Abstract
The purpose of this study is to describe perceptions of environmental and occupational health issues among agricultural workers. Interviews were conducted with 389 agricultural workers in the Yakima Valley in central Washington State in the summers of 2004 and 2005. Undergraduate students from the community conducted interviews in Spanish or English. Environmental and occupational health issues were ranked by frequency of concern, and differences by demographic characteristics were evaluated using multivariate analyses. In both 2004 and 2005, agricultural workers expressed high levels of concern about working in hot weather, agricultural injuries, pesticides, and pediatric asthma. Perceptions of environmental and occupational health issues among agricultural workers differed by certain demographic characteristics, particularly age and ethnicity. Consideration should be given to these issues when designing research studies, creating educational materials, and developing interventions related to environmental and occupational hazards among agricultural workers.
Introduction
Multiple environmental and occupational health-related conditions have been documented in agricultural worker populations including: musculoskeletal and traumatic injuries, respiratory conditions such as allergies and asthma, dermatitis, pesticide poisonings, heat-related illnesses, and mental health conditions (Fenske, Hidy, Morris, Harrington, & Keifer, 2002; Larson, 2001; Mines, 2001; Villarejo, 2003). The disparate social position of agricultural workers compounds their occupational risks. According to the National Agricultural Worker Survey, 75% of agricultural workers are Mexican-born, 44% cannot speak English “at all,” and 13% have completed the 12th grade. The average family income ranges from $15,000-$17,499 and only 8-12% have health insurance as a benefit of employment (U.S. Department of Labor, 2005).
Washington State is one of the top-ten crop producers in the United States. Many labor-intensive crops, such as vegetables and tree fruits, are grown in the Yakima Valley, located in south central Washington. Consequently, there is a large population of migrant and seasonal agricultural workers. Yakima County is a particularly productive agricultural region; it accounts for nearly a quarter of the State's agricultural jobs (Washington State Employment Security, 2005). An estimated 52,476 migrant and seasonal farmworkers are employed in Yakima County (Larson, 2000).
Literature Review
Recently published literature related to farmworkers' perceptions of their occupational and environmental health stressors includes studies that report problems and protective practices related to general occupational health (Farquhar, et al., 2008), vision (Quandt, et al., 2008), hearing loss (Rabinowitz, Sircar, Tarabar, Galusha, & Slade, 2005), skin (Cathcart, et al., 2008; Vallejos, et al., 2008), adolescent pesticide exposure (Salazar, Napolitano, Scherer, & McCauley, 2004), take home pathways of pesticide exposure (Strong, Starks, Meischke, & Thompson, 2009), and injuries among orchard workers (Keifer, Salazar, & Connon, 2009).
Notably, most of these studies focused on a particular issue related to occupational health. Many studies were narrow in scope, which allowed for an in-depth evaluation of the issue being explored, but consequently may have limited other important issues from being identified and discussed. The study by Farquhar et al is a notable exception. This study broadly examined indigenous farmworkers' concerns regarding occupational injury and illness, experiences of discrimination and disrespect, and language and cultural barriers. Most of the articles focused on occupational health topics. Only the study by Strong et al that examined perceptions about take home pesticide exposure among women in farmworker households dealt with the environmental health of farmworker communities.
Innovative research is needed to better understand occupational and environmental risks faced by agricultural communities. Locally relevant and culturally appropriate research and interventions are predicated on understanding worker perspectives of their environmental and occupational health hazards (Arcury, Austin, Quandt, & Saavedra, 1999; Arcury, Quandt, & Dearry, 2001; O'Fallon & Dearry, 2002). The purpose of this study is to describe perceptions of certain environmental and occupational health issues among agricultural workers in a community in the state of Washington.
Conceptual framework
Empowerment is a participatory process designed to assist individuals or groups to make decisions that will advance their health and well being. Health promotion theorists define empowerment as a multidimensional construct that attends to individual, small group, organizational, and community levels of health promotion (Israel, Checkoway, Schulz, & Zimmerman, 1994; Labonte, 1994; Robertson & Minkler, 1994). Early conceptual work around the concept of empowerment fostered the creation of community based participatory research (CBPR) approaches to health promotion research (Israel, et al., 1994; Minkler & Wallerstein, 2003). A critical element in CBPR is the active participation of the community that is affected by the research. CBPR provides a means to obtain new perspectives on occupational and environmental health stressors among agricultural communities. For this study, CBPR provided a means to actively involve members of an agricultural community in the research process.
Methods
El Proyecto Bienestar (The Well Being Project) started as a four-year CBPR project. The goal of the project was to increase local participation in environmental and occupational health-related research. Representatives from a research university, a liberal arts university, a large community/migrant health clinic and a community-based organization came together to create inclusive solutions to the stated occupational and environmental health needs of an agricultural community. A Community Advisory Board helped guide the research process (J. L. Crowe, Keifer, & Salazar, 2008; Ybarra & Postma, 2007).
In 2004, in conjunction with the Yakima Valley Farm Workers Clinic, El Proyecto Bienestar began working with the ConneX (Connecting Students to Health Careers) program to create an undergraduate summer course on environmental and occupational health. ConneX is a local health professions pipeline program for economically or educationally disadvantaged students from the Yakima Valley. As part of the field work component of the course, students conducted interviews with community members about environmental and occupational health issues. Prior to the field research portion of the course, the students received training on interview techniques and research ethics as well as data entry using Zire TM 31 Palm One® Personal Digital Assistants (PDAs). All study protocols were approved by the Institutional Review Board at the University of Washington and the Research Review Committee/HIPAA Privacy Board at the Yakima Valley Farm Workers Clinic. All study participants provided oral consent prior to the interview. Students were supervised at all times while in the field by university researchers who had completed a university-sponsored human subjects research training course.
Participants were recruited for this study using a site-based sampling approach that has been utilized to achieve a representative sample in previous qualitative and quantitative community research efforts (Arcury & Quandt, 1999; Quandt & Rao, 1999). Interview sites were chosen based on recommendations from the Community Advisory Board and other community members who suggested locations (including grocery stores, soccer games, and flea markets) frequented by Hispanic agricultural workers and their families. Store or site managers gave written permission at each survey location where applicable.
Interviews were conducted during one week periods in August 2004 and 2005 between the hours of 8:00 am and 5:00 pm in the case of restaurants and grocery stores and between 6:00 pm and 8:30 pm at soccer fields and community events. Interviews were only conducted during daylight hours for safety reasons. Students approached potential participants and introduced the project. If the person expressed willingness to participate and was at least 18 years old, the students obtained verbal consent and interviewed the participant in English or Spanish. Interviews generally took about 15 minutes to complete. Data were entered using the PDAs.
The content of the surveys was developed based on data from key informant interviews from the first phase of El Proyecto Bienestar [(J. Crowe, 2005; Hom, 2006), references available upon request]. These data sources, in addition to input from investigators involved in the research project and members of the Community Advisory Board, resulted in a list of environmental and occupational health concerns of a priori interest that were included in the surveys. This list included a range of topics such as pesticide exposure, heat-related illness, ladder falls, and other issues. Surveys were translated into Spanish by a local translator and reviewed by bilingual research staff and ConneX students to ensure consistency between the Spanish and English versions. Draft versions of the survey were pilot tested and revised prior to data collection. Pilot testing and review of the survey resulted in several important modifications. For example, some Spanish terms were not commonly used in this community and were replaced with local vocabulary (i.e. “hape” rather than “lúpulo” for hops). Both surveys asked about demographic characteristics and agricultural work history. Demographics included age, gender, race/ethnicity, self-reported health status, time since arrival in Yakima Valley, children in the home, household income, education, and English and Spanish literacy. For agricultural work history, the following information was collected: total years working in agriculture, location of agricultural work, type of agricultural operation, work involving specific fruit and vegetable crops, and types of work activities in orchards (2005 only). The response strata were recoded for several ordered categorical variables – such as income and length of employment in agriculture – to be consistent between the 2004 and 2005 surveys.
Because the goal of the study was to characterize agricultural workers' perceptions of environmental and occupational health hazards, analyses were restricted to participants who had ever worked in agriculture. Participants were further classified as either former or current agricultural workers based on reported work activities and current occupation. Hereafter participants who ever worked in agriculture (e.g. both formerly and currently working in agriculture) are referred to collectively as “agricultural workers.”
Participants were asked to rate their level of concern about a series of health issues on a four point scale. In 2004, participants were asked to state whether a particular issue (for example, “asthma in children”) was: “not a concern,” “a little bit of a concern,” “likely to be a concern,” or “definitely a concern.” In 2005, response categories were restructured to allow participants to select a neutral response if they did not have a strong opinion about a particular issue. That is, participants in 2005 were asked “To what extent do you think the following issues are a concern in the Yakima Valley?” They were then given a list of issues and the following options: “not a concern,” “possibly a concern,” “definitely a concern” and “no opinion.” For the analysis, levels of concern were dichotomized into “definitely a concern” and all other options, which facilitated comparisons across years. The surveys covered similar content, but varied slightly in structure across the two years. In 2004, the questions asked about environmental and occupational health issues; in 2005, although the majority of the issues were the same, they were subcategorized according to exposures and outcomes of concern (Figure 1).
Figure 1. Environmental and occupational health concerns addressed on community surveys, 2004 and 2005.
Survey data were analyzed using the Statistical Program for the Social Sciences (SPSS), version 14.0. The frequency of concern about environmental and occupational health issues was examined in 2004, and the frequency of concern about environmental and occupational exposures and outcomes was examined in 2005. Frequencies are reported for all participants who ever worked in agriculture, and separately for former and current agricultural workers. Multivariate logistic regression analyses were also performed to evaluate the degree of concern about the top three issues in each category based on selected demographic characteristics and agricultural work status. The following covariates were included in the logistic regression models based on bivariate analyses (results not shown): age category (18-34, 35-54, 55+), gender, ethnicity (Hispanic vs. non-Hispanic), parental status, English literacy, and agricultural work status (former vs. current). Preliminary analyses suggested that some subgroups (e.g. middle-aged participants, women, and parents) were more concerned about a greater number of environmental and occupational health issues. To evaluate this observation, analysis of covariance (ANCOVA) models were used to estimate the average number of issues described as “definitely a concern” according to these three demographic characteristics.
Findings
A total of 442 surveys were completed in this study (203 surveys in 2004 and 239 surveys in 2005). Most study participants (N=389; 88.0%) reported having worked in agriculture (Table 1). The mean age of the agricultural workers was 37.9 years in 2004 (range 18-76 years) and 39.8 years in 2005 (range 18-90). Approximately half were male in each year (48.9% and 53.1% respectively). The vast majority were Hispanic or Latino (93.2% in 2004 and 90.0% in 2005). Most (89.8% and 85.2%) had either always lived in the Yakima Valley or had arrived more than five years ago, and most (83.1% and 80.4%) had children. In both years, well over half (67.5% and 58.2%) reported an annual household income of $20,000 or less, and over half each year (60.4% and 53.9%) had not completed high school. In 2005, 68.4% of the workers were born in Mexico, but the majority (85.2%) of workers had lived in the Yakima Valley for more than five years (birthplace was not asked in 2004). Most (88.1% and 80.4%) were literate in Spanish (reported being able to read a newspaper in Spanish) and approximately half (40.1% and 53.6%) reported being able to read a newspaper in English. Most (75.7% and 64.5%) chose to complete the survey in Spanish.
Table 1. Demographic characteristics of agricultural workers.
| 2004 (N=178) | 2005 (N=211) | |||
|---|---|---|---|---|
| N | %* | N | %* | |
| Age in years | ||||
| 18-34 | 84 | 47.7 | 85 | 41.1 |
| 35-54 | 67 | 38.1 | 88 | 42.5 |
| 55+ | 25 | 14.2 | 34 | 16.4 |
| Gender | ||||
| Female | 91 | 51.1 | 99 | 46.9 |
| Male | 87 | 48.9 | 112 | 53.1 |
| Race/ethnicity | ||||
| Hispanic | 165 | 93.2 | 190 | 90.0 |
| White, non-Hispanic | 8 | 4.5 | 12 | 5.7 |
| Other | 4 | 2.3 | 9 | 4.3 |
| Birthplace | ||||
| Mexico | n/a† | 143 | 68.4 | |
| Yakima Valley | 27 | 12.9 | ||
| Washington State, outside YV | 7 | 3.3 | ||
| United States, outside WA | 25 | 12.0 | ||
| Other | 7 | 3.3 | ||
| Arrived in Yakima Valley | ||||
| Within the last year | 4 | 2.3 | 17 | 8.1 |
| 1-5 years ago | 14 | 7.9 | 14 | 6.7 |
| More than 5 years ago | 117 | 66.1 | 146 | 69.9 |
| Have always lived in YV | 42 | 23.7 | 32 | 15.3 |
| Spend >6 months/year in YV | ||||
| No | n/a† | 5 | 2.9 | |
| Yes | 167 | 97.1 | ||
| Children in home | ||||
| No | 30 | 16.9 | 41 | 19.6 |
| Yes | 148 | 83.1 | 168 | 80.4 |
| Household income | ||||
| Under $10,000 | 45 | 27.6 | 30 | 15.9 |
| $10,000-20,000 | 65 | 39.9 | 80 | 42.3 |
| $21,000-30,000 | 28 | 17.2 | 45 | 23.8 |
| More than $30,000 | 25 | 15.3 | 34 | 18.0 |
| Education | ||||
| Did not attend school | 5 | 2.8 | 15 | 7.3 |
| Some elementary school | 23 | 13.0 | 44 | 21.4 |
| Completed elementary school | 39 | 22.0 | 21 | 10.2 |
| Some high school | 40 | 22.6 | 31 | 15.0 |
| High school graduate | 58 | 32.8 | 75 | 36.4 |
| College graduate | 12 | 6.8 | 20 | 9.7 |
| English literacy | ||||
| No | 106 | 59.9 | 97 | 46.4 |
| Yes | 71 | 40.1 | 112 | 53.6 |
| Spanish literacy | ||||
| No | 156 | 11.9 | 41 | 19.6 |
| Yes | 21 | 88.1 | 168 | 80.4 |
| Language for survey | ||||
| English | 43 | 24.3 | 75 | 35.5 |
| Spanish | 134 | 75.7 | 136 | 64.5 |
| Currently employed | ||||
| No | 35 | 19.8 | 56 | 26.5 |
| Yes | 142 | 80.2 | 155 | 73.5 |
| Self-reported health status | ||||
| Poor | 10 | 5.6 | 17 | 8.1 |
| Fair | 62 | 34.8 | 77 | 36.7 |
| Good | 47 | 26.4 | 66 | 31.4 |
| Very good | 39 | 21.9 | 21 | 10.0 |
| Excellent | 20 | 11.2 | 29 | 13.8 |
Missing records were excluded from percentages
Data available for 2005 only
Approximately half of the agricultural workers (55.1% and 44.1% respectively) reported currently working in agriculture at the time of the survey (Table 2). Although approximately half reported having worked in agriculture outside of the Yakima Valley, almost all (96.1% and 95.2%) had done agricultural work in the Yakima Valley. The majority (66.1% and 76.9%) had worked five or more years in agriculture. Most workers reported having worked in a variety of workplaces and with a variety of crops; “orchard or field” was the most common workplace and apples, cherries, pears and asparagus were the most commonly reported crops across both years. In 2005, the most frequently reported work activity for orchard and field workers was harvesting or picking, thinning, and pruning. Only 26.8% had worked as a supervisor or foreman. (These data were not collected in 2004).
Table 2. Work activities of agricultural workers.
| 2004 (N=178) | 2005 (N=211) | |||
|---|---|---|---|---|
| Characteristic | N | %* | N | %* |
| Agricultural work status | ||||
| Former | 80 | 44.9 | 118 | 55.9 |
| Current | 98 | 55.1 | 93 | 44.1 |
| Agricultural operation | ||||
| Orchard or field | 149 | 85.6 | 141 | 77.9 |
| Warehouse or cannery | 96 | 55.2 | 105 | 58.0 |
| Dairy | 5 | 2.9 | 122 | 67.4 |
| Other agricultural operation | 6 | 3.4 | 17 | 9.4 |
| Selected crop work† | ||||
| Apples | 135 | 91.8 | 129 | 91.5 |
| Cherries | 121 | 82.3 | 119 | 84.4 |
| Pears | 102 | 69.4 | 104 | 73.8 |
| Asparagus | 81 | 55.1 | 76 | 53.9 |
| Peaches | 71 | 48.3 | 74 | 52.5 |
| Grapes | 61 | 41.5 | 53 | 37.6 |
| Hops | 50 | 34.0 | 58 | 41.1 |
| Potatoes | 35 | 23.8 | 29 | 20.6 |
| Other crops | 22 | 15.0 | 42 | 29.8 |
| Work activity† | ||||
| Harvesting or picking | n/a‡ | 129 | 93.5 | |
| Thinning | 111 | 80.4 | ||
| Pruning | 83 | 60.1 | ||
| Planting or transplanting | 63 | 45.7 | ||
| Supervisor or foreman | 37 | 26.8 | ||
| Handling pesticides | 23 | 16.7 | ||
| Other work activity | 8 | 5.8 | ||
| Total years working in agriculture | ||||
| Less than 1 year | 8 | 4.6 | 10 | 5.8 |
| 1-2 years | 20 | 11.5 | 12 | 6.9 |
| 3-4 years | 31 | 17.8 | 18 | 10.4 |
| 5 or more years | 115 | 66.1 | 133 | 76.9 |
| Location of agricultural work | ||||
| In the Yakima Valley | 171 | 96.1 | 200 | 95.2 |
| Outside the Yakima Valley | 90 | 51.1 | 90 | 42.9 |
Missing records were excluded from percentages
Restricted to orchard/field workers only
Data available for 2005 only
The most frequently reported environmental health concerns by agricultural workers (according to the number of participants who said the issue was “definitely a concern”) in 2004 were: pediatric asthma, surface water contamination, soil contamination, food borne illness and ground water contamination. The most frequent occupational health concerns reported in 2004 were: working in hot weather, muscular strains/sprains, eye injuries, ladder falls in orchards, and dislocations or broken bones (Table 3). In 2005, the exposures most often ranked “definitely a concern” by agricultural workers were: pesticide exposure, working in hot weather, air contamination and water contamination. The outcomes most often described as “definitely a concern” were: injuries in agricultural work, pediatric asthma, cancer and obesity (Table 4).
Table 3. Percentage of agricultural workers reporting that each issue was “definitely a concern” in 2004*.
| Ever worked in agriculture (N=178) |
Formerly worked in agriculture (N=98) |
Currently work in agriculture (N=98) |
|
|---|---|---|---|
| Category | % | % | % |
| Environmental health concerns | |||
| Pediatric asthma | 70.1%a | 68.4%a | 71.4% |
| Surface water contamination | 66.9% | 66.3% | 67.3% |
| Soil contamination | 64.6% | 62.5% | 66.3% |
| Foodborne illnesses | 64.0% | 60.0% | 67.3% |
| Ground water contamination | 62.9% | 65.0% | 61.2% |
| Garbage collection/disposal | 55.6% | 56.3% | 55.1% |
| “Take home” pesticide exposure† | 55.6% | 47.5% | 62.2% |
| Spray drift during pesticide applications | 51.7% | 52.5% | 51.0% |
| Air pollution from agricultural burning | 51.1% | 47.5% | 54.1% |
| Air pollution from other sources (e.g. factories, meat plants, trucks/vehicles) | 41.6% | 37.5% | 44.9% |
| Air pollution from animal feed lots | 39.3% | 37.5% | 40.8% |
| Noise pollution | 20.8% | 20.0% | 21.4% |
| Occupational health concerns | |||
| Working in hot weather | 76.6%c | 73.8% | 78.9%c |
| Muscular strains/sprains | 68.8%b | 67.5% | 69.8%b |
| Pesticide-related illnesses | 67.6%b | 71.3% | 64.6%b |
| Eye injuries | 66.5%b | 62.5% | 69.8%b |
| Ladder falls in orchards† | 63.6%b | 55.0% | 70.8%b |
| Dislocations or broken bones | 63.4%c | 58.2%a | 67.7%b |
| Lack of access to drinking water | 59.7%b | 58.8% | 60.4%b |
| Work-related stress | 54.3%c | 54.4%a | 54.2%b |
| Injuries caused by farm machinery or other implements | 52.3%b | 53.8% | 51.0%b |
| Tractor accidents | 52.3%b | 57.5% | 47.9%b |
| Occupational asthma | 49.4%b | 48.8% | 50.0%b |
| Dental/oral injuries | 37.5%b | 36.3% | 38.5%b |
| Injuries caused by farm animals | 30.7%b | 25.0% | 35.4%b |
Records with missing values were excluded from percentages
P ≤ 0.05 for Pearson chi-square test comparing former vs. current agricultural workers
Number of missing records excluded from each analysis (none missing unless otherwise noted): One missing record
Number of missing records excluded from each analysis (none missing unless otherwise noted): Two missing records
Number of missing records excluded from each analysis (none missing unless otherwise noted): Three missing records
Table 4. Percentage of agricultural workers reporting that each issue was “definitely a concern” in 2005*.
| Ever worked in agriculture (N=211) |
Formerly worked in agriculture (N=118) |
Currently work in agriculture (N=93) |
|
|---|---|---|---|
| Category | % | % | % |
| Exposures of concern | |||
| Pesticide exposure† | 72.4%a | 77.8%a | 65.6% |
| Working in hot weather | 69.0%a | 70.1%a | 67.7% |
| Air contamination | 60.7% | 60.2% | 61.3% |
| Water contamination | 58.8% | 60.2% | 57.0% |
| Work-related stress | 55.5%b | 59.8%a | 50.0%a |
| Soil contamination | 52.9%a | 51.7% | 54.3%a |
| Meth labs | 47.4% | 51.7% | 41.9% |
| Lead exposure | 41.2% | 41.5% | 40.9% |
| Nuclear plants (e.g. Hanford) | 37.4% | 42.4% | 31.2% |
| Mercury exposure | 27.5% | 28.0% | 26.9% |
| Outcomes of concern | |||
| Injuries in agricultural work | 73.0% | 74.6% | 71.0% |
| Pediatric asthma | 65.4% | 62.7% | 68.8% |
| Cancer | 62.6% | 56.8% | 69.9% |
| Obesity | 58.3% | 55.1% | 62.4% |
| Skin problems | 55.0% | 53.4% | 57.0% |
| Occupational asthma† | 52.1% | 44.1% | 62.4% |
| Learning disabilities/poor school performance | 46.9% | 50.8% | 41.9% |
| Foodborne illnesses | 43.6% | 45.8% | 40.9% |
| Reproductive problems/birth defects | 40.5%a | 40.7% | 40.2%a |
Records with missing values were excluded from percentages
P ≤ 0.05 for Pearson chi-square test comparing former vs. current agricultural workers
Number of missing records excluded from each analysis (none missing unless otherwise noted): One missing record
Number of missing records excluded from each analysis (none missing unless otherwise noted): Two missing records
The degree of concern about the top three issues in each category was also evaluated based on selected demographic characteristics and agricultural work status. In 2004, middle-aged workers (35-54 years old) and Hispanic/Latino workers were more likely to be concerned about pediatric asthma (OR=2.4, CI=1.02-5.60 for middle-aged workers, and OR=15.13, CI=2.72-84.18 for Hispanic/Latino workers) (Table 5). The other top environmental health concerns in 2004 (surface water contamination and soil contamination) were also more of a concern to middle-aged workers relative to younger workers (OR=2.10, CI=0.96-4.61 and OR=2.57, CI=1.15-5.71 respectively).
Table 5. Adjusted odds ratios for reporting that each issue was “definitely a concern” by selected demographic and work characteristics, 2004.
| Environmental health concerns | Occupational health concerns | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pediatric asthma | Surface water contamination | Soil contamination | Working in hot weather | Muscle strains and sprains | Pesticide-related illness | |||||||
| Characteristics | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Age in years | ||||||||||||
| 18-34 | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| 35-54 | 2.40 | 1.02, 5.60 | 2.10 | 0.96, 4.61 | 2.57 | 1.15, 5.71 | 1.39 | 0.56, 3.43 | 1.12 | 0.51, 2.47 | 2.23 | 1.00, 4.99 |
| 55+ | 1.38 | 0.45, 4.22 | 1.09 | 0.40, 2.98 | 0.74 | 0.27, 2.00 | 1.19 | 0.39, 3.65 | 0.88 | 0.31, 2.49 | 1.13 | 0.41, 3.15 |
| Gender | ||||||||||||
| Male | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Female | 0.99 | 0.46, 2.12 | 1.45 | 0.71, 2.95 | 1.28 | 0.63, 2.63 | 3.17 | 1.37, 7.30 | 1.62 | 0.79, 3.33 | 1.04 | 0.50, 2.15 |
| Ethnicity | ||||||||||||
| Non-Hispanic | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Hispanic/Latino | 15.13 | 2.72, 84.18 | 1.00 | 0.26, 3.91 | 1.93 | 0.48, 7.74 | 1.90 | 0.44, 8.25 | 0.82 | 0.21, 3.28 | 3.98 | 0.99, 16.01 |
| Children | ||||||||||||
| No | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Yes | 1.25 | 0.48, 3.30 | 1.07 | 0.42, 2.71 | 1.27 | 0.51, 3.17 | 1.23 | 0.45, 3.35 | 2.04 | 0.81, 5.11 | 1.07 | 0.42, 2.71 |
| English literacy | ||||||||||||
| No | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Yes | 0.64 | 0.26, 1.59 | 0.45 | 0.20, 1.05 | 0.54 | 0.23, 1.26 | 1.46 | 0.54, 3.94 | 0.56 | 0.24, 1.31 | 0.81 | 0.34, 1.94 |
| Agricultural work | ||||||||||||
| Formerly | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Currently | 0.70 | 0.28, 1.70 | 0.78 | 0.34, 1.77 | 0.92 | 0.41, 2.10 | 2.01 | 0.79, 5.11 | 0.96 | 0.42, 2.20 | 0.61 | 0.26, 1.43 |
Analyses of responses about occupational health concerns in 2004 showed that working in hot weather was more of a concern to female workers (OR=3.17, CI=1.37-7.30) and to those currently working in agriculture (OR=2.01, CI=0.79-5.11). Pesticide-related illness was more of a concern to middle-aged workers (OR=2.23, CI=1.00-4.99) and to Hispanic/Latino workers (OR=3.98, CI=0.99-16.01).
Among exposures assessed in 2005, “pesticides” was more of a concern to middle-aged workers than younger workers (OR=2.40, CI=1.10-5.24) (Table 6). Among outcomes of concern, middle-aged workers were also more likely to be concerned about injuries in agricultural work than younger workers (OR=2.49, CI = 1.16-5.53). Both middle-aged workers and older workers (>55 years old) were particularly concerned about cancer when compared to younger workers (OR=3.64, CI=1.79-7.43 and OR=4.60, CI=1.71-12.42 respectively). In addition, current agricultural workers were more likely than former agricultural workers to be concerned about cancer (OR=2.07, CI=1.01-4.23). Hispanic/Latino workers tended to be more concerned about pediatric asthma than non-Hispanics (OR=3.76, CI=1.30-10.88).
Table 6. Adjusted odds ratios for reporting that each issue was “definitely a concern” by selected demographic and work characteristics, 2005.
| Exposures of concern | Outcomes of concern | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pesticides | Working in hot weather | Air contamination | Injuries in agricultural work | Pediatric asthma | Cancer | |||||||
| Characteristics | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI | OR | 95% CI |
| Age in years | ||||||||||||
| 18-34 | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| 35-54 | 2.40 | 1.10, 5.24 | 1.30 | 0.65, 2.61 | 1.87 | 0.96, 3.67 | 2.49 | 1.16, 5.35 | 1.64 | 0.81, 3.32 | 3.64 | 1.79, 7.43 |
| 55+ | 0.81 | 0.31, 2.10 | 1.92 | 0.71, 5.20 | 0.89 | 0.37, 2.14 | 1.46 | 0.56, 3.81 | 1.23 | 0.49, 3.13 | 4.60 | 1.71, 12.42 |
| Gender | ||||||||||||
| Male | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Female | 1.40 | 0.71, 2.79 | 1.24 | 0.66, 2.34 | 1.31 | 0.72, 2.40 | 1.18 | 0.60, 2.31 | 1.55 | 0.82, 2.92 | 1.58 | 0.83, 2.98 |
| Ethnicity | ||||||||||||
| Non-Hispanic | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Hispanic/Latino | 1.03 | 0.28, 3.80 | 1.89 | 0.65, 5.51 | 1.01 | 0.35, 2.89 | 1.45 | 0.44, 4.84 | 3.76 | 1.30, 10.88 | 1.92 | 0.66, 5.58 |
| Children | ||||||||||||
| No | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Yes | 1.26 | 0.55, 2.92 | 0.91 | 0.41, 2.03 | 0.59 | 0.27, 1.32 | 1.02 | 0.44, 2.35 | 1.18 | 0.54, 2.58 | 0.78 | 0.35, 1.73 |
| English literacy | ||||||||||||
| No | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Yes | 1.21 | 0.57, 2.56 | 0.94 | 0.46, 1.92 | 0.85 | 0.44, 1.67 | 1.86 | 0.87, 3.95 | 0.80 | 0.40, 1.63 | 1.40 | 0.68, 2.89 |
| Agricultural work | ||||||||||||
| Formerly | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- | Ref | --- |
| Currently | 0.51 | 0.24, 1.07 | 0.81 | 0.40, 1.64 | 0.99 | 0.51, 1.91 | 1.01 | 0.49, 2.12 | 0.96 | 0.48, 1.93 | 2.07 | 1.01, 4.23 |
Some demographic groups expressed higher levels of concern about most or all of the environmental and occupational health issues explored in this study. Women, parents, and middle-aged (35-54 years old) workers tended to express higher levels of concern about most issues. However, after controlling for gender and parental status, statistically significant differences in the number of issues described as “definitely a concern” were only observed for age category in both years (P=0.037 and P<0.001 for 2004 and 2005, respectively) (Tables 7 and 8). Compared to those workers aged 18-34 years and those over age 55, 35-54 year-old workers consistently answered “definitely a concern” more frequently across the two years and across all environmental issues, occupational issues, exposures, and outcomes of concern. This difference was statistically significant in all categories except the occupational health issues asked about in 2004 (p=0.214). Female workers tended to answer “definitely a concern” more often than male workers, but this trend was only borderline significant for occupational health issues in 2004 and not statistically significant in 2005.
Table 7. Adjusted mean number of issues described as “definitely a concern” by selected demographic characteristics in 2004, based on an ANCOVA model*.
| All issues combined (N=170) | Environmental health issues (N=175) | Occupational health issues (N=171) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Characteristics | Adjusted mean† | 95% CI | P value‡ | Adjusted mean† | 95% CI | P value‡ | Adjusted mean† | 95% CI | P value‡ |
| Age in years | |||||||||
| 18-34 | 12.2 | 10.7, 13.8 | 0.037 | 5.5 | 4.7, 6.3 | 0.016 | 6.7 | 5.8, 7.6 | 0.214 |
| 35-54 | 14.9 | 12.9, 16.9 | 7.1 | 6.1, 8.2 | 7.8 | 6.6, 8.9 | |||
| 55+ | 12.4 | 9.6, 15.2 | 5.7 | 4.1, 7.2 | 6.8 | 5.2, 8.5 | |||
| Gender | |||||||||
| Male | 12.3 | 10.8, 13.9 | 0.112 | 5.8 | 5.0, 6.7 | 0.323 | 6.5 | 5.6, 7.4 | 0.050 |
| Female | 14.0 | 12.0, 16.1 | 6.4 | 5.3, 7.5 | 7.7 | 6.5, 8.9 | |||
| Children | |||||||||
| No | 12.3 | 9.6, 15.0 | 0.208 | 5.7 | 4.3, 7.1 | 0.311 | 6.7 | 5.1, 8.2 | 0.308 |
| Yes | 14.1 | 12.9, 15.2 | 6.5 | 5.9, 7.1 | 7.5 | 6.8, 8.2 | |||
We asked about a total of 25 issues (12 environmental health issues and 13 occupational health issues)
Estimated marginal means based on ANCOVA analysis including age category, gender, and parental status as covariates
Based on F-tests in ANCOVA analysis
Table 8. Adjusted mean number of issues described as “definitely a concern” by selected demographic characteristics in 2005, based on an ANCOVA model*.
| All issues combined (N=199) | Exposures of concern (N=200) | Outcomes of concern (N=204) | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Characteristics | Adjusted mean† | 95% CI | P value‡ | Adjusted mean† | 95% CI | P value‡ | Adjusted mean† | 95% CI | P value‡ |
| Age in years | |||||||||
| 18-34 | 9.0 | 8.0, 10.1 | < 0.001 | 4.8 | 4.2, 5.4 | 0.003 | 4.2 | 3.6, 4.8 | 0.001 |
| 35-54 | 12.1 | 10.8, 13.3 | 6.3 | 5.6, 6.9 | 5.8 | 5.1, 6.5 | |||
| 55+ | 11.1 | 9.3, 13.0 | 5.6 | 4.5, 6.6 | 5.5 | 4.5, 6.5 | |||
| Gender | |||||||||
| Male | 10.1 | 9.0, 11.1 | 0.061 | 5.2 | 4.6, 5.8 | 0.064 | 4.8 | 4.3, 5.4 | 0.087 |
| Female | 11.4 | 10.1, 12.7 | 5.9 | 5.2, 6.6 | 5.5 | 4.8, 6.2 | |||
| Children | |||||||||
| No | 11.1 | 9.5, 12.8 | 0.370 | 5.8 | 4.9, 6.8 | 0.242 | 5.2 | 4.3, 6.1 | 0.749 |
| Yes | 10.3 | 9.6, 11.1 | 5.2 | 4.8, 5.7 | 5.1 | 4.7, 5.5 | |||
We asked about a total of 19 issues (10 exposures of concern and 9 outcomes of concern)
Estimated marginal means based on ANCOVA analysis including age category, gender, and parental status as covariates
Based on F-tests in ANCOVA analysis
Discussion
Community health surveys conducted in 2004 and 2005 revealed specific issues of concern among agricultural workers in one central Washington community. These surveys were used as one method to involve a large number of community members in the process of identifying high-priority environmental and occupational health issues for future interventions, without requiring an extensive time commitment on the part of the participants (Arcury, et al., 1999). Although barriers to conducting research with agricultural workers have been discussed in the literature (e.g. low rates of participation, fear of employer reprisal or investigation by Immigration and Customs Enforcement), this study was successful at meeting its recruitment goals in terms of the population it reached and the number of respondents, likely due to the use of local, bilingual student interviewers and sampling in public locations (Arcury, Quandt, & McCauley, 2000; Flores, Abreu, & Tomany-Korman, 2006; Rao, Arcury, & Quandt, 2004).
Analyses demonstrated particular concern across both years in terms of pediatric asthma, workplace injuries, working in hot weather, and pesticides. Some of the results may reflect local outreach efforts and provide an opportunity to collaborate with local and state institutions to develop and test health and safety interventions. For example, the concern about pediatric asthma may be explained in part by the efforts of the Yakima Valley Farm Workers Clinic to address pediatric asthma in the Hispanic agricultural community (Yakima Valley Farm Workers Clinic Planning and Development Department, 2004). Concerns about injuries in agricultural work may be a result of the “Eyes and Falls” initiative sponsored by the Washington State Department of Labor and Industries, or the farmworker death in the summer of 2005 from heat stroke (Safety & Health Assessment & Research for Prevention, 2006; Washington State Department of Labor and Industries, 2001). Events such as these may influence community awareness about important issues and prime people to take action to promote health.
This study is unique in that in addition to describing agricultural worker perceptions of a variety of occupational and environmental issues, differences in the degree of concern about selected issues were examined between subgroups based on demographic characteristics and work history. For example, in both years, Hispanic workers were more likely than non-Hispanic workers to report pediatric asthma as a definite concern. Likewise, middle aged workers were more likely than younger or older workers to report “pesticide-related illness” or “pesticides” as a definite concern. Overall, middle-aged (35-54 years old) participants expressed higher levels of concern about most issues. Findings from this study may indicate the need to target younger workers (who had lower levels of concerns about many issues) who may not perceive themselves as vulnerable. Similar risk perceptions have been found among adolescent farmworkers (Salazar, et al., 2004).
As in other CBPR projects, results will be used by researchers to inform locally relevant research and interventions. For example, in other agricultural communities, CBPR practitioners have used exploratory data to inform linguistically and culturally appropriate occupational health information for indigenous farm workers (Farquhar, et al., 2008), prevent occupational exposures to pesticides (Arcury, et al., 2001), and disseminate information about children's environmental health risks (Israel, et al., 2005). Likewise, these findings will inform El Proyecto Bienestar as they create radio novelas (Spanish language radio soap operas) to educate the farm worker community about occupational and environmental health risks they face.
In addition to its strengths, this study had a number of limitations. Inconsistencies between the two surveys made comparisons across the years and with other studies somewhat difficult. Also, study participants were not selected using a random sampling method. It is possible that some spouses were included in the sample, which may have affected the independence of the data. However, based on field staff observations during data collection it is unlikely that many spouses were included. It should also be noted that the sample captured agricultural workers who were socially similar to national samples of workers, except that a higher percentage in the study sample were born in the United States and were parents (U.S. Department of Labor, 2005). The high proportion of U.S.-born agricultural workers can be explained by the relatively stable nature of the Hispanic population in Yakima County. Overall, similarities between the demographic characteristics of this study population and other national surveys of agricultural workers suggest that bias due to non-random sampling may not be a serious limitation.
Although surveys were pilot tested in both years and subsequently revised with feedback from Proyecto Bienestar investigators and Community Advisory Board members, a more thorough validation of the survey instruments was not feasible given the limited time frame of the ConneX summer program. Also, students' lack of research experience may have resulted in some errors in recording survey responses. For example, in 2005 there was some inconsistency between interviewers regarding whether data on agricultural work history were recorded for participants who had formerly worked in agriculture. Consequently, work history information was missing for approximately 22-27% of former agricultural workers. (The amount of missing data varied somewhat between variables.)
In addition, there were relatively small numbers of participants in some demographic groups (e.g. non-Hispanic participants). Consequently, results for these analyses should be cautiously interpreted. Finally, because a number of different demographic and work history characteristics were considered in relation to concern about selected environmental and occupational health issues, some of the differences in perceptions of risk observed in this study may have been statistically significant by chance due to multiple comparisons.
Implications for Practice
Results of this study suggest that overall, there was particular concern among respondents in terms of pediatric asthma, workplace injuries, working in hot weather, and pesticides. Agricultural workers' perceptions of some environmental and occupational health issues differed with respect to certain demographic and work history characteristics. In particular, middle-aged workers tended to express higher levels of concern when compared to younger or older workers. Occupational health nurses that work in agricultural practice settings or as clinicians in agricultural communities can benefit from understanding risk perceptions among workers and community members. For example, in the Occupational Health Nurses in Agricultural Communities project, nurses used community organizing strategies in an effort to change community norms around the expectation that injuries and fatalities are a necessary part of agricultural work (Lexau, Kingsbury, Lenz, Nelson, & Voehl, 1993). Occupational health nurses can provide leadership in this area by working across disciplines (e.g anthrolopology, health sciences) and developing coalitions with community, government and corporate sponsors to raise the visibility and unique needs of seasonal and migrant agricultural workers (Culp & Umbarger, 2004; Randolph & Migliozzi, 1993). At the individual level, clinicians may need to spend more time with adolescent workers to teach them about the unique risks they face at work, approaches they can take to mitigate those risks, and regulations in place to protect them on the job.
Understanding different levels of concern about environmental and occupational health risks that exist within a workforce or community may allow for more effective research studies, educational materials, and occupational and environmental risk reduction interventions to be developed. Occupational health nurses play an important role in responding to the unique needs of individuals and subgroups that make up a diverse workforce by targeting subgroups with health promotional campaigns and advocating for healthy workplaces (Lundvall & Olson, 2001). Occupational health nurses also serve as liaisons between agricultural, health, and farm worker communities (Lundvall & Olson, 2001). Because historically, vulnerable populations have not been influential in the research process, it is especially important to include worker representatives in efforts to promote their health and safety (Postma, 2006). To appropriately address the needs of specific worker subgroups, occupational health professionals must grapple with the complexity that exists within the workforce.
Sidebar: Applying Research to Practice.
Based on surveys collected in 2004 and 2005 in one agricultural community, agricultural workers expressed high levels of concern about working in hot weather, agricultural injuries, pesticides, and pediatric asthma. Perceptions of environmental and occupational health issues among agricultural workers differed by certain demographic characteristics, particularly age and ethnicity. The degree of concern expressed by subpopulations based on demographic characteristics and work history suggest that tailored interventions are needed to meet the needs of subgroups within agricultural worker populations.
Footnotes
Proprietary Interests Statement: The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
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