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Random digit dialing (RDD) telephone sampling, although experiencing declining response rates, remains one of the most accurate and cost-effective data collection methods for generating national population-based estimates. Such methods, however, are inefficient when sampling hard-to-reach populations because the costs of recruiting sufficient sample sizes to produce reliable estimates tend to be cost prohibitive. The authors implemented a novel respondent-driven sampling (RDS) approach to oversample cigarette smokers and lesbian, gay, bisexual, and transgender (LGBT) people. The new methodology selects RDS referrals or seeds from a probability-based RDD sampling frame and treats the social networks as clusters in the weighting and analysis, thus eliminating the intricate assumptions of RDS. The authors refer to this approach as RDD+RDS. In 2016 and 2017, a telephone survey was conducted on tobacco-related topics with a national sample of 4,208 U.S. adults, as well as 756 referral-based respondents. The RDD+RDS estimates were comparable with stand-alone RDD estimates, suggesting that the addition of RDS responses from social networks improved the precision of the estimates without introducing significant bias. The authors also conducted an experiment to determine whether the number of recruits would vary on the basis of how the RDS recruitment question specified the recruitment population (closeness of relationship, time since last contact, and LGBT vs. tobacco user), and significant differences were found in the number of referrals provided on the basis of question wording. The RDD+RDS sampling approach, as an adaptation of standard RDD methodology, is a practical tool for survey methodologists that provides an efficient strategy for oversampling rare or elusive populations.

Past research has shown that commonly reported cultural group disparities in health-related indices may be attributable to culturally mediated differences in the interpretation of translated survey questions and response scales. This problem may be exacerbated when administering single-item survey questions, which typically lack the reliability seen in multi-item scales. We adapt the test-retest approach for single-item survey questions that have been translated from English into Spanish and demonstrate how to use this approach as a quick and efficient pilot test before fielding a major survey. Three retest conditions were implemented (English-Spanish, Spanish-English, and English-English) on a convenience sample (n = 109) of Latinos and non-Latinos where translated items were compared against an English-English condition that served as our control. Several items were flagged for investigation using this approach. Discussion centers on the utility of this approach for evaluating the Spanish translation of single-item questions in population-based surveys.

Purpose – The purpose of this paper is to provide an overview of the literature pertaining to occupational health disparities experienced by Latino immigrant workers in the USA and to advance a general framework based on systems science to inform epidemiological and intervention research. Design/methodology/approach – Using papers and other sources from 2000 to the present, the authors examined the employment conditions and health outcomes of Latino immigrant workers and critically analyzed the pervasive evidence of health disparities, including causal mechanisms and associated intervention programs. Findings – The occupations, including the work environment and resultant living conditions, frequently performed by Latino immigrants in the USA represent a distinct trigger of increased injury risk and poor health outcomes. Extant intervention programs have had modest results at best and are in need of more comprehensive approaches to address the complex nature of health disparities. Practical implications – An integrated, systems-based framework concerning occupational health disparities among Latino immigrant workers allows for a holistic approach encompassing innovative methods and can inform high-leverage interventions including public policy. Originality/value – Reductionist approaches to health disparities have had significant limitations and miss the complete picture of the many influences. The framework the authors have provided elucidates a valuable method for reducing occupational health disparities among Latino immigrant workers as well as other populations.

Objectives The U. S. Food and Drug Administration (FDA) now has regulatory authority over all tobacco products. Little is known about public awareness and perceptions of FDA in their new role as a tobacco regulator. This research utilizes focus groups to examine perceptions of FDA as a tobacco regulator so that FDA can better communicate with the public about this role. Methods We conducted 6 focus groups in 2014 among a diverse sample of smokers and non-smokers. Participants were asked if they had heard of FDA, what they knew about FDA, if they associated FDA with tobacco, and their thoughts about this FDA role. Results A total of 41 individuals participated. Although nearly all participants had heard of FDA, most were not aware of FDA's regulatory authority over tobacco products, did not associate the role of FDA with tobacco, and some drew comparisons between FDA's work in tobacco and their work regulating food and drugs. Conclusion Data suggest that although public awareness of FDA regulatory authority over tobacco is low, with proper public education, the public may find FDA to be a trustworthy source of tobacco regulation.

BACKGROUND: There is widespread agreement that work organization is an important element of occupational safety and health, but the health effects of many aspects of work organization are likely to vary considerably across different sectors of work and geographies. METHODS: We examined existing employment policies and work organization-related research relevant specifically to immigrant workers in the Agriculture, Forestry, and Fishing (AgFF) Sector of the US workforce focusing, when possible, on the southeastern US. RESULTS: A number of specific aspects of work organization within AgFF subsectors have been described, but most of this literature exists outside the purview of occupational health. There are few studies that directly examine how attributes of work organization relevant to the AgFF Sector affect workers', much less immigrant workers', occupational health exposures and outcomes. CONCLUSIONS: In contrast to the broader literature, research linking occupational health outcomes to work organization in the AgFF Sector is limited and weak. A systematic program of research and intervention is needed to develop strategies that eliminate or substantially mitigate the deleterious health effects of occupational exposures whose origins likely lie in the organization of AgFF work. Language: en

Background Several studies have documented poor housing conditions for farmworkers but none has focused on migrant farmworker housing, which is often provided as a condition of employment. Farmworker housing quality is regulated, but little documentation exists of compliance with regulations. Methods A 2007 survey of 43 randomly selected farmworker camps and a 2008 survey of 27 camps randomly selected from the 2007 sample documented housing conditions via interviewer administered questionnaire and housing checklist. Results Substandard conditions are common in migrant housing. All camps had at least one exterior housing problem; 93% had at least one interior problem. Housing conditions worsen across the agricultural season. Characteristics including no residents with H2A visa and 11 or more residents are associated with poorer conditions. Conclusions Housing standards are not adequately enforced. An increase in post-occupancy inspections and targeting camps with characteristics that place them at increased risk for substandard conditions are recommended. Am. J. Ind. Med. 54:533–544, 2011. © 2011 Wiley-Liss, Inc.

Background Symptoms of occupational heat illness provide an early warning that workers are in potentially life-threatening environmental conditions. Purpose This analysis was designed to assess the extent to which strategies to reduce the health impact of extreme heat were associated with the prevalence of heat illness among Latino farm workers. Methods Between June and September 2009, a total of 300 Latino men and women participated in a cross-sectional survey about farm worker health. Participants reported whether they were employed through the H-2A temporary agricultural worker program and whether they had ever worked in conditions of extreme heat during their work in the U.S. agricultural industry. Workers who had worked in extreme heat also responded to questions about selected activities and behaviors and whether they experienced symptoms of heat illness. Data analysis was conducted in 2009 to assess associations of altering work hours and activities, drinking more water, resting in shaded areas, and going to air-conditioned places during or after work, with the prevalence of symptoms of heat illness among H-2A and non–H-2A workers. Results Working in extreme heat was reported by 281 respondents (94%), among whom 112 (40%) reported symptoms of heat illness. Changes in work hours and activities during hot conditions were associated with a lower prevalence of heat illness among H-2A workers but not among non–H-2A workers. Conclusions These findings suggest the need to improve the understanding of working conditions for farm workers and to assess strategies to reduce agricultural workers' environmental heat exposure.

Background Organophosphate pesticides act as cholinesterase inhibitors. For those with agricultural exposure to these chemicals, risk of potential exposure-related health effects may be modified by genetic variability in cholinesterase metabolism. Cholinesterase activity is a useful, indirect measurement of pesticide exposure, especially in high-risk individuals such as farmworkers. To understand fully the links between pesticide exposure and potential human disease, analyses must be able to consider genetic variability in pesticide metabolism. Objectives We studied participants in the Community Participatory Approach to Measuring Farmworker Pesticide Exposure (PACE3) study to determine whether cholinesterase levels are associated with single-nucleotide polymorphisms (SNPs) involved in pesticide metabolism. Methods Cholinesterase levels were measured from blood samples taken from 287 PACE3 participants at up to four time points during the 2007 growing season. We performed association tests of cholinesterase levels and 256 SNPs in 30 candidate genes potentially involved in pesticide metabolism. A false discovery rate (FDR) p-value was used to account for multiple testing. Results Thirty-five SNPs were associated (unadjusted p < 0.05) based on at least one of the genetic models tested (general, additive, dominant, and recessive). The strongest evidence of association with cholinesterase levels was observed with two SNPs, rs2668207 and rs2048493, in the butyrylcholinesterase (BCHE) gene (FDR adjusted p = 0.15 for both; unadjusted p = 0.00098 and 0.00068, respectively). In participants with at least one minor allele, cholinesterase levels were lower by 4.3–9.5% at all time points, consistent with an effect that is independent of pesticide exposure. Conclusions Common genetic variation in the BCHE gene may contribute to subtle changes in cholinesterase levels.

The goal of this study was to understand the potential threat of job stressors to farmworker health. To accomplish this goal we studied pesticide exposure, an issue with immediate and long-term health consequences, and predictions from the Demands-Control model of occupational stress. Longitudinal, self-report data and urine samples were collected at monthly intervals from a cohort of Latino farmworkers (N = 287) during the 2007 agricultural season. The primary hypothesis was that greater exposure to psychological demands, physical exertion, and hazardous work conditions are associated with greater odds of detecting dialkylphosphate (DAP) urinary pesticide metabolites, biomarkers indicating exposure to pesticides. Contrary to this hypothesis, results indicated that none of the elements of the Demands-Control model were independently associated with detection of DAP urinary pesticide metabolites. However, analyses produced several interaction effects, including evidence that high levels of control may buffer the effects of physical job demands on detection of DAP urinary pesticide metabolites.

Background Farmworkers can be exposed to a wide variety of pesticides. Assessing cholinesterase activity over time can be used to monitor exposure to organophosphorus and carbamate pesticides. Objectives The goal of this study was to document patterns and variation in cholinesterase levels across the agricultural season (May–August) among field-workers, and to explore the association of cholinesterase depression with pesticide exposure across the agricultural season. Methods Dried blood samples collected from 231 migrant farmworkers sampled from camps in eastern North Carolina up to four times across a summer agricultural season were analyzed for cholinesterase activity, and urine samples were analyzed for metabolites of organophosphorus and carbamate pesticides. Reductions of ≥ 15% from an individual’s highest value were identified and considered evidence of meaningful cholinesterase activity depression. Results The average cholinesterase activity levels were lowest in June, with significantly higher mean values in July and August. When adjusted for age, sex, minutes waited to shower, and days worked in the fields, the number of organophosphorus and carbamate pesticides detected in urine predicted reductions in cholinesterase activity. Conclusions These data demonstrate that workers are experiencing pesticide exposure. Greater enforcement of existing safety regulations or strengthening of these regulations may be warranted. This study demonstrates that serial measurements of cholinesterase activity across an agricultural season can detect exposure to pesticides among field-workers.

The National Agricultural Workers Survey estimates that immigrants constitute approximately 78% of the migrant and seasonal farmworkers in the United States. Migrant farmworkers, defined as those traveling at least 75 miles and establishing a temporary abode within the previous year for work, made up 42% of the crop workers in 2001–2002.1 Farmworkers are exposed to hazardous working conditions, such as exposure to pesticides, working long hours in hot climates, and working with dangerous machinery. These working conditions predispose agricultural workers to occupational skin disease, among other health problems.2 Contact dermatitis, an irritating and inflammatory skin reaction to a foreign substance, is one of the most common skin problems among farmworkers. However, there is limited research involving the prevalence and specific etiologies of contact dermatitis in migrant farmworkers. In many countries, occupational contact dermatitis is the most common reportable occupational disease, and makes up 30% of payable compensation.3 It is difficult to accurately compare data from different countries due to differences in the reporting of occupational diseases and the fact that national registries are often incomplete.4 In the United States, the Bureau of Labor Statistics acquires data regarding occupational disease from an annual survey that includes a representative random sample of business establishments in private industries. In the sector of agriculture, forestry, fishing, and hunting, the incidence of nonfatal occupational injuries/illnesses was 6.4 per 100 full time workers, second only to manufacturing in the goods producing industries.5 However, the incidence of occupational skin disease may actually be underreported of by 10 to 50 times, according to some estimates.4 Due to the paucity of data specific to skin disease in migrant farmworkers, we describe the existing knowledge on the prevalence of occupational contact dermatitis in any farmworker.

Migrant farmworkers are exposed to numerous workplace hazards, with pesticides being a ubiquitous occupational exposure. This analysis describes farmworker experiences of field and camp safety conditions and their safety behaviors, and delineates farmworker characteristics associated with safety conditions and behaviors. Data were collected from 255 migrant farmworkers up to four times at monthly intervals during the 2007 agricultural season in eastern North Carolina. Measures assess field safety conditions and camp sanitation required by federal and state regulations. Most of the farmworkers were Latino men from Mexico. About 20% had not received pesticide safety training across the season; many of those who received such training did not understand it. Water for washing was not available for about one-third of the workers; soap and towels were not available for over half. About 20% lived in camps with more than eight workers per showerhead and about 20% lived in camps that failed to meet the standard of 30 or fewer workers per washtub/washing machine. Important predictors of variation included H2A visa status and years of experience. Four themes emerged from the analysis: (1) safety regulations are not consistently met; (2) farmworkers do not always practice safety behaviors; (3) camps become more crowded and less compliant during the middle of the agricultural season; and (4) workers with H2A visas experience better conditions and practice more safety behaviors than do workers who do not have H2A visas. Further research needs to account for social and cultural factors. Regulations should be compared with pesticide metabolite levels to measure their effectiveness. More effort is needed to enforce existing regulations.

This analysis describes the detection of urinary pesticide metabolites for Latino farmworkers across the agricultural season. Two hundred and eighty four farmworkers were recruited from 44 camps in eastern North Carolina in 2007. Data were collected at one month intervals for a total of 939 data points. The OP insecticide metabolites 3,5,6-trichloropyridinol (46.2%), malathion dicarboxylic acid (27.7%), and para-nitrophenol (97.4%); the pyrethroid metabolite 3-phenoxybenzoic acid (56.4%); and the herbicides 2,4-D (68.1%), acetochlor (29.2%), and metolachlor (16.9%) were found in sizable percentages of the samples. The percentage of farmworkers for whom metabolites were detected varied across the agricultural season. None of the farmworker characteristics were significantly associated with the detection of any pesticide metabolite. Seasonality overrides the effects of other farmworker characteristics in predicting detection of pesticide urinary metabolites. Future research needs to collect multiple exposure measures at frequent intervals over an extended period to characterize factors associated with exposure.

Background: Melasma is a common condition of Latino women that detracts from their quality of life (QOL). The prevalence and impact of melasma in Latino men is not well characterized. Aim: To assess the prevalence of melasma and its association with QOL in Latino men from Mexico and Central America working in the USA. Methods: The prevalence of melasma was assessed in three studies of Latino men: by direct examination in a study of 25 Latino poultry workers; by direct examination in a study of 54 Latino farm workers; and by examination of store-and-forward teledermatology images in a study of 300 Latino farm workers. QOL was assessed with a Spanish version of the Dermatology Life Quality Index (DLQI). Results: The prevalence of melasma was 36.0%, 7.4%, and 14.0% in the three studies. The prevalence of melasma was greatest amongst those aged 31 years and older, who were from Guatemala, and who spoke an indigenous language. The presence of melasma was associated with higher DLQI scores, indicating a poorer QOL, in the poultry worker population. Conclusions: Melasma is a common condition in Latino men and is associated with a poor QOL in some affected individuals. Clinicians should be aware that melasma may be a concern for their male Latino patients. Research on the association of skin conditions with QOL amongst minority men is needed.

Context: Skin diseases are common occupational illnesses for migrant farmworkers. Farmworkers face many barriers in accessing health care resources. Purpose: Framed by the Health Behavior Model, the purpose of this study was to assess health care utilization for skin disease by migrant Latino farmworkers. Methods: Three hundred and four migrant and seasonal Latino farmworkers in North Carolina were enrolled in a longitudinal study of skin disease and health care utilization over a single agricultural season. Self-reported and dermatologist-diagnosed skin condition data were collected at baseline and at up to 4 follow-up assessments. Medical visit rates were compared to national norms. Findings: Self-reported skin problems and diagnosed skin disease were common among farmworkers. However, only 34 health care visits were reported across the entire agricultural season, and none of the visits were for skin diseases. Nevertheless, self-treatment for skin conditions was common, including use of non-prescription preparations (63%), prescription products (9%), and home remedies (6%). General medical office visits were reported in 3.2% of the assessments, corresponding to 1.6 office visits per person year. Conclusions: The migrant farmworker population consists largely of young men who make little use of clinic services. Skin conditions are very common among these workers, but use of medical services for these conditions is not common. Instead, farmworkers rely primarily on self-treatment. Clinic-based studies of farmworker skin conditions will not account for most injury or disease in this population and have the potential for biased estimates.

In this article, the authors describe the self-reported eye conditions, eyecare history, and eye safety practices of migrant farmworkers in eastern North Carolina. The authors administered interviews to 79 farmworkers recruited at migrant clinics. Data collected included eye-related complaints and diagnoses, self-assessed visual acuity, eye symptoms, use of protective gear during work, and attitudes toward eye protection gear. Fair or poor eyesight was reported by 21.3%. Only 4 (5.1%) reported wearing glasses or contact lenses. More than 11% reported difficulty in recognizing a friend across the street, and 19.5% reported difficulty in reading. About 20% reported each of several eye symptoms. Fewer than 1 in 10 wore eye protection at work. Of all, 38% reported never having visited any eyecare professional. Farmworkers have a high level of unmet need for both routine preventive eye care and treatment or correction of vision problems.

Background: This study estimates the prevalence of self-reported skin problems among Latino farmworkers and identifies associated risk factors. Methods: The study used a longitudinal surveillance design. Participants were interviewed up to five times and reported skin problems and personal, work, and environment characteristics. Frequencies and counts were calculated for 13 skin problems. Adjusted odds ratios were obtained for six skin problems. Results: More than one-third of participants reported skin problems, including skin and nail fungus; sunburn; bumps, pimples, or acne; calluses; itching; rash; and insect bite. A variety of work and environment factors were associated with higher rates of skin problems. One of the strongest predictors was working in wet clothes or shoes. Conclusions: Programs are needed to educate farmworkers about measures they can take to decrease their risk of skin problems. Changes in work practices and personal protective equipment provided could help decrease the prevalence of skin problems.

Background Farmworkers in the US constitute a medically underserved population at substantial risk for numerous environmental and occupational health problems. Most US farmworkers are Latino. Skin disease is one health problem to which farmworkers are particularly vulnerable. Interventions to reduce skin disease must be adapted to farmworkers' understanding of such disease, including their beliefs or knowledge of risk factors for skin disease. Methods Structured by the Explanatory Models of Illness framework, this analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (6 females, 24 males) to determine beliefs and perceptions of the causes of common occupational skin diseases in this population. Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. Results Skin disease is a major concern among farmworkers because it affects work, social interaction, and other aspects of their lives. Farmworker beliefs and perceptions of skin disease causation can be integrated into a general model in which perceived risk factors include sun and heat, chemicals, plants, insects, moisture, hygiene, and contagion. Each of these factors is moderated by the individual's personal susceptibility to that cause. The interaction or combination of two or more factors is thought to amplify their individual effects. Conclusions The farmworker model of skin disease causation suggests important content for health education to reduce skin disease among farmworkers. Am. J. Ind. Med. 2006. © 2006 Wiley-Liss, Inc.

The authors describe the prevalence and severity of pterygium among Latino migrant farmworkers in North Carolina and delineate its risk factors. They selected a sample of 304 farmworkers working in eastern North Carolina in 2005. Digital photographs were taken of each farmworker, including a facial view showing the eyes. Two physicians independently rated each farmworker for the presence and severity of pterygia, with an initial intercoder agreement of 91%. Sixty-eight (23.3%) participants had a pterygium in at least 1 eye; 28 (9.5%) had bilateral pterygia. Age was significantly associated with pterygia (odds ratio = 1.07; 95% confidence interval = 1.03-1.11). Research on the causes of pterygium among farmworkers is needed. In the interim, improvements in farmworkers' preventive behaviors, such as wearing ultraviolet protective lenses and brimmed hats, are reasonable and inexpensive measures.

The authors designed this study to assess skin ailments among male Latino poultry-processing workers in one plant in North Carolina. Because conditions in poultry plants expose workers to multiple agents affecting the skin, the number of skin ailments was expected to be high. A visual skin examination was conducted by a single board-certified dermatologist for 25 male workers. Dermatological Life Quality Index scores and self-reported skin treatment data were obtained through interviews. Each worker had at least one dermatological diagnosis. Infections were most common (onychomycosis, 76%; tinea pedis, 72%), followed by inflammatory diagnoses (acne, 64%). No workers had sought medical treatment. Dermatological Life Quality Index scores indicated impaired quality of life. Worker self-reports were not strongly associated with dermatologist diagnoses. Skin diseases are common among poultry workers and impact workers' quality of life; reasons for lack of medical care should be investigated.

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

Respiratory health is an important component of the ability to perform physically demanding work. We assessed the prevalence of self-reported respiratory symptoms among Latino farmworkers primarily engaged in crop production and investigated work activities as risk factors for respiratory symptoms. During June-September 2008, 122 farmworkers completed up to three interviewer-administered questionnaires. We estimated the associations between work activities and wheezing symptoms using alternating logistic regression, controlling for age and smoking. At the first data collection, 24% (n=29) of farmworkers reported ever wheezing and 8% reported wheezing within the past month. Though not statistically significant, the odds of wheezing were elevated for individuals who reported performing tobacco-related work in the last three days. The odds were decreased among individuals who reported harvesting activities (odds ratio: 0.3, 95% confidence interval: 0.1, 1.0). Among Latino farmworkers, respiratory symptoms may be associated with work activities.

Background—Little is known about the HIV and sexually transmitted disease (STD) risk behaviors of Hispanic/Latino farmworkers. This study was designed to describe risk factors for HIV and STD infection, explore personal characteristics associated with condom use, and evaluate the feasibility of collecting self-report and biomarker data from farmworkers. Methods—Self-report and biomarker data were collected from a sample of male farmworkers living in 29 camps in North Carolina during the 2008 growing season. Results—Over half of the 100 male workers, mean age 37.1 (range 19–68) years, reported binge drinking during the past 12 months. Forty percent of those who reported having had sex during the past three months indicated that they were under the influence of alcohol. Knowledge of HIV and STD transmission and prevention was low. Among the 25 workers who reported having had sex during the past three months, 16 and 2 reported using a condom consistently during vaginal and anal sex, respectively, and nearly one out of six workers reported paying a woman to have sex. Two workers tested positive for syphilis. Conclusions—Farmworkers in this sample demonstrated significant HIV and STD risks; however, when exploring potential bivariate associations with consistent condom use no statistically significant associations were identified perhaps due to the small sample size. Because it was feasible to collect self-report and biomarker data related to HIV and STDs from Hispanic/ Latino farmworkers, research needed to further explore risks and develop interventions to reduce disease exposure and transmission among this vulnerable population.

Background Limited data document the multiple and repeated pesticide absorption experienced by farmworkers in an agricultural season or their risk factors. Methods Data were collected from 196 farmworkers four times at monthly intervals in 2007. Urine samples were tested for 12 pesticide urinary metabolites. Questionnaire data provided measures of exposure risks. Results Farmworkers had at least one detection for many pesticide urinary metabolites; for example, 84.2% had at least one detection for acephate, 88.8% for 3,5,6-trichloro-2pyridinol. Most farmworkers had multiple detections for specific metabolites; for example, 64.8% had two or more detections for acephate, 64.8% for 3,5,6-trichloro-2-pyridinol, 79.1% for 3-phenoxybenzoic acid, and 86.7% for 2,4-dichlorophenoxyacetic acid. Housing type had a consistent significant association with metabolite detections. Conclusions Farmworkers are exposed to multiple pesticides across an agricultural season, and they experience repeated exposures to the same pesticides. Reducing farmworker pesticide exposure and delineating the health outcomes of this exposure require more detailed data. Am. J. Ind. Med. 53:802–813, 2010. 2010 Wiley-Liss, Inc.

Immigrant Latino farmworkers confront multiple challenges that threaten their mental health. Previous farmworker mental health research has relied primarily on cross-sectional study designs, leaving little opportunity to describe how farmworker mental health changes or to identify factors that may contribute to these changes. This study used prospective data obtained at monthly intervals across one 4-month agricultural season from a large sample of Latino farmworkers in North Carolina (N = 288) to document variation in depressive symptoms across the agricultural season and delineate structural and situational factors associated with mental health trajectories across time. Depressive symptoms generally followed a U-shaped distribution across the season, but there was substantial variation in this pattern. Structural stressors like marital status and situational stressors like the pace of work, crowded living conditions, and concerns about documentation predicted depressive symptoms. The pattern of results suggests that strategies to address mental health problems in this vulnerable population will require coordinated action at the individual and social level.

Despite the recent interest in organically grown foods, most agricultural crops use multiple pesticides to optimize yield. There are many persons whose health may be affected by the spraying; there is the active applicator and the passive neighbors. In between these extremes are the farm workers who pick the crops anywhere from days to weeks after application. How much pesticide residue are these workers exposed to during a workday and how much is transferred back to the residence? Despite the low vapor pressures, what is the true concentration of pesticides surrounding a person when pesticides adsorbed to particulate matter are included? What is the relationship between the concentration around an individual and the amount adsorbed/ingested? To answer these questions on a statistically significant scale in actual field conditions, a portable, fast, inexpensive measurement device is required. We present herein results obtained using Surface-Enhanced Raman Spectroscopy (SERS) that demonstrate the capability to detect < 100 organophosphate, organochlorine and carbamate-based pesticides in the vapor phase as well as the ability of SERS sensors to detect a particular analyte in a synthetic urine matrix. We will also present data collected from CDC quantified urine samples and will present results obtained in a field test wherein SERS sensors wore worn as dosimeters in the field and real-time vapor sampling of the farm workers barracks was performed. The issue of potential interferences will also be discussed.

Tattoos raise several medical concerns, including the potential for spreading blood-borne infection. Infection control measures typically used by professional tattooists include changing gloves between clients, hand and skin cleansing, and sterilization or single-use equipment (e.g. needles, tattoo guns, and ink supplies)1 however, such behavior is highly operator-dependent. The lack of aseptic technique in amateur tattoos results in greater risk of exposure to blood-borne diseases, including hepatitis B, hepatitis C, HIV, syphilis, warts, tuberculosis, and others.1–6 While the prevalence of people with amateur tattoos is unknown, the number of virulent community-acquired pathogen outbreaks (e.g., methicillin-resistant staphylococcus infection) associated with amateur or unlicensed tattooists or to poor adherence to aseptic tattooing techniques is increasing.1 Migrant Latino farmworkers are one group of particular concern for the spread of blood-borne infection. Farmworkers live away from their home communities and families in crowded conditions that are conducive to the spread of infectious disease.7 Traditional beliefs about self-medication involving reuse and sharing of injection needles adds to the potential risks of spreading contagion in this population.8,9 We conducted an observational analysis of migrant Latino farmworkers to assess the prevalence and type (i.e. amateur) of tattooing in this immigrant population. During the 2005 agricultural season, 304 farmworkers residing in 45 camps in nine North Carolina counties were interviewed. A standard set of 10 digital images was made of each farmworker and reviewed by a single research assistant to assess the frequency and type of tattoos in this population. Amateur tattoos were defined by the presence of a single blue-black color and broad lines with indistinct borders (figure 1). Professional tattoos were identified by their use of multiple colors, fine lines and details, and sharp, distinct borders.10 Figure 1 Amateur tattoo. Amateur tattoos are generally simple in appearance, without complex colors or design features. The lines within amateur tattoos tend to be thicker and less distinct than lines in professional tattoos. In our study, participant age ranged from 18 to 45 years, years of education varied from 1 to 12. There was a broad range of Mexican state of origin (Figure 2), and the study population included individuals with and without H2A visas. Tattoos were identified in 19 (6%) of the participants. Three workers (1%) had only professional tattoos, thirteen others had only amateur tattoos (4.3%, figure 1), and three workers (1%) had both types. Farmworkers with tattoos had no distinguishing personal characteristics (Table 1). Only two farmworkers with tattoos (10.5%) spoke an indigenous language. Figure 2 Map of Mexican States with the relative distribution of tattooed farmworkers. For two states, Zacatecas and Tlaxcala, two types of tattooing patterns exist. Table 1 Personal Characteristics of Migrant Latino Farmworkers with Tattoos.

Background Community Participatory Approach to Measuring Farmworker Pesticide Exposure, PACE3, used a longitudinal design to document pesticide biomarkers among farmworkers. This article presents an overview of PACE3 and provides a descriptive analysis of participant characteristics and one set of pesticide biomarkers, the dialkylphosphate (DAP) urinary metabolites of organophosphorus (OP) pesticides. Methods Two hundred eighty seven farmworkers were recruited during 2007 from 44 farmworker camps in 11 eastern North Carolina counties. Participants provided interviews, urine samples, blood samples, and saliva samples up to four times at monthly intervals beginning in May. A total of 939 data points were collected. Results Farmworkers were largely men (91.3%) from Mexico (94.8%) with a mean age of 33.7 years (SE 0.82); 23.3% spoke an indigenous language. Across all data points, frequencies of detection and median urinary concentrations were 41.3% and 0.96 µg/L for dimethylphosphate (DMP), 78.3% and 3.61 µg/L for dimethylthiophosphate (DMTP), 33.3% and 0.04 µg/L for dimethyldithiophosphate (DMDTP), 40.5% and 0.87 µg/L for diethylphosphate (DEP), 32.3% and 0.17 µg/L for diethylthiophosphate (DETP), and 8.09% and 0.00 µg/L for diethyldithiophosphate (DEDTP). The frequencies of detection and urinary concentrations of the DAP metabolites increased during the season. Conclusions More PACE3 participants were from Mexico, male, migrant workers, and spoke an indigenous language compared to national data. PACE3 participants had comparable frequencies of detection and urinary metabolite concentrations with participants in other studies. Variability in the frequencies of detection and urinary concentrations of the DAP metabolites indicates the importance of longitudinal studies of biomarkers of currently used pesticides in farmworker populations. Am. J. Ind. Med. 52:539–550, 2009. © 2009 Wiley-Liss, Inc.

Background Immigrant farmworkers are a population at risk for numerous environmental and occupational exposures. The metals arsenic, lead, mercury, and cadmium are known neurotoxins to which workers can be exposed both in the US and in their country of origin. Because farmworkers are exposed to neurotoxic pesticides, they may be at risk for adverse health effects from the combined exposure. Objectives To examine the relationship between exposure to metals, as measured in urine, with personal and work-related characteristics of Mexican migrant and seasonal farmworkers in the US. Methods We analyzed data on metals found in urine of 258 farmworkers recruited from 44 camps in eastern North Carolina in 2007. Geometric means and 95% confidence intervals (CI) were used to compare data with data from the National Health and Nutrition Examination Survey (NHANES). We used multivariate regression models fitted for each metal to estimate the association of creatinine-corrected urinary metals and worker characteristics related to environmental and occupational exposures. Results Geometric mean urinary metals concentrations (μg/g creatinine) exceeded NHANES reference values for arsenic (13.23 [CI 11.11, 15.35] vs. 8.55 [CI 7.23, 9.86]) and lead (1.26 [CI 1.08, 1.43] vs. 0.63 [CI 0.60, 0.66]). Age, being from the central region of Mexico, and pack years of cigarette smoking were significant predictors of metals exposure; being a current smoker and years worked in US agriculture were not. Conclusions This first study to examine indicators of worker body burdens of metals shows that workers have body burdens related to exposures other than work in the US. Further research should address their risk for adverse health outcomes due to combined exposures to neurotoxins in pesticides.

Context: Rural patients have limited access to dermatologic care. Farmworkers have high rates of skin disease and limited access to care. Purpose: This exploratory study assessed whether teledermatology consultations could help meet the needs of health care providers for farmworkers in rural clinics. Methods: Dermatologists provided 79 consultations, using store-and-forward teledermatology, to farmworkers who presented with a skin disease to rural North Carolina clinics. Clinic providers rated the value of the consultation. Finding: Most requests for consultations (94%) came from family nurse practitioners or physician assistants. Twelve percent of consultations were rated somewhat helpful, and the remainder helpful or very helpful. After receiving the consultation, providers changed the diagnosis in 13% of cases. The consultation led providers to contact or attempt to contact 21% of patients to change treatment recommendations. Conclusions: Access to expert dermatologic services is needed by rural health care providers. Teledermatology consultations may be a helpful tool to meet this need.

Skin rashes are among the most common problems seen by those providing health care to agricultural workers. We present a case report of a migrant farmworker patient with a painful, blistering eruption of the axilla and adjacent skin developing after an insect bite. The possibility of infection was not initially considered, and teledermatology was helpful in making the diagnosis of bullous impetigo. This was important because initial culture confirmation was not obtained and antibiotic treatment had not been initiated. After the consultation, the impetigo was treated by empiric antibiotic coverage. The environmental conditions of migrant farmworkers raise special issues for infectious skin diseases like bullous impetigo. Crowded living conditions, lack of proper sanitary facilities, and poor accessibility to health care increase the risk of occurrence and spread of this disease. With the recent emergence of multi-drug-resistant organisms such as methicillin-resistant Staphylococcus aureus in community settings, this case report should serve to reinforce the need to recognize the possibility of infection and to obtain culture specimens at the initial visit to better treat and control this infectious skin condition.

Background: Skin diseases are common occupational illnesses for farmworkers. Migrant farmworkers commonly access rural health clinics for diagnosis and treatment of skin disease. Purpose: To assess common skin conditions of migrant farmworkers treated in rural clinics and to describe effective and economic management of these conditions. Methods: Seventy-nine farmworkers with a skin condition were seen as patients at 4 clinics in eastern North Carolina. A list of the most common conditions encountered was compiled and treatment methods were found in the literature. Results: Twenty-three common conditions were identified. The most common conditions were contact dermatitis, melasma, tinea, seborrheic keratoses, and impetigo. A table of treatment recommendations was composed that can be used by clinicians in this setting. Conclusions: Generally, the most common skin conditions seen in the migrant farmworker population in eastern North Carolina are similar to conditions found in the general population.

Skin disease is common among migrant Latino farmworkers. These workers rarely use formal health care services but commonly engage in self-treatment of their skin disease. We present a patient with dermatitis who self-treated with bleach. This patient illustrates a common practice that exacerbates skin disease and sheds light on social and cultural factors of which health care providers serving this community should be aware.

Background: Skin diseases are known to affect the quality of life (QoL), but data to support this are based on clinical samples. Few data document the skin-related QoL in the general population, and whether its association differs with self-reported or dermatologist-diagnosed skin ailments. Farmworkers are at high risk for skin diseases, and are an appropriate population in which to explore these associations. Objectives: To compare the association between skin-related QoL and workers’ self-reports of skin conditions or dermatologist-diagnosed skin diseases over the course of a work season. Methods: Three hundred and four Latino farmworkers were recruited from 45 randomly selected residential sites in North Carolina, USA, for longitudinal surveillance. The participants were interviewed up to five times at 3-week intervals and the reported skin problems and Dermatology Life Quality Index (DLQI) were recorded. Nine digital photographs were taken of each participant. A board-certified dermatologist rated each for the presence of specific skin diseases. Results: An impact of skin disease on QoL was reported in 16% of interviews. In multivariate analyses with self-reported skin problems, feet or skin fungus, rash, itching, and poison ivy were predictors of QoL. Dermatologist-diagnosed inflammatory diseases and pigmentary disorders were significant predictors of QoL. The association was stronger for self-reported skin problems than for dermatologist-diagnosed conditions. Conclusions: In a population of farmworkers, skin problems had a clinically significant impact on QoL. Itch-related conditions and cosmetic conditions, such as acne and melasma, were important determinants of QoL. Treatment for these conditions in this population may enhance QoL.

Background: Farmworkers in North America work in an environment likely to produce skin injuries and illnesses that affect quality of life (QOL). Objective: We identified the dimensions of skin-related QOL that were most impaired and examined predictors in a cohort of North Carolina farmworkers. Methods: We conducted a longitudinal survey of 304 Latino farmworkers across a work season (1,048 interviews). We assessed skin-related QOL using the Dermatology Life Quality Index. Results: Effects on QOL were reported in 38.7% of observations. The greatest impacts of skin impairments were seen in the Symptoms and Feelings and Work and School Subscales. In multivariate analysis, specific work tasks and high temperatures were associated with greater decrements in QOL. Conclusions: Skin disease among farmworkers is sufficiently severe to affect QOL. Future research should test the effectiveness of interventions on modifiable factors such as facilities for personal hygiene and field sanitation on skin-related QOL.

Background: Green tobacco sickness (GTS) affects approximately one-quarter of tobacco workers. The primary aim of this analysis is to expand existing knowledge of GTS risk factors by delineating the association of measures of skin integrity with the prevalence of GTS among Latino farmworkers. Methods: Data are from a longitudinal study of skin disease among 304 North Carolina Latino farmworkers conducted in 2005. Results: 18.4% of the farmworkers met the GTS case definition. Self-reported rash increased the odds of having GTS in the bivariate (OR 2.29, 95% CI 1.21, 4.35), and multivariate analyses (OR 3.30, CI 2.17, 5.02). Self-reported itch (OR 3.54, CI 2.38, 5.24) and superficial wounds (OR 2.49, CI 1.15, 5.39) had a significant relationship to GTS in the bivariate analysis. Conclusions: These analyses extend current knowledge of GTS risk factors to include skin integrity. Farmworkers with rash and other skin conditions can protect these affected skin areas from exposure to the tobacco plant to reduce their risk of GTS.

Migrant farmworkers experience a high incidence of skin disease. This report provides information on the case history of cutaneous larva migrans in a Latino migrant farmworker. Treatment options are reviewed, and information for prevention is discussed.

Occupational skin disease is highly prevalent among agricultural workers. Tobacco cultivation and harvest are particularly hazardous for farmworkers. We report 5 migrant Latino farmworkers in North Carolina with contact dermatitis related to tobacco work. These cases show a characteristic distribution of contact dermatitis; the flexural and medial surfaces of the upper extremities were affected in each case, whereas most cases showed some involvement of the torso and axilla. This pattern most likely reflects a common occupational practice of holding the tobacco leaves under the arm and pressed against the body during harvesting.

Latino migrant and seasonal farmworkers experience high rates of skin disease that result from their working and living conditions. Knowledge of the ways farmworkers treat skin disease symptoms will provide a foundation for developing culturally appropriate health education, improving the delivery of health services, and improving occupational health policy for agricultural workers. The purpose of this paper is to describe skin disease self-management practices among Latino migrant and seasonal farmworkers in North Carolina. This analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (six females, 24 males). Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. Participants shared a consistent set of health self-management actions in treating skin disease. These actions were within the domains of self-care and medical care. A model of skin disease self-management among Latino farmworkers includes the self-care actions of hygiene, use of home remedies and use of over-the-counter remedies, with farmworkers often combining different domains of self-care. While farmworkers acknowledge the benefits of medical care, they are also mindful of barriers to its use, including cost, transportation and language. The large percentage of farmworkers who experience skin problems indicates that health outreach workers who serve this population need to provide education on preventing and treating skin problems, and they need to recommend to farmworkers appropriate over-the-counter medicines for the treatment of these skin problems. Appropriate medical care for treating skin problems that are dangerous and reduce farmworkers' quality-of-life needs to be made available to this population.

An estimated 4.2 million seasonal and migrant farm workers and their dependents live in the U.S. Most of these farmworkers are Latino. These workers are exposed to numerous occupational and environmental risk factors that can result in skin disease. Few data exist on the prevalence of skin disease in this population. The purpose of this study was to estimate the prevalence and predictors of skin disease in a sample of Latino farmworkers in North Carolina. A sample of 59 farmworkers was recruited and interviewed at two camps during the 2004 agricultural season. A dermatologist completed a skin exam of each worker and recorded any skin disease present. Forty-two (77.7%) of the 54 men, and all five of the women examined had a diagnosed skin disease. For the men, onychomycosis (nail fungus, 31.5%), tinea pedis (foot fungus, 27.8%), and acne (24.1%) were the most commonly diagnosed skin diseases, with contact dermatitis diagnosed in 5.6% of the sample. Other diagnoses included scars, sunburn, and atopic dermatitis. Among the women, diagnoses included melasma (dark patches on the face, 2 cases), xerosis (excessively dry skin, 1 case), tinea pedis (2 cases), onychomycosis (1 case), acne (1 case), and insect bites (1 case). There were no statistically significant differences between workers in the two camps despite different growing seasons and different crops harvested. Skin disease is prevalent among the North Carolina Latino farmworkers who participated in this study, with fungal disease being the most prevalent.

Lead paint is one source of exposure for lead poisoning; however, recent Latino and other immigrant populations are also at risk of exposure through ceramic cooking pots with lead glaze, some imported candies, and certain stomach ailment home remedies. Public health agencies and practitioners acknowledge that Latino families should be educated about lead poisoning prevention but report barriers to conducting outreach and education in Latino communities. This study reports findings from focus groups and interviews with the local Latino immigrant community and professionals on (1) current knowledge and beliefs about lead poisoning and (2) recommendations of culturally appropriate educational strategies.

Spanish is the second most common language spoken in the United States. Physicians can expect a growing population of patients who speak Spanish as their primary language. The purpose of this study was to develop a glossary of Spanish dermatological vocabulary commonly used by Mexican workers. Dermatologic terms were gathered from transcripts of in-depth interviews with 31 Latino farmworkers in North Carolina. Participants were asked to name and define words related to skin irritations. Farmworkers provided several definitions of some terms, and several Spanish equivalents exist for specific English words. This glossary is a supplement to other resources for learning medical Spanish and expands health care professionals' knowledge of dermatology-related Spanish vocabulary.