The California Agricultural Worker Health Survey

Conducted by the California Institute for Rural StudiesFunded by The California

Endowment

Investigators and Key Staff

• David Lighthall, Executive Director• Don Villarejo, Founder & Director Emeritus• Bonnie Bade, Co-investigator• Steve McCurdy, Co-investigator• Richard Mines, Co-investigator• Steve Samuels, Project Statistician• Daniel William III, Project Coordinator• Ann Souter, Senior Site Coordinator

Random Selection of Subjects

• Communities – Five of six agricultural regions represented by randomly selected community sites.

• Dwellings – Enumeration of ALL places (dwellings) in each community where farmworkers are found to reside; then randomly select dwellings to contact.

• Residents – Enumeration of ALL eligible persons in randomly selected dwellings; then random selection of one or more residents to be subjects.

Qualifications of Subjects

• Age 18 years or older• Performed hired farm work in the

previous twelve months• No limit on duration of farm

employment• Livestock & crop work of any type• Exclude off-farm food processing

CAWHS Survey Components

• Main Survey Instrument, In Dwelling, 1 ½ to 2 hours, Interviewer

• Physical Examination, At Clinic, 20 to 30 minutes, Medical Staff, By Appointment, Transportation Provided

• Risk Behavior Instrument, At Clinic, 20 to 30 minutes, Interviewer, Private Room

CAWHS Main Instrument

• Household Composition• Personal Demographics• Health Services Utilization• Self-reported Health Conditions• Doctor-reported Health Conditions• Work History• Income and Living Conditions

CAWHS Main Instrument (continued)

• Workplace Health Conditions• Protective Equipment & Safety

Training• Working With Pesticides in the U.S.A.• Field Sanitation• Work Related Injuries and Injury

Module• Immigration Status

CAWHS Physical Examination

• Biometric• Dental• Skin• Body• Screening• Blood Chemistry• Medical History

Risk Behavior

• Health Habits (alcohol, tobacco)• Domestic Violence• Workplace Violence & Workplace

Risks• Sexual Behaviors• Drug Use• Mental & Psychological Illness• Reproductive Health (female only)

Summary Results, CAWHS, 1999

Dwellings enumerated 11,876

Dwellings contacted 2,989

Dwellings with eligible residents 1,174

Acceptances 968

Response rate 82.4%

Physical exams completed 652

Physical exam participation rate 67.4%

CAWHS Sample, 1999, N=968

Characteristic CAWHS Sample

Age - median 34 years

Gender 36% female

Place of birth 92% foreign-born

Marital status 59% married

48% have children

Educational attainment 63%, six years or less

Literacy 51% read Spanish well; 5% read English well

Income – median 1998 $7,500 - $9,999

What is your current immigration status?

0%

10%

20%

30%

40%

50%

60%

US Citizen PermanentResident

Other documented Undocumented Doesn't know /NA

Undocumented Status by Site

0%

10%

20%

30%

40%

50%

60%

Arbuckle Calistoga Cutler Firebaugh Gonzales Mecca Vista

Anemia, Male Subjects with Hemoglobin Concentration below Normal, CAWHS, 1999, N=392

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

0.09

20-49 50-69

Age Range

Per

cen

t o

f S

ub

ject

s

TCE CAWHS

CDC-1987

High Serum Cholesterol, by Immigration Status, CAWHS, 1999, N=528

0%

5%

10%

15%

20%

25%

Documented Undocumented

Immigration Status

Perc

ent H

igh

Seru

m

Chol

este

rol

Female

Male

Obesity, by Immigration Status, CAWHS, 1999, N=528

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Documented Undocumented

Immigration Status

Perc

ent O

bese Female

Male

Dental Outcomes, CAWHS, 1999, N=652

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Decayed teeth Missing/brokenteeth

Gingivitis Other dentalproblems

Dental Outcome

Per

cen

t o

f S

ub

ject

s

Male

Female

Does Your Employer Offer Health Insurance? CAWHS, 1999, N=726

Yes

No

DK/NA

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Yes No DK/NA

Most Recent Visit to Doctor or Clinic, CAWHS, 1999, N=971

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

0-5 mo. 6-11 mo. 1-2 years 2-5 years 5+ years Never

Date of most recent visit

Per

cen

t o

f su

bje

cts

Male

Female

Most Recent Dental Care Visit, CAWHS, 1999, N=971

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

0-5 mo. 6-11 mo. 1-2 years 2-5 years 5+ years Never

Date of most recent visit

Per

cen

t o

f su

bje

cts

MaleFemale

Most Recent Eye Care Visit, CAWHS, 1999, N=971

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

0-5 mo. 6-11 mo. 1-2 years 2-5 years 5+ years Never

Date of most recent visit

Pe

rce

nt

of

su

bje

cts

Male

Female

Self-reported Health Conditions, CAWHS, 1999, N=971

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Dental Back pain Itchy/irritatedeyes

Knee pain Feet pain Hand pain

Health condition

Per

cen

t o

f su

bje

cts

Self-reported Workplace Health Conditions, CAWHS, 1999, N=968

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Type of health condition

Per

cen

t o

f su

bje

cts

Employer Type

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Have you received pesticide safety training?, CAWHS, 1999

Yes

No

DK/NA

0%

10%

20%

30%

40%

50%

60%

Yes No DK/NA

Have you ever received pesticide safety training? (by study site)

0%20%40%60%80%

100%

Yes

No

Who trained or instructed you?

0%

5%

10%

15%

20%

25%

30%

35%

40%

How was the training or instruction delivered?

0%

10%

20%

30%

40%

50%

60%

Contact with Pesticides (17.5% Total)

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

Sprayed or blow n Spilled While cleaning

Pesticide Exposure, Related Illness, and Treatment

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

16.0%

18.0%

20.0%

Exposed Sick Due to Exposure Exposed, Sought MedicalTreatment

Does Your Employer Provide These EVERYDAY? N=968

Clean drinking water and disposable cups

Yes - both 80%

Yes - water only 5%

No water, no cups 12%

Toilets Yes 88%

No 11%

Wash water Yes 82%

No 16%

Job Injury with Workers Compensation Payments-Ever, CAWHS, 1999, N=652

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Yes No Don't know Not answered

Su

bje

cts

(p

erc

en

t)

Injured while working on a farm in past twelve months? California Hired Farmworker Health Needs Assessment, 1999

Yes5%

No93%

DK/NA2%

Employer Has Insurance to Pay You if You Are Injured on the Job and Can't Work, CAWHS, 1999,

N=706

YesNo

DK/NA

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Yes No DK/NA

Conclusions: Occupational Safety and Health

1. High level of non-compliance with Worker Protection Standard pesticide training regulations.

2. For workers who are trained, the quality of WPS training is questionable: Multiple sources of training with a high proportion of workers receiving inadequate training.

3. Evidence that lateral, airborne pesticide drift is common, suggesting weak compliance with WPS pesticide application rules.

4. Overall, WPS appears relatively ineffective.5. High rates of musculoskeletal complaints:

66% reported chronic M-S pain in past year.6. Clear evidence of need for better eye

protection: 22% report chronic eye irritation.

Conclusions: Access to Care and Chronic Disease

1. Strikingly high proportions of workers who have rarely or never been to doctor, dentist, or optom.

2. Major problems of access to preventative and primary care: Dental, musculoskeletal (back, etc.), vision are perhaps the most serious.

3. Little affordable employer-provided health insurance, low levels of MediCal participation.

4. Cultural traditions of health care are being confronted by emergence of new chronic diseases tied to dietary changes in Mexico and the U.S.

5. Genetic predisposition (diabetes) and high rates of obesity increase long-term risk to heart disease, hypertension, stroke, and diabetes.

6. Looming long-term health costs for county and state health system if access to preventative and primary care is not dramatically improved.