and civilian system can result in favourable outcomes. The manuscript is an attempt to bring this unique situation, its type of injuries, and the difficulties of the health system in coping with it, to the notice of all authorities that may address a similar challenge.

Hired crop worker injuries on farms in the United States: A comparison of two survey periods from the National Agricultural Workers Survey

BACKGROUND

Hired crop workers in the United States are at high risk of occupational injury. Targeted surveillance is important for effective occupational safety efforts.

METHODS

The National Agricultural Workers Survey was utilized to collect injury data during the years 1999, 2002-2004 (period I) and 2008-2010 (period II).

RESULTS

The overall injury rate declined between the two periods from 4.3 to 2.9/100 per full-time week-based equivalents (FTEWB ). Injury rates remained high during both periods for those with greater than 20 years farm experience (3.6 and 3.8/100 FTEWB ) and pesticide handling work (4.9 and 5.0/100 FTEWB ). Overexertion, contact with objects and equipment, and falls from height were common during both periods. Older workers comprised a greater proportion of injury cases in period II.

CONCLUSION

Overexertion that leads to sprains/strains, dangerous ladder use, and pesticide use should be targeted as important risk exposures on the farm.

The Feasibility of Using Electronic Health Records to Describe Demographic and Clinical Indicators of Migrant and Seasonal Farmworkers

Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care and complement current surveillance and epidemiologic studies of underserved working populations, such as MSFWs. The aim of this feasibility study was to describe the demographics and baseline clinical indicators of patients at an FQHC by MSFW status. The authors described 2012 patient demographics, social history, medical indicators, and diagnoses by MSFW status from the de-identified EHR database of a large, multisite Colorado Migrant Health Center (MHC). Included in the study were 41,817 patients from 2012: 553 (1.3%) MSFWs, 20,665 (49.4%) non-MSFWs, and 20,599 (49.3%) who had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish-speaking compared with non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, or a back disorder. Although there were significant missing values, this feasibility study was able to analyze medical data in a timely manner and show that Meaningful Use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of this study were consistent with current literature available for MSFWs. By reaching this vulnerable working population, EHRs may be a key data source for occupational injury and illness surveillance and research.

Why do farmworkers delay treatment after debilitating injuries? Thematic analysis explains if, when, and why farmworkers were treated for injuries

BACKGROUND

Farmworkers who delay treatment after workplace injuries may increase injury severity and experience longer recovery times. To understand why farmworkers delay treatment we employed a mixed-methods analysis of 393 farmworker injury narratives from the National Agricultural Workers Survey (NAWS).

METHODS

First, open-ended injury narratives were coded for attitudes related to injury timing and delay. Next, narratives were compared against demographic survey attributes to assess contextual information and patterns linked to treatment timing.

RESULTS

Four treatment timings were identified: immediate medical treatment (57.9%), delayed medical treatment (18.2%) self- administered treatment (14.9%), and no treatment at all (8.9%). Delay was primarily attributed to attitudes prioritizing work over pain, and when workers were able to work despite injury. However, immediate treatment was sought when workers were completely debilitated and unable to work, when a supervisor was notified, or when exposed to pesticides during injury. Timing choices varied by education, gender and migrant status.

CONCLUSIONS

Training on timely treatment, including notification of supervisors, may help reduce treatment delay for farmworkers.

Stooped postures are modified by pretask walking in a simulated weed-pulling task

Seasonal agricultural workers are hired in some sectors for intermittent manual weed removal, a stoop and grasp harvesting task likely similar to those associated with the high prevalence of musculoskeletal disorders in agriculture. Evaluation of this task in an experimental situation would be useful for identifying and controlling musculoskeletal injury risks, presuming a valid experimental model of the task can be created. The purpose of the present study was to examine how a relevant work-related task, namely prolonged walking, altered the biomechanics of manual weed removal in a laboratory setting. Preliminary field assessments informed the development and analysis of a simulated manual weed removal with two separate conditions: not primed, where 11 participants (4 female, mean age 21.6 years) manually removed a simulated weed six times, and primed, where 23 participants (13 female, mean age 22.1 years) walked 1600 m prior to manually removing the same simulated weed six successive times. Segment end point markers and experimental motion capture were used to determine hip, knee, and ankle angles, as well as toe-target proximity, during weed removal. Significant differences between primed and not primed participants were found for angular displacement at the ankle (t(32) = 5.08, P < .001) and toe-target proximity (t(32) = 2.78, P = .008), where primed participants had increased ankle flexion and a greater distance to the weed, leading to decreased trunk flexion during the harvesting task. These findings suggest that priming can positively influence whole-body postures for manual weed removal.

Medical repatriation of migrant farm workers in Ontario: a descriptive analysis

BACKGROUND

Approximately 40 000 migrant farm workers are employed annually in Canada through temporary foreign worker programs. Workers experiencing health conditions that prevent ongoing work are normally repatriated to their home country, which raises concerns about human rights and health equity. In this study, we present data on the reasons for medical repatriation of migrant farm workers in Ontario.

METHODS

In this retrospective descriptive study, we examined medical repatriation data from Foreign Agricultural Resource Management Services, a non-profit corporation managing the contracts of more than 15 000 migrant farm workers in Ontario annually. We extracted repatriation and demographic data for workers from 2001-2011. Physician volunteers used a validated system to code the reported reasons for medical repatriation. We conducted descriptive analyses of the dominant reasons for repatriation and rates of repatriation.

RESULTS

During 2001-2011, 787 repatriations occurred among 170 315 migrant farm workers arriving in Ontario (4.62 repatriations per 1000 workers). More than two-thirds of repatriated workers were aged 30-49 years. Migrant farm workers were most frequently repatriated for medical or surgical reasons (41.3%) and external injuries including poisoning (25.5%).

INTERPRETATION

This study provides quantitative health data related to a unique and vulnerable occupational group. Our findings reinforce existing knowledge regarding occupational hazards and health conditions among migrant farm workers. Medical repatriation of migrant farm workers merits further examination as a global health equity concern.

Injury Patterns Among Illegal Migrants from Africa in Israel

In recent years Israel has become a destination for many migrants from Africa that illegally cross the Egyptian-Israeli border. The objective of this paper is to describe the epidemiological characteristics of injuries among illegal migrants in Israel. The study was carried out retrospectively using data from 19 trauma centers that participated in the Israel National Trauma Registry between 1 January 2006 and 31 December 2011. Illegal migrants from Africa were compared to the local population. Migrants were injured more often than the local population from intentional injuries (57.11 %). Migrants were also less likely than the local population (58.38 %) to sustain a minor injury (i.e., injury severity ≤8). The study also shows the hospitalization cost as a result of injuries among migrants from Africa. Preventive measures among illegal migrants from Africa should prioritize intentional injuries and industrial site injuries.

Differences in exposure to occupational health risks in Spanish and foreign-born workers in Spain (ITSAL Project)

Migrant workers usually show higher rates of work-related health problems than natives. However, little information is available about their exposure to occupational risks. We describe self-reported working exposure in Spanish and foreign-born workers. A cross-sectional survey was conducted as part of the ITSAL Project. Data on sociodemographic and self-reported occupational exposure in 1,841 foreign-born and 509 Spanish workers were collected through face-to-face interviews. Prevalence and adjusted odds ratios-aOR- (by age, education, type of contract) were calculated. Foreign-born men in non-services sectors and those in manual occupations perceived exposure to occupational risks with lower prevalence than Spanish workers. Foreign-born women reported higher prevalence of exposure than Spanish female workers. By occupation, foreign-born female workers were more likely than Spanish workers to report working many hours/day (aOR2.68; 95 % CI 1.06-6.78) and exposure to extreme temperatures (aOR2.19; 95 % CI 1.10-4.38). Some groups of migrant workers may need increased protection regarding some occupational exposures.

Migrant and seasonal crop worker injury and illness across the northeast

BACKGROUND

Northeast farmworkers are a small, widely dispersed, and isolated population. Little is known about their occupational injury and illness risk.

METHODS

Researchers conducted chart reviews in migrant health centers across the Northeast, and calculated incidence-density for agricultural morbidity based on a new method for estimating total worker hours at risk, and adjusting for cases seen at other sources of care.

RESULTS

An estimated annual average of 1,260 cases translated to an incidence of 30.27 per 10,000 worker weeks, (12.7 per 100 FTEs). Straining/spraining events (56% cases) was the most common occurrence (16.8 per 10,000 worker weeks), and lifting (21.5% cases) was the leading contributing factor. Incidence by crop category ranged from 12.95 (ground crop) to 29.69 (bush crop) per 10,000 weeks. Only 2.8% filed for Workers' Compensation.

CONCLUSION

The predominance of straining/spraining events affecting the back, and their association with lifting suggests that Northeastern farmworker occupational health programs should focus on ergonomics, and specifically on safe lifting.

Exercise habits and tobacco use among male Latino farmworkers

Migrant farmworkers risk occupational injury and are at risk for developing chronic health conditions. Exercise may enhance health and help to reduce the risk of occupational injury and/or reduce the risk of developing a chronic health condition. Little is known, however, about the exercise habits of Latino migrant farmworkers. Male Latino migrant farmworkers completed an exercise and health habits questionnaire at health screening clinics. One hundred fifty-three (58.2%) subjects reported exercising during the week. There was no difference in age between those who reported exercising and those who did not (p = .78). Only 42 (16%) of all workers reported exercising for 3 or more hours a week. Seventeen percent of the subjects reported smoking and almost 10% reported chewing tobacco. A majority of subjects do not meet the Centers for Disease Control and Prevention (CDC) exercise guidelines. Tobacco use is highest among individuals who do not exercise. These findings suggest the need for health education interventions for this population. Additional studies are warranted to understand exercise and health habits of this population.

Assessment of psychosocial risks faced by workers in Almería-type greenhouses, using the Mini Psychosocial Factor method

This work reports the use of the Mini Psychosocial Factor (MPF) method for assessing the psychosocial risks faced by agricultural workers in the greenhouses of Almería (Spain) with the aim of improving their health. The variables Rhythm, Mobbing, Relationships, Health, Recognition, Autonomy, Emotional Involvement, Support, Compensation, Control, Demands, and Mental Load were recorded using a pre-validated questionnaire containing 15 questions. The sex, age, and nationality of the respondents (n = 310) were also recorded, as were the type of greenhouse in which each worked, the size of the greenhouse, and the crop grown. The results showed psychosocial risks to exist for the workers. Multiple correspondence analysis, however, showed that moderate risks can be offset by new prevention programmes that improve Spanish legislation in terms of workers' salaries, worker-employer social days, work timetables to facilitate family life, and training courses. This could improve the work environment and health of Almería's greenhouse workers as well as their productivity.

Exploratory study of the occupational health and health-seeking of migrant and seasonal farmworkers on the U.S.-Mexico border

The U.S. migrant and seasonal farmworker (MSFW) workforce is aging. Aging causes functional changes that can affect work performance and increase injury/accident risk. It also has been linked with deferred health-seeking. The exploratory study was conducted to investigate occupational injuries and health-seeking in Hispanic MSFW on the U.S.-Mexico border. Data were collected using an abbreviated Spanish-version of the California Agricultural Worker Health Survey. Nearly 60% of the 141 participants were middle-aged or older. Musculoskeletal injuries and those consistent with agrochemical and environmental exposures were common. Farmworkers aged >40 years were 2.5-5 times more likely than younger MSFW to report persistent single and multiple injuries involving the knees, shoulder, feet, and hands. Except for neck and back injuries, few received any medical treatment. Although many self-treated with traditional home remedies, few used CAM practitioners. The study findings highlight the multiple workplace health and health-seeking challenges faced by aging immigrant MSFW.

Injuries to hired crop workers in the United States: a descriptive analysis of a national probability survey

BACKGROUND

Little empirical data are available examining the injury experience of hired crop workers in the United States (US). This study analyzed work-related injury data collected on these workers from a national survey.

METHODS

Data were collected through the National Agricultural Workers Survey (NAWS) for the federal fiscal years 1999, 2002, 2003, and 2004. These data provided descriptive injury characteristics and rate estimates from a sample of 13,604 crop farm workers.

RESULTS

The injury rate was 4.3 injuries per 100 week-based full-time equivalents (FTE(WB) ). The majority of the injuries occurred to male (84%) and Mexican born (72%) workers. Shuttle migrants had the highest injury rate at 7.2 injuries/100 FTE(WB) . Workers reporting one or more health conditions and workers reporting one or more musculoskeletal complaints had higher injury. The most common injury events were overexertion from lifting (20%), being struck by hand held objects (13%), and falls to a lower level (10%). Injuries due to falls to a lower level accounted for the highest average number of restricted workdays (45 days).

CONCLUSIONS

The use of hand tools, falls, and lifting overexertion injuries were identified as significant causes of injury among hired crop workers. Increased injury risk was also seen for crop workers with existing health or musculoskeletal complaints. These results are useful for targeting injury prevention efforts and future research needs for this unique worker population. Am. J. Ind. Med. 54:734-747, 2011. © 2011 Wiley-Liss, Inc.

Self-reported musculoskeletal pain in Latino vineyard workers

The agricultural economy in the United States is dependent on millions of Latino migratory workers. Despite the health risks associated with this line of work, many agricultural workers lack health insurance or access to health care services. The purpose of this study was to collect demographic data and investigate the musculoskeletal health of Latino migratory vineyard workers. A physical therapy team collected demographic data at health clinics held at vineyards in Oregon. Nearly half (48.4%) of all vineyard workers reported experiencing musculoskeletal symptoms (MSS) in at least one region of the body. The primary region of reported MSS was the back (32% of all men and 43.7% of all women). In most cases, those who reported MSS were significantly older than those who did not report MSS. Future research is necessary to identify personal and work related injury risk factors in order to develop prevention programs.